Diagnostic Thresholds for Blood Pressure Measured at Home in the Context of the 2017 Hypertension Guideline

Wanpen Vongpatanasin, Colby Ayers, Hamza Lodhi, Sandeep R Das, Jarett D Berry, Amit Khera, Ronald G. Victor, Feng Chang Lin, Anthony J. Viera, Yuichiro Yano, James A de Lemos

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Most guidelines have recommended lower home blood pressure (BP) threshold when clinic BP threshold of 140/90 mm Hg is used for diagnosis of hypertension. However, home BP thresholds to define hypertension have never been determined in the general population in the United States. We identified home BP thresholds for stage 1 (BP ≥130/80 mm Hg) hypertension using a regression-based approach in the DHS (Dallas Heart Study; n=5768) and the NCMH study (North Carolina Masked Hypertension; n=420). Home BP thresholds were also assessed using outcome-derived approach based on the composite of all-cause mortality or cardiovascular events in the DHS cohort. For this approach, BP thresholds were identified only for systolic BP because diastolic BP was not associated with the outcome. Among untreated participants, the regression-derived thresholds for home BP corresponding to clinic BP for stage 1 hypertension were 129/80 mm Hg in blacks, 130/80 mm Hg in whites, and 126/78 mm Hg in Hispanics, respectively. The results are similar in the North Carolina cohort. The 11-year composite cardiovascular and mortality events corresponding to clinic systolic BP >130 mm Hg were higher in blacks than in whites and Hispanics (13.3% versus 5.98% versus 5.52%, respectively). Using a race/ethnicity-specific composite outcome in the untreated DHS participants, the outcome-derived home systolic BP thresholds corresponding to stage 1 hypertension were 130 mm Hg in blacks, 129 mm Hg in whites, and 131 mm Hg in Hispanics, respectively. Our data based on both regression-derived and outcome approach support home BP threshold of 130/80 mm Hg for diagnosis of hypertension in blacks, whites, and Hispanics.

Original languageEnglish (US)
Pages (from-to)1312-1319
Number of pages8
JournalHypertension (Dallas, Tex. : 1979)
Volume72
Issue number6
DOIs
StatePublished - Dec 1 2018

Fingerprint

Guidelines
Blood Pressure
Hypertension
Hispanic Americans
Masked Hypertension
Mortality

Keywords

  • blood pressure
  • blood pressure determination
  • blood pressure monitors
  • hypertension
  • mortality
  • United States

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Diagnostic Thresholds for Blood Pressure Measured at Home in the Context of the 2017 Hypertension Guideline. / Vongpatanasin, Wanpen; Ayers, Colby; Lodhi, Hamza; Das, Sandeep R; Berry, Jarett D; Khera, Amit; Victor, Ronald G.; Lin, Feng Chang; Viera, Anthony J.; Yano, Yuichiro; de Lemos, James A.

In: Hypertension (Dallas, Tex. : 1979), Vol. 72, No. 6, 01.12.2018, p. 1312-1319.

Research output: Contribution to journalArticle

Vongpatanasin, Wanpen ; Ayers, Colby ; Lodhi, Hamza ; Das, Sandeep R ; Berry, Jarett D ; Khera, Amit ; Victor, Ronald G. ; Lin, Feng Chang ; Viera, Anthony J. ; Yano, Yuichiro ; de Lemos, James A. / Diagnostic Thresholds for Blood Pressure Measured at Home in the Context of the 2017 Hypertension Guideline. In: Hypertension (Dallas, Tex. : 1979). 2018 ; Vol. 72, No. 6. pp. 1312-1319.
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abstract = "Most guidelines have recommended lower home blood pressure (BP) threshold when clinic BP threshold of 140/90 mm Hg is used for diagnosis of hypertension. However, home BP thresholds to define hypertension have never been determined in the general population in the United States. We identified home BP thresholds for stage 1 (BP ≥130/80 mm Hg) hypertension using a regression-based approach in the DHS (Dallas Heart Study; n=5768) and the NCMH study (North Carolina Masked Hypertension; n=420). Home BP thresholds were also assessed using outcome-derived approach based on the composite of all-cause mortality or cardiovascular events in the DHS cohort. For this approach, BP thresholds were identified only for systolic BP because diastolic BP was not associated with the outcome. Among untreated participants, the regression-derived thresholds for home BP corresponding to clinic BP for stage 1 hypertension were 129/80 mm Hg in blacks, 130/80 mm Hg in whites, and 126/78 mm Hg in Hispanics, respectively. The results are similar in the North Carolina cohort. The 11-year composite cardiovascular and mortality events corresponding to clinic systolic BP >130 mm Hg were higher in blacks than in whites and Hispanics (13.3{\%} versus 5.98{\%} versus 5.52{\%}, respectively). Using a race/ethnicity-specific composite outcome in the untreated DHS participants, the outcome-derived home systolic BP thresholds corresponding to stage 1 hypertension were 130 mm Hg in blacks, 129 mm Hg in whites, and 131 mm Hg in Hispanics, respectively. Our data based on both regression-derived and outcome approach support home BP threshold of 130/80 mm Hg for diagnosis of hypertension in blacks, whites, and Hispanics.",
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