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

Abstract

Most guidelines have recommended lower home 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 mmHg) hypertension using a regression-based approach in the Dallas Heart Study (n=5,768) and the North Carolina Masked Hypertension study (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 Dallas Heart Study cohort. For this approach, BP thresholds were identified only for systolic BP as 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 mmHg in Blacks, 130/80 mmHg in Whites, and 126/78 mmHg 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 mmHg were higher in Blacks than Whites and Hispanics (13.3% vs. 5.98% vs. 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 mmHg in Blacks, 129 mmHg in Whites, and 131 mmHg in Hispanics, respectively. Our data based on both regression-derived and outcome approach support home BP threshold of 130/80 mmHg for diagnosis of hypertension in Blacks, Whites, and Hispanics.

Artificial intelligence in medical devices and clinical decision support systems

“…For example, on November 13, 2017, the American College of Cardiology and the American Heart Association reduced the threshold for determining high blood pressure (hypertension) to 130/80 from 140/90 (Vongpatanasin, 2018). Though these blood pressure levels seem very, very close to one another, the new, lower limit may well shift nearly half of the US adult population into the high blood pressure category (Cunningham, 2017)!…”

Emergence of Home Blood Pressure-Guided Management of Hypertension Based on Global Evidence

“…In these studies, home BP thresholds were 129/80 mm Hg in black participants, 130/80 mm Hg in white participants, and 126/78 mm Hg in Hispanic participants. 48 According to an outcome-derived approach based on the composite of CVD events or all-cause mortality over 11 years of follow-up of Dallas Heart Study participants, the home SBP thresholds corresponding to office SBP of 130 mm Hg were 130 mm Hg in black participants, 129 mm Hg in white participants, and 131 mm Hg in Hispanic participants. Home BP thresholds were identified using the outcomes-based approach for SBP only as home diastolic BP was not associated with outcomes.…”

“…Both the regression-derived and outcome-derived approaches in these studies support a home BP threshold of 130/80 mm Hg for hypertension status in several racial/ethnic groups. 48 As these data are supported primarily by observational studies, randomized controlled trials should examine whether lowering of home BP leads to a reduction in cardiovascular events and also determine the optimal BP thresholds to define hypertension. 49…”

Out-of-Clinic Blood Pressure Thresholds for Diagnosing and Managing Hypertension, Filling an Important Evidence Gap

“…In the current issue of Hypertension , Vongpatanasin et al report values of blood pressure measured in the home that correspond with BP levels measured in a clinic setting. 3…”

“…The study by Vongpatanasin et al in the current issue of Hypertension reports on an analysis of two data sets, the Dallas Heart Study (DSH) and the North Carolina Masked Hypertension (NCMS) study, that were used to identify home BP thresholds corresponding with clinic-measured SBP levels of 120, 130, 140 and 160 mm Hg and DBP levels of 80, 85, 90, and 100 mm Hg. 3 The DHS is a large-scale population-based study of CVD, which included HBPM and enrolled whites, blacks and Hispanics from Dallas County, Texas. The DHS sample consisted of adults taking and not taking antihypertensive medication.…”