Home-measured blood pressure is more strongly associated with electrocardiographic left ventricular hypertrophy than is clinic blood pressure: the Finn-HOME study

Abstract

Electrocardiographic evidence of left ventricular hypertrophy (ECG-LVH) has a grave prognostic significance in hypertensive patients. The purpose of our study was to assess whether ECG-LVH is more strongly associated with home-measured blood pressure (BP) than with clinic BP, and whether the correlation between home BP and ECG-LVH increases with the number of home measurements performed. We studied a representative sample of the general adult population (1989 subjects 45-74 years of age) in Finland. Subjects included in the study underwent a clinical interview, electrocardiography and measurement of clinic BP (mean of two clinic measurements) and home BP (mean of 14 duplicate home measurements performed during 1 week). Home BP correlated significantly better than clinic BP with the Sokolow-Lyon voltage (home/clinic systolic: r=0.23/0.22, P=0.60; diastolic: r=0.17/0.12, P=0.009), Cornell voltage (systolic: r=0.30/0.25, P=0.004; diastolic: r=0.21/0.12, P<0.001) and Cornell product (systolic: r=0.30/0.24, P=0.001; diastolic r=0.22/0.14, P<0.001) criteria of ECG-LVH. The correlation between home BP and ECG-LVH increased slightly with the number of home measurements, but even the mean of the initial two home BP measurements correlated equally well (systolic BP), or better (diastolic BP) with ECG-LVH than did clinic BP. In conclusion, home BP measurement allows us to obtain a large number of measurements that have a strong association with ECG-LVH. Our data support the application of home BP measurement in clinical practice.

Prediction of albuminuria by different blood pressure measurement methods in type 1 diabetes: a pilot study

“…6 Studies in nondiabetic hypertensives have shown HBP monitoring to be as good as ambulatory monitoring in predicting albuminuria and left ventricular hypertrophy. [23][24][25][26] To our knowledge, no published study provided a direct comparison of home with ABP in terms of their association with albuminuria in type 1 diabetes. It is clear that the development of albuminuria and its relationship with the rise in BP is fundamentally different in type 1 diabetes compared with type 2.…”

Home blood pressure measurement: a means for improving blood pressure control?

“…The clinical usefulness of BP measurement at home by semiautomated devices has been investigated over the past 30 years. Several studies have shown that home BP (HBP) measurement, by providing multiple BP recordings under relatively stable conditions and avoiding the so-called 'white-coat effect', is superior to office or clinic BP measurement in terms of reliability, 3 correlation with organ damage 4,5 and predictive value of cardiovascular events. [6][7][8][9] In addition, HBP has been shown to be free of the placebo effect, to improve patients' compliance and to be useful in detecting white-coat and masked hypertension phenomena.…”

Electrocardiographic abnormalities and home blood pressure in treated elderly hypertensive patients: Japan home versus office blood pressure measurement evaluation in the elderly (J-HOME-Elderly) study

“…4 Some studies have shown that hypertension for several years is associated with the development of ECG abnormalities that in turn are related to a higher left ventricular mass among patients without ischemic heart disease. [5][6][7][8] These abnormalities are also associated with hypertension [9][10][11] and a poor prognosis. 3,4,12 Measuring blood pressure (BP) at home (home BP) allows the collection of multiple measurements under controlled conditions, and it is more reliable than conventional (office) BP measurements, because bias arising from both observer and regression dilution is avoided and the white-coat effect is eliminated.…”

“…13,14 Cross-sectional and a prospective cohort studies have found that home BP measurement has stronger power for predicting target organ damage, morbidity and mortality than office BP measurement. 11,[15][16][17][18][19] Tsunoda et al found that the degree of LVH determined by echocardiography was more closely associated with home than with office BP values among 209 hypertensive Japanese patients. 15 However, the relationship between home BP and LVH determined by ECG among treated patients in Japan is unclear.…”

“…Niiranen et al reported that the mean of morning and evening home BP measurements is more closely associated with LVH determined by ECG than by office BP among the general population in Finland. 11 However, they assessed their findings using univariate analysis and did not consider confounding factors such as patients' characteristics or drug information. 11,15 This study uses multivariate analysis to compare relationships between each of morning home, evening home and office BP with LVH, abnormal T waves and ST segment depression determined by ECG among treated hypertensive Japanese patients.…”