Skip to main content

Advertisement

SpringerLink
Log in

Out-of-Office Blood Pressure Improves Risk Stratification in Normotension and Prehypertension People

  • Blood Pressure Monitoring and Management (G Ogedegbe and JA Staessen, Section Editors)
  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

This review addresses to what extent out-of-office blood pressure, the ambulatory blood pressure monitoring and the self-measured home blood pressure, refines conventional blood pressure-based risk stratification across increasing blood pressure categories, in particular individuals assumed to be associated with no or only mildly increased risk. Compared with sustained normotension, individuals with prehypertension as well as masked hypertension tend to be developed to true hypertension. Ambulatory blood pressure measurement refines risk stratification among prehypertensive people. Home blood pressure is more useful for the prediction of cerebrovascular diseases than conventional blood pressure, by replacing information from conventional to home blood pressure in risk stratification system. Furthermore, the two participant-level meta-analyses demonstrated that the out-of-office blood pressure substantially refines risk stratification in normotension and prehypertension, particularly among participants with masked hypertension. Properly organized randomized clinical trials are required to demonstrate that identification and treatment of masked hypertension, compared with the current standard care based on conventional pressure, lead to the reduction of cardiovascular diseases in population and are cost-effective.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Paper of particular interest, published recently, have been highlighted as: • of importance

  1. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52.

    Article  PubMed  CAS  Google Scholar 

  2. Ogihara T, Kikuchi K, Matsuoka H, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009). Hypertens Res. 2009;32:3–107.

    Article  PubMed  CAS  Google Scholar 

  3. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159–219.

    Article  PubMed  Google Scholar 

  4. Staessen JA, Thijs L, Ohkubo T, et al. Thirty years of research on diagnostic and therapeutic thresholds for the self-measured blood pressure at home. Blood Press Monit. 2008;13:352–65.

    Article  PubMed  Google Scholar 

  5. Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D. Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52:10–29.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Asayama K, Ohkubo T, Kikuya M, et al. Use of 2003 European Society of Hypertension-European Society of Cardiology guidelines for predicting stroke using self-measured blood pressure at home: the Ohasama study. Eur Heart J. 2005;26:2026–31.

    Article  PubMed  Google Scholar 

  7. Little P, Barnett J, Barnsley L, Marjoram J, Fitzgerald-Barron A, Mant D. Comparison of acceptability of and preferences for different methods of measuring blood pressure in primary care. BMJ. 2002;325:258–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ohkubo T, Imai Y, Tsuji I, et al. Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, Japan. J Hypertens. 1998;16:971–5.

    Article  PubMed  CAS  Google Scholar 

  9. Asayama K, Ohkubo T, Kikuya M, et al. Prediction of stroke by home “morning” versus “evening” blood pressure values: the Ohasama study. Hypertension. 2006;48:737–43.

    Article  PubMed  CAS  Google Scholar 

  10. Niiranen TJ, Hanninen MR, Johansson J, Reunanen A, Jula AM. Home-measured blood pressure is a stronger predictor of cardiovascular risk than office blood pressure: the Finn-Home study. Hypertension. 2010;55:1346–51.

    Article  PubMed  CAS  Google Scholar 

  11. Imai Y, Obara T, Asayama K, Ohkubo T. The reason why home blood pressure measurements are preferred over clinic or ambulatory blood pressure in Japan. Hypertens Res. 2013;36:661–72.

    Article  PubMed  Google Scholar 

  12. Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Pede S, Porcellati C. Ambulatory pulse pressure: a potent predictor of total cardiovascular risk in hypertension. Hypertension. 1998;32:983–8.

    Article  PubMed  CAS  Google Scholar 

  13. Hansen TW, Kikuya M, Thijs L, et al. Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7030 individuals. J Hypertens. 2007;25:1554–64.

    Article  PubMed  CAS  Google Scholar 

  14. Kikuya M, Hansen TW, Thijs L, et al. Diagnostic thresholds for ambulatory blood pressure monitoring based on 10-year cardiovascular risk. Circulation. 2007;115:2145–52.

    Article  PubMed  Google Scholar 

  15. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367:1747–57.

    Article  PubMed  Google Scholar 

  16. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217–23.

    Article  PubMed  Google Scholar 

  17. The Lancet. Raising the pressure on hypertension. Lancet. 2013;381:1157. This editorial introduced the fact that high blood pressure is the leading risk factor for global disease burden, and is estimated to cause more than half of deaths caused by total cardiovascular disease.

  18. Zhang H, Thijs L, Kuznetsova T, Fagard RH, Li X, Staessen JA. Progression to hypertension in the non-hypertensive participants in the Flemish Study on Environment, Genes and Health Outcomes. J Hypertens. 2006;24:1719–27.

    Article  PubMed  CAS  Google Scholar 

  19. Schutte R, Thijs L, Liu YP, et al. Within-subject blood pressure level—not variability—predicts fatal and nonfatal outcomes in a general population. Hypertension. 2012;60:1138–47.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  20. Hansen TW, Staessen JA, Zhang H, et al. Cardiovascular outcome in relation to progression to hypertension in the Copenhagen MONICA cohort. Am J Hypertens. 2007;20:483–91.

    Article  PubMed  Google Scholar 

  21. Shimbo D, Newman JD, Schwartz JE. Masked hypertension and prehypertension: diagnostic overlap and interrelationships with left ventricular mass: the Masked Hypertension Study. Am J Hypertens. 2012;25:664–71.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Zhu H, Yan W, Ge D, et al. Cardiovascular characteristics in American youth with prehypertension. Am J Hypertens. 2007;20:1051–7.

    Article  PubMed  Google Scholar 

  23. Pierdomenico SD, Pannarale G, Rabbia F, et al. Prognostic relevance of masked hypertension in subjects with prehypertension. Am J Hypertens. 2008;21:879–83.

    Article  PubMed  Google Scholar 

  24. Manios E, Michas F, Tsivgoulis G, et al. Impact of prehypertension on carotid artery intima-media thickening: actual or masked? Atherosclerosis. 2011;214:215–9.

    Article  PubMed  CAS  Google Scholar 

  25. Whitworth JA, World Health Organization, International Society of Hypertension Writing Group. World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003;21:1983–92.

  26. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–76.

  27. Brguljan-Hitij J, Thijs L, Li Y, et al. Risk stratification by ambulatory blood pressure monitoring across JNC classes of conventional blood pressure. Am J Hypertens. 2014;27:956–65. This participant-level meta-analysis revealed that ambulatory blood pressure refined risk stratification in normotension and prehypertension mainly by enabling the diagnosis of masked hypertension.

    Article  PubMed  Google Scholar 

  28. Asayama K, Ohkubo T, Kikuya M, et al. Prediction of stroke by self-measurement of blood pressure at home versus casual screening blood pressure measurement in relation to the JNC-7 classification: the Ohasama study. Stroke. 2004;35:2356–61.

    Article  PubMed  Google Scholar 

  29. Asayama K, Ohkubo T, Sato A, et al. Proposal of a risk-stratification system for the Japanese population based on blood pressure levels: the Ohasama study. Hypertens Res. 2008;31:1315–22.

    Article  PubMed  Google Scholar 

  30. Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens. 2003;21:1011–53.

    Article  Google Scholar 

  31. Guidelines Subcommittee. Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2004). Hypertens Res. 2006;29:S1–106.

    Google Scholar 

  32. Niiranen TJ, Thijs L, Asayama K, et al. The International Database of HOme blood pressure in relation to Cardiovascular Outcome (IDHOCO): moving from baseline characteristics to research perspectives. Hypertens Res. 2012;35:1072–9.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Asayama K, Thijs L, Brguljan-Hitij J, et al. Risk stratification by self-measured home blood pressure across categories of conventional blood pressure: a participant-level meta-analysis. PLOS Med. 2014;11:e1001591. In this meta-analysis based on the individual data, authors demonstrated that the self-measured home blood pressure substantially refined risk among untreated people with conventional blood pressure levels assumed to carry no or mildly increased risk, in particular in the presence of masked hypertension.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.

    Article  PubMed  Google Scholar 

  35. Staessen JA, Kuznetsova T, Stolarz K. Hypertension prevalence and stroke mortality across populations. JAMA. 2003;289:2420–2.

    Article  PubMed  Google Scholar 

  36. Fukunaga H, Ohkubo T, Kobayashi M, et al. Cost-effectiveness of the introduction of home blood pressure measurement in patients with office hypertension. J Hypertens. 2008;26:685–90.

    Article  PubMed  CAS  Google Scholar 

  37. Staessen JA, Byttebier G, Buntinx F, Celis H, O’Brien ET, Fagard R. Antihypertensive treatment based on conventional or ambulatory blood pressure measurement. A randomized controlled trial Ambulatory Blood Pressure Monitoring and Treatment of Hypertension Investigators. JAMA. 1997;278:1065–72.

    Article  PubMed  CAS  Google Scholar 

  38. Staessen JA, Den Hond E, Celis H, et al. Antihypertensive treatment based on blood pressure measurement at home or in the physician’s office: a randomized controlled trial. JAMA. 2004;291:955–64.

    Article  PubMed  CAS  Google Scholar 

  39. Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet. 2010;375:1624–33.

    Article  PubMed  Google Scholar 

  40. Segnan N, Armaroli P, Bonelli L, et al. Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian Randomized Controlled Trial—SCORE. J Natl Cancer Inst. 2011;103:1310–22.

    Article  PubMed  Google Scholar 

  41. Schoen RE, Pinsky PF, Weissfeld JL, et al. Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. N Engl J Med. 2012;366:2345–57. This large-scale randomized trial probed that screening with flexible sigmoidoscopy was associated with a significant decrease in colorectal-cancer incidence in both distal and proximal colon and mortality in distal colon.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  42. Mathers CD, Fat DM, Boerma J. The global burden of disease: 2004 update: World Health Organization; 2008.

  43. Sonnenberg A, Delco F, Inadomi JM. Cost-effectiveness of colonoscopy in screening for colorectal cancer. Ann Intern Med. 2000;133:573–84.

    Article  PubMed  CAS  Google Scholar 

  44. O’Leary BA, Olynyk JK, Neville AM, Platell CF. Cost-effectiveness of colorectal cancer screening: comparison of community-based flexible sigmoidoscopy with fecal occult blood testing and colonoscopy. J Gastroenterol Hepatol. 2004;19:38–47.

    Article  PubMed  Google Scholar 

  45. Lovibond K, Jowett S, Barton P, et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. Lancet. 2011;378:1219–30. Authors did a Markov model-vbased cost-effectiveness analysis and demonstrated that ambulatory blood pressure monitoring as a diagnostic strategy for hypertension would reduce misdiagnosis and save costs, and ambulatory blood pressure should be applied for most patients before the start of antihypertensive drugs.

    Article  PubMed  Google Scholar 

  46. Jones DW. Dietary sodium and blood pressure. Hypertension. 2004;43:932–5.

    Article  PubMed  CAS  Google Scholar 

  47. Fagard RH. The role of exercise in blood pressure control: supportive evidence. J Hypertens. 1995;13:1223–7.

    Article  PubMed  CAS  Google Scholar 

  48. Khan NA, Hemmelgarn B, Padwal R, et al. The 2007 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2 - therapy. Can J Cardiol. 2007;23:539–50.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  49. Parati G, Kilama MO, Faini A, et al. A new solar-powered blood pressure measuring device for low-resource settings. Hypertension. 2010;56:1047–53.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

The authors would like to thank Professor Jan A. Staessen and his research group in University of Leuven, Belgium, for their valuable help.

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Yutaka Imai received research support and lecturing fees from Astellas, AstraZeneca, Daiichi Sankyo, Dainippon-Sumitomo, Merck Sharpe and Dohme, Novartis, Pfizer, Takeda, and Tanabe-Mistubishi. Omron Healthcare gave research support to Kei Asayama and Yutaka Imai. Jana Brguljan-Hitij declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan

    Kei Asayama

  2. Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan

    Kei Asayama & Yutaka Imai

  3. Division of Hypertension, Department of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Jana Brguljan-Hitij

Authors
  1. Kei Asayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jana Brguljan-Hitij
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yutaka Imai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kei Asayama.

Additional information

This article is part of the Topical Collection on Blood Pressure Monitoring and Management

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Asayama, K., Brguljan-Hitij, J. & Imai, Y. Out-of-Office Blood Pressure Improves Risk Stratification in Normotension and Prehypertension People. Curr Hypertens Rep 16, 478 (2014). https://doi.org/10.1007/s11906-014-0478-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11906-014-0478-0

Keywords

Search

Navigation