Cardiovascular outcome and home blood pressure in relation to silent myocardial ischemia in a clinical population: The J-HOP study

Abstract

Several guidelines recommend measuring home blood pressure (BP) and lowering blood pressure than ever before. But several studies reported that lowering diastolic blood pressure (DBP) increased the incidence of coronary artery disease (CAD). We analyzed 3605 individuals who underwent both home and office BP monitoring over 14 days and baseline Hs-cTnT measurement and identified follow-up data of the Japan Morning Surge-Home Blood Pressure (J-HOP) study who had a history of or risk factors for cardiovascular disease. During a mean follow-up period of 6.4 years (23 173 person-years), 114 coronary artery disease and 81 stroke events occurred. Elevated Hs-cTnT (≥0.014 ng/mL) was observed in 298 patients (8.3%). In the group with non-elevated Hs-cTnT (<0.014 ng/mL, n = 3307), an adjusted Cox hazard model showed that home systolic BP (SBP) was associated with a risk of stroke incidence (hazard ratio [HR] per 1 SD, 1.62; 95% confidence interval [CI], 1.29-2.03). This association was also observed in office SBP (HR per 1 SD, 1.43; 95%CI, 1.07-1.91). There was no association between office or home BP and CAD events in the group with non-elevated Hs-cTnT. In the group with elevated Hs-cTnT, an adjusted Cox hazard model showed that home DBP was associated with a risk of CAD incidence (HR per 1 SD, 0.54; 95%CI, 0.30-0.99). However, this association was not observed in office DBP. In patients with elevated Hs-cTnT, which is a marker of subclinical myocardial ischemia, excessive lowering of home DBP may be associated with a risk of incident CAD.

Keywords: coronary artery disease; diastolic blood pressure; home blood pressure; troponin T.

Figure 1

Association between home blood pressure and CAD incidence according to non‐elevated and elevated Hs‐cTnT. A, shows the CAD incidence per 1000 person‐years across home SBP category. B, shows the CAD incidence per 1000 person‐years across home DBP category. Values are the incidence per 1000 person‐years (95% confidence interval). CAD indicates coronary artery disease; DBP, diastolic blood pressure; Hs‐cTnT, high‐sensitive cardiac troponin T; SBP, systolic blood pressure. *P < .05, †P < .01 vs non‐elevated Hs‐cTnT group in each BP category

Figure 2

Association between home blood pressure and stroke incidence according to non‐elevated and elevated Hs‐cTnT. A, shows the stroke incidence per 1000 person‐years across home SBP category. B, shows the stroke incidence per 1000 person‐years across home DBP category. Values are the incidence per 1000 person‐years (95% confidence interval). DBP, diastolic blood pressure; Hs‐cTnT, high‐sensitive cardiac troponin T; SBP, systolic blood pressure. *P < .05, †P < .01 vs non‐elevated Hs‐cTnT group in each BP category