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. 2023 Dec 5;12(23):e030992.
doi: 10.1161/JAHA.123.030992. Epub 2023 Dec 1.

Agreement Between Guideline Thresholds Using an "All-in-One" Device to Measure Office, Home, and Ambulatory Blood Pressures

Kazuomi Kario  1 , Naoko Tomitani  1 , Satoshi Hoshide  1 , Masafumi Nishizawa  2 , Tetsuro Yoshida  3 , Tomoyuki Kabutoya  1 , Takeshi Fujiwara  1 , Hiroyuki Mizuno  1 ; HI‐JAMP Study Group
Affiliations

Agreement Between Guideline Thresholds Using an "All-in-One" Device to Measure Office, Home, and Ambulatory Blood Pressures

Kazuomi Kario et al. J Am Heart Assoc. .

Abstract

Background: Blood pressure (BP) thresholds for diagnosing and managing hypertension vary for office, home, and ambulatory readings, and between guideline documents. This analysis determined corresponding office, home, and ambulatory BP thresholds using baseline data from the HI-JAMP (Home-Activity Information and Communication Technology-Based Japan Ambulatory Blood Pressure Monitoring Prospective) study, which used a validated "all-in-one" BP monitoring device.

Methods and results: Data from 2322 treated patients with hypertension who underwent office BP measurement, then 24-hour ambulatory BP monitoring, then home BP monitoring for 5 days were analyzed. Corresponding BP thresholds for office, home, and ambulatory measurements were determined using Deming regression. Values equivalent to office systolic BP (SBP) of 120 and 140 mm Hg were as follows: 115.9 and 127.7 mm Hg for 24-hour ambulatory SBP; 120.8 and 134.0 mm Hg for daytime ambulatory SBP; 104.9 and 117.9 mm Hg for nighttime ambulatory SBP; and 122.0 and 134.2 mm Hg for morning-evening average home SBP. Deming regression showed that morning-evening average home SBP and daytime ambulatory SBP were almost the same (home SBP=0.99×daytime ambulatory SBP+0.27 mm Hg; r=0.627). Morning-evening average home SBP values of 120 and 135 mm Hg were equivalent to daytime ambulatory SBP values of 119.1 and 133.9 mm Hg, respectively. A home SBP threshold of 130 mm Hg corresponded to 24-hour and nighttime ambulatory SBP values of 123.5 and 113.6 mm Hg, whereas a home SBP threshold of 135 mm Hg corresponded to 24-hour and nighttime ambulatory SBP values of 128.0 and 119.2 mm Hg.

Conclusions: Ambulatory and home BP thresholds in this analysis were similar to those proposed by existing guidelines. The similarity between the home BP and daytime ambulatory BP thresholds was a clinically relevant finding.

Keywords: ambulatory blood pressure; blood pressure control; home blood pressure; hypertension; office blood pressure; thresholds.

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Figures

Figure 1
Figure 1. Deming regression between office SBP and ambulatory SBP (A, 24‐hour average; B, daytime; and C, nighttime).
Each horizontal line indicates the ambulatory SBP value corresponding to an office SBP value in the same color based on the 2017 ACC/AHA guidelines. Red lines indicate office SBP: 80 mm Hg; 24‐hour average SBP: 75 mm Hg; daytime SBP: 80 mm Hg; and nighttime SBP: 65 mm Hg. Blue lines indicate office SBP: 90 mm Hg; 24‐hour average SBP: 80 mm Hg; daytime SBP: 85 mm Hg; and nighttime SBP: 70 mm Hg. Green lines indicate office SBP: 100 mm Hg; 24‐hour average SBP: 90 mm Hg; daytime SBP: 90 mm Hg; and nighttime SBP: 85 mm Hg. *P<0.001. ACC indicates American College of Cardiology; AHA, American Heart Association; HI‐JAMP, Home‐Activity Information and Communication Technology–Based Japan Ambulatory Blood Pressure Monitoring Prospective; and SBP, systolic blood pressure.
Figure 2
Figure 2. Deming regression between office SBP and home SBP (A, ME average; B, morning; and C, evening).
Each horizontal line indicates the ambulatory SBP value corresponding to office SBP value in the same color based on the 2017 ACC/AHA guidelines. Red lines indicate office SBP: 80 mm Hg; ME average SBP, morning SBP, and evening SBP: 80 mm Hg. Blue lines indicate office SBP: 90 mm Hg; ME average SBP, morning SBP, and evening SBP: 85 mm Hg. Green lines indicate office SBP: 100 mm Hg; ME average SBP, morning SBP, and evening SBP: 90 mm Hg. *P<0.001. ACC indicates American College of Cardiology; AHA, American Heart Association; HI‐JAMP, Home‐Activity Information and Communication Technology–Based Japan Ambulatory Blood Pressure Monitoring Prospective; ME, morning‐evening; and SBP, systolic blood pressure.
Figure 3
Figure 3. Deming regression between ME average SBP and ambulatory SBP (A, 24‐hour average; B, daytime; and C, nighttime).
Each horizontal line indicates the ambulatory SBP value corresponding to office SBP value in the same color based on the ACC/AHA guidelines. Red lines indicate ME average SBP: 80 mm Hg; 24‐hour average SBP: 75 mm Hg; daytime SBP: 80 mm Hg; and nighttime SBP: 65 mm Hg. Blue lines indicate ME average SBP: 85 mm Hg; 24‐hour average SBP: 80 mm Hg; daytime SBP: 85 mm Hg; and nighttime SBP: 70 mm Hg. Green lines indicate office SBP: 90 mm Hg; 24‐hour average SBP: 90 mm Hg; daytime SBP: 90 mm Hg; and nighttime SBP: 85 mm Hg. *P<0.001. ACC indicates American College of Cardiology; AHA, American Heart Association; HI‐JAMP, Home‐Activity Information and Communication Technology–Based Japan Ambulatory Blood Pressure Monitoring Prospective; ME, morning‐evening; and SBP, systolic blood pressure.
See this image and copyright information in PMC

Comment in

  • Mean-ing Beyond Office Blood Pressure.
    Ogungbe O, Rose E, Juraschek SP. Ogungbe O, et al. J Am Heart Assoc. 2023 Dec 5;12(23):e032576. doi: 10.1161/JAHA.123.032576. Epub 2023 Dec 1. J Am Heart Assoc. 2023. PMID: 38038183 Free PMC article. No abstract available.

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