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Self-measured home blood pressure highlights cardiovascular risk in women: the HOMED-BP study

Hypertension Research volume 46, pages 2400–2408 (2023)Cite this article

Abstract

No studies examined sex differences in relation to the prognostic significance of self-measured home blood pressure (HBP). We compared the predictive power for the risk of cardiovascular events in 1547 women and 1516 men with hypertension using HBP captured at treatment-free baseline and during on-treatment follow-up, based on the Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP) study. To express the change in risk for the composite cardiovascular endpoint associated with a 1–SD increase in HBP at baseline or on treatment, we derived multivariable-adjusted hazard ratios (HR) based on a Cox regression model. Over a median follow-up of 7.3 years, 100 composite events occurred, including 40 events in women. In women, systolic HBP both at baseline and on-treatment showed significant risk increment (at baseline: HR per 1-SD increment, 1.62; 95% confidence interval [CI], 1.17–2.24. on-treatment: HR, 1.74; 95% CI, 1.32–2.29). However, systolic HBP at baseline did not predict cardiovascular events in men (P = 0.25). On-treatment HBP was significantly associated with cardiovascular risk (P ≤ 0.012) irrespective of sex. Nevertheless, the point estimate of HR for systolic HBP in men (1.33) was less than that in women (1.74), and the interaction of sex with 1 SD-increase in systolic HBP in cardiovascular risk was significant irrespective of baseline (P = 0.039) or follow-up (P = 0.040) measurement when they were mutually adjusted. The increase in cardiovascular risk with the systolic HBP was steeper in women than in men for both baseline and on-treatment. The current findings unveil the importance of the control of systolic HBP, especially in women. Clinical Trial Registration: UMIN Clinical Trial Registry (http://www.umin.ac.jp/ctr), Unique identifier: C000000137.

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Acknowledgements

We are grateful all HOMED-BP study collaborators as listed previously [4] for their valuable contribution. We thank the staff of Tohoku University and Teikyo University for their valuable help. This study was funded by grants from the Japan Cardiovascular Research Foundation, the Japan Arteriosclerosis Prevention Fund, and Tohoku University. Fujitsu Systems East Limited (Tokyo, Japan) and Omron Healthcare Co., Ltd. (Kyoto, Japan) developed and maintained the Internet-based infrastructure for the measurement of the blood pressure at home and the management of patients. This study was also supported by Grants-in-Aid for Scientific Research (21H04984, 22H03358) from the Ministry of Education, Culture, Sports, Science and Technology, Japan, and ACRO Incubation Grants of Teikyo University, Japan. No funding agencies had any role in the design or conduct of the study; in the collection, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan

    Chiaki Ohata, Kei Asayama, Kyoko Nomura, Tomoko Yamamura, Takahiro Kimura, Yukako Tatsumi, Masahiro Kikuya & Takayoshi Ohkubo

  2. Division of Nephrology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan

    Chiaki Ohata & Shigeru Shibata

  3. Tohoku Institute for Management of Blood Pressure, Sendai, Japan

    Kei Asayama, Yutaka Imai & Takayoshi Ohkubo

  4. Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Japan

    Miki Hosaka

  5. Department of Public Health, Akita University Graduate School of Medicine, Akita, Japan

    Kyoko Nomura

  6. General Medical Education and Research Center, Teikyo University, Tokyo, Japan

    Tomoko Yamamura

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  1. Chiaki Ohata
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Correspondence to Kei Asayama.

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Conflict of interest

KA, YI and TO concurrently held the position of director of the Tohoku Institute for Management of Blood Pressure and were supported by Omron Healthcare Co., Ltd. KA and TO received a joint research grant from Omron Healthcare Co., Ltd.

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Ohata, C., Asayama, K., Hosaka, M. et al. Self-measured home blood pressure highlights cardiovascular risk in women: the HOMED-BP study. Hypertens Res 46, 2400–2408 (2023). https://doi.org/10.1038/s41440-023-01408-6

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