Home blood pressure control status altered the cardiovascular prognosis associated with left ventricular hypertrophy in a Japanese nationwide general practice population: The J-HOP Study

Abstract Introduction Home blood pressure (BP) is a pivotal predictor for left ventricular hypertrophy (LVH) and future cardiovascular disease (CVD) events in hypertensive patients. Prior studies have demonstrated that strict office BP control leads to a reduction of CVD events risk associated with LVH. However, there has been no study to date to evaluate the association between home BP control status and CVD outcomes associated with LVH. Purpose We examined the association between home BP control status and the CVD risk associated with LVH in clinical practice. Methods This was a prospective observational study including Japanese patients with CVD or high risk of CVD. Three home BP readings were taken in both the morning and evening for 14 consecutive days. Echocardiography was performed at the baseline visit. Controlled home BP was defined as mean morning systolic BP 135 mmHg and mean morning diastolic BP 85 mmHg. LVH was defined by LV mass index 115 g/m2 in males and 95 g/m2 in females. The association between home BP control status and incident total CVD events associated with LVH was examined using Cox regression. Results 1,823 patients were followed for a median of 6.8 years (11,985 person-years), during which 140 (7.5%) CVD events occurred. Mean age (standard deviation) was 65.1 (11.6) years; 48.6% were male; 82.0% took antihypertensive medications. In the total group, 662 (36.3%) patients had LVH, with 233 cases in males and 429 in female. Among the total patients, 711 (39.0%) showed controlled BP, while 1,112 (61.0%) showed uncontrolled BP. Patients with LVH in the uncontrolled BP group (n=440) had higher incident rates of total CVD events compared to those without LVH (n=672), but this was not the case in the controlled BP group (Figure). LVH was associated with increased risk of total CVD events in the uncontrolled BP group (adjusted hazard ratio aHR 1.80, 95% confidence interval CI 1.17–2.75), and again, this was not the case in the controlled BP group (aHR 1.32, 95%CI 0.70–2.50). Conclusion The CVD risk associated with LVH differed depending on the home BP control status. Our findings suggest that the assessment of LVH is important to optimize risk stratification of CVD in clinical practice, especially in patients with uncontrolled home BP.Figure