Sam S. E. Siven

White-coat and masked hypertension as risk factors for progression to sustained hypertension: the Finn-Home study

Objectives: To assess the risk of progression from white-coat hypertension (WCHT) and masked hypertension (MHT) to sustained hypertension (SHT) in a nationwide unselected population sample. Methods: Both office and home blood pressure (BP), along with other cardiovascular risk factors, were measured in an unselected population sample of 944 participants in 2000 and 2011. We compared the risk of progression to SHT (office BP ≥140/90 mmHg and home BP ≥135/85 mmHg or start of treatment with antihypertensive medication) between 528 participants with normotension (office BP <140/90 mmHg and home BP <135/85 mmHg), 142 participants with WCHT (office BP ≥140/90 mmHg and home BP < 135/85 mmHg), and 63 participants with MHT (office BP < 140/90 mmHg and home BP ≥135/85 mmHg) at baseline. We used the &khgr;2 test and a multivariable-adjusted log-binomial regression model to evaluate the association between baseline BP categories and incident SHT. Results: During an 11-year follow-up, the rate of progression to SHT increased from normotension (18%) to WCHT (52%) and MHT (73%), P < 0.0001. Progression to SHT became more likely with an increasing baseline home BP category (Ptrend < 0.0001). The multivariable-adjusted relative risks (95% confidence interval) for developing SHT, as compared with normotension, were 2.8 (2.2–3.6, P < 0.0001) for WCHT and 3.8 (2.9–5.0, P < 0.0001) for MHT. Conclusions: Persons with WCHT and MHT have a three to four-fold risk for developing SHT than those with NT and could benefit from active follow-up and lifestyle counselling.

The association between home vs. ambulatory night-time blood pressure and end-organ damage in the general population

Objective: The aim of this study was to test the agreement between night-time home and night-time ambulatory blood pressure (BP) and to compare their associations with hypertensive end-organ damage for the first time in the general population. Methods: A population sample of 248 participants underwent measurements for night-time home BP (three measurements on two nights with a timer-equipped home device), night-time ambulatory BP, pulse wave velocity (PWV), carotid intima–media thickness (IMT) and echocardiographic left ventricular mass index (LVMI). Results: No significant or systematic differences were observed between mean night-time ambulatory and home BPs (systolic/diastolic difference: 0.7 ± 7.6/0.2 ± 6.0 mmHg, P = 0.16/0.64). All night-time home and ambulatory BPs were positively correlated with PWV, IMT and LVMI (P < 0.01 for all). No significant differences in Pearsons correlations between end-organ damage and night-time home or ambulatory BP were observed (P ≥ 0.11 for all comparisons using Dunn and Clarks Z), except for a slightly stronger correlation between PWV and ambulatory SBP than for home SBP (r = 0.57 vs. 0.50, P = 0.03). The adjusted R2 of all multivariable-adjusted models for PWV, IMT or LVMI that included night-time home or ambulatory SBP/DBP were within 2/1%. Conclusion: Our study demonstrates that night-time home and ambulatory measurements produce similar BP values that have comparable associations with end-organ damage in the general population even when a clinically feasible measurement protocol is used for measuring night-time home BP. In the future, night-time home BP measurement may offer a feasible and easily accessible alternative to ambulatory monitoring for the measurement of night-time BP.

Social, lifestyle and demographic inequalities in hypertension care.

Aims: Recent nationwide in-depth analyses on inequalities in hypertension prevalence and care are scarce. This study assessed sociodemographic and lifestyle factors associated with the prevalence, awareness, treatment and control of hypertension in Finland. Methods: A representative nationwide sample (participation rate 58%) of the Finnish adult population underwent a health examination and interview in 2011. After excluding participants with missing data, 4230 people were included in the analyses. Weighted regression modelling was used to explore the associations of sociodemographic and lifestyle factors with the prevalence, awareness, treatment and control of hypertension. Results: The prevalence, awareness, treatment and control rates of hypertension (blood pressure ⩾140/90 mmHg or antihypertensive medication) in Finland were 47%, 57%, 51% and 48%, respectively. Older age, male sex, lower education, retirement, higher BMI, never-smoking and heavy alcohol use were associated with a higher prevalence of hypertension (p<0.05). In contrast, younger age, non-retirement, lower BMI, smoking and high physical activity were associated with lower awareness and treatment rates (p<0.05). In addition, male sex was associated with lower awareness rates (p<0.01). Hypertension control was better in younger participants (p<0.05). Conclusions: In addition to high prevalence and moderate treatment rates of hypertension, serious sociodemographic and lifestyle inequities in hypertension care exist in Finland. Hypertension is more prevalent in older people of lower socio-economic status with adverse lifestyles. However, hypertension is more often unrecognised and untreated among people with low risk of hypertension.

Home versus office blood pressure: longitudinal relations with left ventricular hypertrophy: the Finn-Home study

Objectives: Electrocardiographically assessed left-ventricular hypertrophy (ECG-LVH) is a particularly high-risk phenomenon that is a part of every hypertensive patients initial work-up. Several cross-sectional studies have demonstrated that home blood pressure (BP) has a stronger relation to LVH than office BP. However, longitudinal evidence on the association between home BP and target organ damage is scarce to nonexistent. Methods: We studied in a sample of 615 community-dwelling participants (mean age at baseline 53.7 ± 7.2, 58% women) whether change in home BP is more strongly associated with change in ECG-LVH than change in office BP over an 11-year follow-up. Results: Pearsons correlation coefficients between changes in home/office SBP and changes in Sokolow–Lyon index, Cornell voltage, Cornell product and R wave amplitude in aVL were 0.21/0.18, 0.28/0.17*, 0.25/0.16*, and 0.32/0.20*, respectively (asterisk indicates P < 0.05 for between-method difference in correlations with Steigers z test). For change in home/office DBP and change in the aforementioned ECG-LVH indexes, the correlations were 0.12/0.12, 0.20/0.15, 0.16/0.12, and 0.28/0.19*. Multivariable-adjusted regression modelling provided similar results. No clinically significant increase in correlations between home BP and ECG-LVH indexes occurred after the fourth day of home BP measurement. Conclusion: Our study demonstrates for the first time the superiority of home BP over office BP in the follow-up of left ventricular mass. The results of this and previous studies underline the importance of using out-of-office BP measurements as the primary method for assessing blood pressure levels.

[OP.7D.02] HOME AND OFFICE BLOOD PRESSURE AS DETERMINANTS OF KIDNEY DISEASE IN THE GENERAL POPULATION: THE FINN-HOME STUDY

Objective: Previous, mainly cross-sectional studies performed in small patient populations have provided inconclusive results on whether home BP is a stronger correlate of prevalent and incident chronic kidney disease than office BP. We therefore compared the associations of home and office BP with prevalent albuminuria, incident decreased glomerular filtration rate (GFR), and decline in GFR in a nationwide population sample. Design and method: We studied a population sample of 2009 participants (56 ± 9 years; 54% women) representative of the Finnish adult population in 2000–2001 and re-examined 1109 individuals 11 years later. We measured office BP, home BP, serum creatinine and spot urine albumin/creatinine ratio at baseline and serum creatinine at follow-up. We estimated GFR of each participant at baseline and follow-up using the Chronic Kidney Disease Epidemiology Collaboration equation. We defined decreased GFR as GFR <60 ml/min/1.73 m2 and albuminuria as a urine albumin/creatinine ratio of >2.5 mg/mmol in men and >3.5 mg/mmol in women. We examined the associations between 1-SD increases in baseline home versus office BP and prevalent albuminuria, incident decreased glomerular filtration rate, and change in GFR from baseline to follow-up using unadjusted logistic and linear regression models. We included home and office BP simultaneously in the models. Results: At baseline, 143 of 2009 (7.1%) participants had albuminuria. Systolic and diastolic home BP were associated with prevalent albuminuria whereas systolic and diastolic office BP were not (Table). Mean GFR change from baseline to follow-up was −9.3 ± 9.8 ml/min/1.73 m2 and 83 of 1109 (7.5%) participants developed decreased GFR during follow-up. Of all BP parameters, only baseline systolic home BP was associated with GFR change and incident decreased GFR (Table). Conclusions: Our results suggest that home BP is more strongly associated with prevalent and incident chronic kidney disease than office BP. Our findings are in line with previous work and support the superiority of home BP over office BP. Figure. No caption available.

OS 07-06 THE ASSOCIATION BETWEEN HOME VERSUS AMBULATORY NIGHTTIME BLOOD PRESSURE AND END-ORGAN DAMAGE IN THE GENERAL POPULATION

Objective: The aim of this study was to test the agreement between nighttime home and nighttime ambulatory blood pressure (BP) and to compare their associations with hypertensive end-organ damage for the first time in the general population. Design and Method: A population sample of 248 participants underwent measurements for nighttime home BP (3 measurements on 2 nights with a timer-equipped home device), nighttime ambulatory BP, pulse wave velocity (PWV), carotid intima-media thickness (IMT) and echocardiographic left ventricular mass index (LVMI). Results: No significant differences were observed between mean nighttime home and ambulatory BPs (systolic/diastolic difference: 0.7 ± 7.6/0.2 ± 6.0 mmHg, p = 0.16/0.64). Furthermore, no systematic differences in systolic or diastolic nighttime BPs were identified between the two methods in Bland-Altman plots (Figure). All nighttime home and ambulatory BPs were positively correlated with PWV, IMT and LVMI (p < 0.01 for all). Correlation coefficients for BP indices and end-organ damage and their comparisons are shown in the Table. No significant differences in Pearsons correlation coefficients between end-organ damage and nighttime home or ambulatory BP were observed (p ≥ 0.11 for all comparisons using Dunn and Clarks Z), except for a slightly stronger correlation between PWV and ambulatory systolic BP than for home systolic BP (r = 0.57 vs. 0.50, p = 0.03). The adjusted R2 of all multivariable-adjusted models for PWV, IMT or LVMI that included nighttime home or ambulatory systolic/diastolic BP were within 2/1%. Conclusions: Our study demonstrates that nighttime home and ambulatory measurements produce similar BP values that have comparable associations with end-organ damage in the general population even when a clinically feasible measurement protocol is used for measuring nighttime home BP. In the future, nighttime home BP measurement may offer a feasible and easily accessible alternative to ambulatory monitoring for the measurement of nighttime BP.

[OP.6B.07] NIGHTTIME BLOOD PRESSURE MEASURED WITH A TIMER-EQUIPPED HOME DEVICE – AN ALTERNATIVE TO AMBULATORY MONITORING

Objective: Our objective was to test the agreement between nighttime home and nighttime ambulatory blood pressure (BP) and to compare their associations with left ventricular hypertrophy, arterial stiffness and carotid atherosclerosis. Design and method: A population sample of 248 participants underwent measurements for 24-hour ambulatory BP and nighttime home BP (3 measurements at 2, 3 and 4 hours during 2 nights). We measured ambulatory BP with a Microlife WatchBP O3 device and home BP with a timer-equipped Microlife WatchBP Home N device. In addition, the participants underwent measurement of pulse wave velocity (PWV) and ultrasonographic examinations for left ventricular mass index (LVMI) and carotid intima-media thickness (IMT). The agreement between nighttime BPs were assessed with paired t-test, intra-class correlation and Bland-Altman plots. In addition, Pearsons correlation coefficients were calculated to assess the associations between nighttime BPs and end-organ damage, and the coefficients were compared with method described by Dunn and Clark. Results: The mean number of ambulatory and home nighttime BP measurements was 16.6 ± 3.5 and 5.6 ± 1.3, respectively. No significant differences were found between mean ambulatory and home nighttime BPs (systolic/diastolic difference: 0.7 ± 7.6/0.2 ± 6.0 mmHg, p = 0.16/0.64). Furthermore, no systematic differences in systolic or diastolic nighttime BPs were identified between the two methods in Bland-Altman plots. Intra-class correlation coefficients for the relationships between systolic/diastolic nighttime BPs were high (0.81/0.71, p < 0.0001 for both). Correlation coefficients for BP indices and end-organ damage and their comparisons are shown in the Table. All home and ambulatory nighttime BP indices were positively correlated with PWV, LVMI, and IMT. The only significant difference in the correlations between end-organ damage and nighttime ambulatory or nighttime home BP, was a slightly stronger correlation between PWV and ambulatory systolic BP than for home systolic BP (p = 0.03, Table). Conclusions: We conclude that home and ambulatory monitors produce similar nighttime BP values that had comparable associations with end-organ damage. Therefore, nighttime home BP measurement can be promoted as an alternative to ambulatory monitoring for measuring nighttime BP. Figure. No caption available.

[OP.6B.05] CHANGE IN HOME BLOOD PRESSURE ASSOCIATES MORE STRONGLY WITH CHANGE IN ECG-LVH THAN CHANGE IN OFFICE BLOOD PRESSURE DOES: THE FINN-HOME STUDY

Objective: It has been previously shown that regression of electrocardiographic left ventricular hypertrophy (ECG-LVH) in treated hypertensives is associated with a more favourable cardiovascular outcome. Our aim was to further elucidate, whether 1) change in home ([delta]home) or 2) change in office ([delta]office) blood pressure (BP) is more strongly associated with change in ECG-LVH ([delta]ECG-LVH). Design and method: The study sample consisted of 1097 participants, randomly chosen at baseline to be representative of the Finnish general adult population aged 45–74 years. ECG, home BP (28 self-measurements over 7 days with an oscillometric monitor) and office BP (a duplicate measurement by a nurse with a mercury sphygmomanometer) were measured in the baseline and 11-year follow-up examinations. ECG-LVH was determined using following measures: A) Sokolow-Lyon index, B) Cornell voltage and C) maximum R amplitude from aVL (RaVL). Pearsons correlation was used to examine the associations between [delta]BP and [delta]ECG-LVH. We also assessed whether [delta]ECG-LVH is more strongly associated with [delta]home BP than [delta]office BP with the Steigers test. Results: The correlation coefficients between [delta]ECG-LVH and 1) [delta]home and 2) [delta]office BP are shown in the Table. All correlations were statistically significant (P < 0.001). However, [delta]home BP was more strongly associated with with changes in Cornell voltage and RaVL (for systolic) than [delta]office BP. No significant difference was observed in correlations between change in Sokolow-Lyon and 1) [delta]home and 2) [delta]office BP. In a subpopulation of 793 participants who had performed all 28 home BP measurements at baseline and follow-up, the correlations between [delta]home BP and [delta]Cornell voltage increased slightly with the number of home measurements (r for systolic/diastolic BP, day 1: 0.24/0.24, day 3: 0.26/0.26 and day 7: 0.27/0.25), but no material improvement in coefficients occurred after day 3 (12 measurements). Conclusions: In conclusion, home BP measuring should be used as a first-line method for both the diagnosis and follow-up of hypertension as it seems to be more strongly associated with changes in left ventricular hypertrophy than office BP measuring is. Figure. No caption available.