Prognostic Impact of Home Blood Pressures for Adverse Cardiovascular Outcomes and Mortality in Patients With Resistant Hypertension: A Prospective Cohort Study

Home blood pressure (HBP) monitoring has been increasingly used in hypertension management. We aimed to evaluate the prognostic importance of HBP parameters in patients with resistant hypertension in relation to office and ambulatory blood pressures (BPs). Three hundred thirty-three patients with resistant hypertension performed 24-hour ambulatory and HBP monitoring at baseline and were followed up for a median of 5.6 years. Primary outcomes were total cardiovascular events, major adverse cardiovascular events, and all-cause and cardiovascular mortality. Associations between HBPs (total mean, morning and evening BPs, analyzed as continuous and as dichotomical variables) and outcomes were assessed by multivariable-adjusted Cox analyses. Improvement in risk discrimination with HBP was evaluated by C statistics and the Integrated Discrimination Improvement index. During follow-up, there were 48 cardiovascular events (42 major adverse cardiovascular events) and 43 all-cause deaths (26 cardiovascular). Continuous HBP parameters were associated with significantly higher risks of all adverse outcomes, with hazard ratios varying from 1.7 to 2.1, after adjustments for office and ambulatory BPs. In dichotomical analyses, uncontrolled HBP was associated with significantly higher risks of all outcomes, except for the evening HBP. Morning HBP was associated with the highest risks. HBP parameters improved risk discrimination, with increases in C statistics of up to 0.044 and relative Integrated Discrimination Improvements up to 42%, equivalent to those obtained from ambulatory BPs, except for all-cause and cardiovascular mortalities, in which ambulatory BPs provided greater improvements than HBPs. In conclusion, higher/uncontrolled HBP levels are predictive of adverse cardiovascular outcomes and mortality and improve risk discrimination in patients with resistant hypertension.