Incorporating self-blood pressure measurements at home in the guideline from the Ohasama study

Recent guidelines for the treatment of hypertension have all emphasized the importance of self-blood pressure (BP) measurements at home (home BP) in clinical applications of practice, research, and epidemiology. In the Ohasama study, a cohort study based on home BP, we have demonstrated several important findings to be incorporated in those guidelines. We demonstrated that home BP more accurately and reliably reflect target organ damage and the prognosis of cardiovascular disease than conventional BP, whereas the predictive value of home BP increased progressively with the number of measurements. Even the initial-first home BP values (one measurement) showed a significantly greater relation with stroke risk than conventional BP values (mean of two measurements). Home BP in the morning (morning BP) and in the evening (evening BP) provide equally useful information for stroke risk, whereas morning hypertension, which is that specifically observed only in the morning, might be a good predicator of stroke, particularly among individuals using anti-hypertensive medication. Home BP increased the predictive power of categorizations of guidelines compared with conventional BP. Heart rate values assessed at home using a device designed for home BP measurement (home heart rate) was significantly associated with the risk of cardiovascular mortality, independent of home BP. We expect that continuous follow-up and further analysis of the Ohasama data would contribute to producing further important findings worth incorporating in future hypertension guidelines.