Association between home blood pressure control status and cardiovascular prognosis in participants with left ventricular hypertrophy: the J-HOP study.

Objective: We examined the association between home blood pressure (BP) control status and the cardiovascular disease (CVD) risk associated with left ventricular hypertrophy (LVH) in clinical practice.

Methods: J-HOP (Japan Morning Surge-Home BP) Study participants underwent home BP monitoring in the morning and evening for a 14-day period and echocardiography at baseline. Controlled home BP was defined as morning SBP less than 135 mmHg and morning DBP less than 85 mmHg. LVH was defined as LV mass index greater than 115 g/m2 in males and greater than 95 g/m2 in females.

Results: Among 1823 participants [mean [SD] age: 65.1 [11.6] years; 48.6% men; 82% on antihypertensive medications], 1112 (61%) showed uncontrolled BP, and 662 (36.3%) participants had LVH (233 men, 429 women). Over a median 6.8-year follow-up (11 985 person-years), 140 total CVD events occurred. In the uncontrolled BP group (n = 440), participants with LVH had higher incident rates of total CVD events compared to those without LVH, but this was not the case in the controlled BP group. Cox models suggested that 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 morning home BP control status. The assessment of LVH is important to optimize risk stratification of CVD in clinical practice, especially in participants with uncontrolled home BP.