Prognosis of isolated systolic and isolated diastolic hypertension as assessed by self-measurement of blood pressure at home - The Ohasama Study

Background: Although the clinical significance of systolic-diastolic hypert ension and isolated systolic hypertension has been established, the signifi cance of isolated diastolic hypertension has not been fully investigated. Objective: To clarify the prognostic significance of isolated systolic and isolated diastolic hypertension as assessed by self-measurement of blood pr essure (BP) at home (home BP measurements), which has a better reproducibil ity and prognostic value than casual BP measurements in the general populat ion. Subjects and Methods: We obtained home BP measurements for 1913 subjects ag ed 40 years or older, then followed up their survival status (mean, 8.6 yea rs). We classified the subjects into the following 4 groups according to th eir home BP levels: systolic-diastolic hypertension, isolated systolic hype rtension, isolated diastolic hypertension, and normotension. The prognostic significance of each type of hypertension for the risk of cardiovascular m ortality risk was investigated using a Cox proportional hazards regression model adjusted for possible confounding factors. Results: The risk for isolated systolic hypertension and systolic-diastolic hypertension were significantly higher than the relative hazard for normot ension, while isolated diastolic hypertension was associated with no signif icant increase in risk. Home pulse pressure measurement was also independen tly associated with an increase in the risk of cardiovascular mortality. Conclusions: Isolated diastolic hypertension, as assessed by home BP measur ements, carried a low risk of cardiovascular mortality, similar to that fou nd in subjects with normotension, suggesting that the prognosis of hyperten sion would be improved by treatment focused on systolic rather than on dias tolic home BP measurements. To our knowledge, this study is the first to de monstrate the clinical significance of pulse pressure as assessed by home B P measurement.