Is "isolated home" hypertension as opposed to "isolated office" hypertension a sign of greater cardiovascular risk?

Background: The SHEAF (Self-Measurement of Blood Pressure at Home in the El derly: Assessment and Followup) study is an observational study (from Febru ary 1998 to early 2002) designed to determine whether home blood pressure ( BP) measurement has a greater cardiovascular prognostic value than office B P measurement among elderly (greater than or equal to 60 years) French pati ents with hypertension. The objective of this present work is to describe t he baseline characteristics of the treated patients in the SHEAF study from February 1998 to March 1999, placing special emphasis on "isolated office" and "isolated home" hypertension. Methods: Baseline office BP measurement was assessed using a mercury sphygm omanometer. Home BP measurement was performed over a 4-day period. A 140/90 -mm Hg threshold was chosen to define office hypertension, and a 135/85-mm Hg threshold to define home hypertension. Results: Of the 5211 hypertensive patients in the SHEAF study with a valid home BP measurement, 4939 received treatment with at least 1 antihypertensi ve drug. Patients with isolated office hypertension represented 12.5% of th is population, while patients with isolated home hypertension represented 1 0.8%. The characteristics of the patients with isolated office hypertension were similar to those of patients with controlled hypertension. However, p atients with isolated office hypertension had fewer previous cardiovascular complications. In contrast, rates of cardiovascular risk factors and histo ry of cardiovascular disease in patients with isolated home hypertension re sembled those in patients with uncontrolled hypertension. Conclusions: This retrospective analysis suggests that patients with isolat ed home hypertension belong to a highrisk subgroup. The 3-year follow-up of these patients will provide prospective data about the cardiovascular prog nosis of these subgroups.