Home blood pressure best guide to metabolic risk

Home blood pressure (BP) is a good guide to which patients are likely to have the metabolic syndrome, say researchers.

Marjo-Riitta Hänninen (National Institute for Health and Welfare, Turku, Finland) and team found that home BP mediated the association between different hypertension categories and the metabolic syndrome.

The study involved 1582 participants, aged between 44 and 74 years, of whom 15.0% had white-coat hypertension (elevated office but normal home BP), 8.1% had masked hypertension (normal office but elevated home BP), and 27.1% had sustained hypertension (both measures elevated).

The prevalence of the metabolic syndrome in the whole population ranged from 17.5% using the European Group for the Study of Insulin Resistance criteria and based on home BP to 43.5% using the harmonized definition and office BP.

The harmonized definition requires the presence of at least three of five metabolic risk factors (obesity, hypertension, elevated blood glucose, raised triglycerides, and low high-density lipoprotein cholesterol). By this definition, and based on office BP, rates of the metabolic syndrome rose from 24.4% in people with normal BP, to 50.6%, 58.6%, and 70.5% among those with white-coat, masked, and sustained hypertension, respectively.

When home BP was used to define the hypertension element of the metabolic syndrome, its prevalence among normotensive participants was relatively unchanged, at 22.8%, and fell slightly in the white-coat hypertension group, at 41.4%. But the metabolic syndrome prevalence increased to 65.6% in the masked hypertension group, to come close to that seen among participants with sustained hypertension.

Hänninen et al therefore suggest that home BP should be used to define the metabolic syndrome in patients with masked hypertension.

“It should be noted that masked hypertension is associated with adverse lifestyles, such as smoking, high alcohol consumption and obesity, compared with white-coat hypertension or normotension,” they write in the Journal of Human Hypertension.

“These risk factors are related to [metabolic syndrome] components and may modify the associations between BP categories and metabolic disorder.”

The associations between hypertension categories and metabolic clustering based on home BP became nonsignificant after adjusting for home systolic and diastolic BP, showing that these variables accounted for the associations.

“Elevated home BP could be a useful method to assess the risk of metabolic risk factor clustering,” the team concludes.

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