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Prediction of Stroke by Self-Measurement of Blood Pressure at Home Versus Casual Screening Blood Pressure Measurement in Relation to the Joint National Committee 7 Classification: The Ohasama Study

Background and Purpose— To compare the predictive power of self-measured home blood pressure (HBP) and casual blood pressure (CBP) for stroke risk in relation to the Joint National Committee 7 (JNC-7) classification. Methods— HBP and CBP measurements were taken in 1702 subjects (≥40 years) without a history of stroke, who were followed up for an average of 11 years. Subjects were classified into 4 groups on the basis of either HBP or CBP, according to the JNC-7 criteria: group 1 (HBP <115/75 mm Hg; CBP <120/80 mm Hg); group 2 (115/75≤HBP<135/85 mm Hg; 120/80≤CBP<140/90 mm Hg); group 3 (135/85≤HBP<150/95 mm Hg; 140/90≤CBP<160/100 mm Hg); and group 4 (HBP≥150/95 mm Hg; CBP ≥160/100 mm Hg). Groups 2, 3, and 4 were further divided into 2 subgroups (a and b): those without and with cardiovascular disease risks, respectively. The risk of the first stroke in these groups was examined by the Cox hazards model adjusted for age and sex. Results— The stroke risk in groups 3b and 4b (defined by HBP and CBP) was 2 to 5× higher than that in group 1 with significant differences. The risk in groups 2a, 3a, and even 4a was not significantly different from that in group 1 by the CBP-based classification, but the risk in group 4a was significantly higher than that in group 1 by the HBP-based classification, which also showed a stepwise increase in risk from groups 2a to 4a. Conclusions— The JNC-7 classification had a stronger predictive power using HBP-based classification compared with CBP-based classification, suggesting the usefulness of HBP in the management of hypertension.