Morning Home Blood Pressure Is a Strong Predictor of Coronary Artery Disease: The HONEST Study.

Abstract Background Few studies have evaluated out-of-office blood pressure (BP) measurements as predictors of coronary artery disease (CAD) events. Objectives The aim of this study was to determine morning home blood pressure (HBP) as a predictor of CAD events. Methods Using data from the HONEST (Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure) study, we investigated the relationship between morning HBP and incidence of stroke and CAD events. Results In 21,591 treated hypertensive patients (mean age 64.9 years; mean follow-up 2.02 years), 127 stroke events (2.92 per 1,000 patient-years), and 121 CAD events (2.78 per 1,000 patient-years) occurred. The incidence of stroke events was significantly higher in patients with morning home systolic blood pressure (HSBP) ≥145 mm Hg compared with  Conclusions Morning HBP is a strong predictor of future CAD and stroke events, and may be superior to clinic BP in this regard. There does not appear to be a J-curve in the relationship between morning HBP and stroke or CAD events. (Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure Study [HONEST]; UMIN000002567 )