Association Between Ambulatory Blood Pressure and Risk of Home Hypertension in a Normotensive Population: The Ohasama Study

Shingo Nakayama, Michihiro Satoh, Hirohito Metoki, Takahisa Murakami, Yukako Tatsumi, Kei Asayama, Azusa Hara, Takuo Hirose, Megumi Tsubota-Utsugi, Masahiro Kikuya, Takefumi Mori, Atsushi Hozawa, Yutaka Imai, Takayoshi Ohkubo

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: We investigated the association between ambulatory blood pressure (BP) and the risk of home hypertension in a normotensive population and whether considering ambulatory BP improves the 10-year prediction model for home hypertension risk, which was developed in the previous Ohasama Study. Methods: In this prospective study, we followed up with 410 participants (83.2% women; age, 53.6 years) without a home and ambulatory hypertension in the general population of Ohasama, Japan. The Cox model was used to assess the hazard ratios (HRs) for home hypertension (home BP=≥=135/≥85 mmHg or the initiation of antihypertensive treatment) and model improvement. Results: During a mean 14.2-year follow-up, 225 home hypertension incidences occurred. The HR (95% confidence interval) for home hypertension incidence per 1-SD higher (=6.76 mmHg) 24-hour systolic BP (SBP) was 1.59 (1.33 to 1.90), after adjustments for possible confounding factors, including baseline home SBP. Harrell's C-statistics increased from 0.72 to 0.73 (P===0.11) when 24-hour SBP was added to the basic 10-year home hypertension prediction model, which includes sex, age, body mass index, smoking status, office SBP, and baseline home SBP. Continuous net reclassification improvement (0.53, P=<=0.0001) and integrated discrimination improvement (0.028, P===0.0014) revealed improvement in the model. Conclusions: A total of 24-hour SBP could be an independent predictor of future home hypertension. Home BP and 24-hour BP can longitudinally influence each other in the long term.

Original languageEnglish
Pages (from-to)151-158
Number of pages8
JournalAmerican Journal of Hypertension
Issue number3
Publication statusPublished - 2023 Mar 1


  • ambulatory blood pressure
  • blood pressure
  • cohort studies
  • epidemiology
  • home hypertension
  • hypertension


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