Diagnostic Thresholds for Blood Pressure Measured at Home in the Context of the 2017 Hypertension Guideline: Analysis From 2 US Cohorts

Most guidelines have recommended lower home blood pressure (BP) threshold when clinic BP threshold of 140/90 mmHg is used for diagnosis of hypertension. However, home BP thresholds to define hypertension have never been determined in the general population in the United States. We identified home BP thresholds for stage 1 (BP 130/80 mmHg) hypertension using a regression-based approach in the DHS (Dallas Heart Study; n=5768) and the NCMH study (North Carolina Masked Hypertension; n=420). Home BP thresholds were also assessed using outcome-derived approach based on the composite of all-cause mortality or cardiovascular events in the DHS cohort. For this approach, BP thresholds were identified only for systolic BP because diastolic BP was not associated with the outcome. Among untreated participants, the regression-derived thresholds for home BP corresponding to clinic BP for stage 1 hypertension were 129/80 mmHg in blacks, 130/80 mmHg in whites, and 126/78 mmHg in Hispanics, respectively. The results are similar in the North Carolina cohort. The 11-year composite cardiovascular and mortality events corresponding to clinic systolic BP >130 mmHg were higher in blacks than in whites and Hispanics (13.3% versus 5.98% versus 5.52%, respectively). Using a race/ethnicity-specific composite outcome in the untreated DHS participants, the outcome-derived home systolic BP thresholds corresponding to stage 1 hypertension were 130 mmHg in blacks, 129 mmHg in whites, and 131 mmHg in Hispanics, respectively. Our data based on both regression-derived and outcome approach support home BP threshold of 130/80 mmHg for diagnosis of hypertension in blacks, whites, and Hispanics.