Ambulatory and home blood pressure monitoring for cardiovascular disease risk evaluation: a systematic review and meta-analysis of prospective cohort studies

Abstract

Objective: The aim of this work was to systematically review the level of evidence based on prospective cohort studies investigating the role of 24-h ambulatory blood pressure measurement (ABPM) and home blood pressure measurement (HBPM) on cardiovascular disease (CVD) risk prediction. Methods: Eight studies were included in the meta-analysis. The Der Simonian and Laird's random-effects model with standard error adjustment using the Knapp-Hartung method was used. Results: SBP from ABPM and HBPM was significantly and positively associated with CVD risk [combined hazard ratio per 1-SD SBP, 95% confidence interval (95% CI): 1.32, 1.19–1.45, I 2 = 35.8%, and 1.30, 95% CI: 1.11–1.49, I 2 = 79.1%, respectively], after adjusting for office BP levels and other potential confounders. DBP from both ABPM and HBPM was positively associated with CVD risk (combined hazard ratio per 1-SD DBP, 95% CI: 1.15, 1.01–1.29, I 2 = 73.1% and 1.21, 1.05–1.37, I 2 = 84.5%, respectively). Conclusion: BP either from ABPM or HBPM could predict CVD risk. As so, at least one of out-of-office BP measurements have to be taken into account during the evaluation of the hypertensive population.