Hypertension is a prevalent non-communicable disease and a significant cardiovascular risk factor in India, affecting 25% of adults. Among those treated, only 52.5% achieved controlled clinic blood pressure (CBP). We investigated blood pressure (BP) control in India using CBP and home BP (HBP). This multicenter, cross-sectional study across 18 centers in 12 states within 7 regions enrolled hypertensive participants aged 20–70 years receiving antihypertensive medications for ≥3 months who regularly visited their clinic. A background survey and four CBP readings were collected at baseline (“Clinic Visit 1”) and Clinic Visit 2. Participants underwent HBP monitoring for seven days. Based on average CBP across the two clinic visits and average HBP, participants were classified as having well-controlled hypertension (CBP < 140/90 mmHg and HBP < 135/85 mmHg), white-coat uncontrolled hypertension (WUCH; CBP ≥ 140/90 mmHg and HBP < 135/85 mmHg), masked uncontrolled hypertension (MUCH; CBP < 140/90 mmHg and HBP ≥ 135/85 mmHg), or sustained uncontrolled hypertension (SUCH; CBP ≥ 140/90 mmHg and HBP ≥ 135/85 mmHg). Among 1920 participants, 1578 with appropriate CBP and HBP readings were analyzed. Of these, 55.9% had well-controlled hypertension, 5.1% had WUCH, 21.8% had MUCH, and 17.2% had SUCH. The proportion classified as controlled was 77.7% using clinic BP alone versus 55.9% using both clinic and home BP, a difference of 21.8 percentage points. These findings highlight the importance of incorporating HBP alongside CBP for comprehensive assessment of BP control and identification of BP control phenotypes. Clinical trial registration: Registered at Clinical Trials Registry-India (CTRI) under CTRI/2023/02/049486 on 06 February 2023.
The extent to which renal denervation (RDN) improves sustained blood pressure (BP) control, medication burden, and time in therapeutic range (TTR) in real-world Asian populations remains incompletely defined. We analyzed data from a prospective, nationwide, multi-center registry enrolling consecutive hypertensive patients undergoing catheter-based RDN at seven hospitals in Taiwan. Office BP, medication burden, and TTR were assessed over 12 months. Among 142 patients (mean age 59.4 ± 14.7 years; 68.3% men), baseline BP was 155.2 ± 24.1/84.1 ± 14.2 mmHg with a mean medication burden of 2.28 ± 1.19. BP decreased significantly and was sustained throughout follow-up. At 12 months, BP decreased by 13.9 ± 25.2/6.3 ± 20.5 mmHg from baseline (p < 0.01), while medication burden decreased by 0.76 ± 1.26 (p < 0.01). For BP < 140/90 mmHg, TTR increased from 27.7% at baseline to 47.5% at 12 months (p < 0.01); for BP < 130/80 mmHg, TTR increased from 12.8% to 25.9% (p < 0.01). No major procedure-related complications were observed. In this nationwide real-world registry, RDN was associated with durable BP reduction, improved time in therapeutic range, and reduced medication burden over 12 months. These findings suggest that RDN may not only lower BP but also enhance sustained BP control while reducing antihypertensive medication burden in routine clinical practice.
We aimed to assess whether home blood pressure (BP) self-recorded through a personal health record (PHR) application in a real-world setting was associated with cardiovascular disease (CVD) events among individuals not receiving antihypertensive treatment. Using an insurer-based database that links annual health checkup records and home BP self-recorded in the “kencom” PHR application, 6654 participants (mean age: 51.8 ± 9.1 years, males: 68.0%) not receiving antihypertensive treatment were selected. Morning home BP was calculated as the average of morning values over the first 28 days. Office BP was derived from annual health checkup data. The primary outcome was total CVD identified from hospitalization claims. Cox models were used to assess hazard ratios (HRs). The average of home systolic/diastolic BP was 124.5 ± 13.7/80.9 ± 10.9 mmHg, and 80.6% entered their home BP manually. The correlation between home and office BP was r = 0.56 for systolic and r = 0.61 for diastolic BP. During a mean follow-up of 2.79 ± 1.76 years (18,592 person-years), 447 total CVD events occurred. The HRs for total CVD per 1-SD higher in BP were 1.31 for home systolic, 1.12 for office systolic, 1.32 for home diastolic, and 1.21 for office diastolic BP. Results were consistent for stroke and heart failure. When home and office BP were entered simultaneously into the same model, only home systolic/ diastolic BP was independently associated with total CVD risk. Morning home BP self-recorded by users in a PHR application under real-world conditions was more strongly associated with CVD than office BP, supporting the potential value of PHR-based home BP.
