A new proposal for the target value for home BP in type 2 diabetes patients: The J-HOP study

OBJECTIVE The target levels of home-monitored blood pressure (BP) in patients with type 2 diabetes mellitus (T2DM) have not yet been established. We sought to examine the appropriate target home BP level in T2DM. METHODS This is a subanalysis of the Japan Morning Surge-Home Blood Pressure (J-HOP) study. We enrolled 4,310 patients who had at least 1 cardiovascular risk factor, and clinic and home BP monitoring was performed. The urinary albumin-to-creatinine ratio (UACR) was measured as a marker of microvascular disease. Quadratic equations of the relationship between clinic/home systolic BP (SBP) and log-transformed UACR were used to determine the home BP value. Home BP levels corresponding to clinic SBP/diastolic BP (DBP) level using the UACR values were calculated separately by the presence/absence of diabetes. RESULTS The mean age of the patients was 64.9±10.9 years; 47.0% were males. Of the 4,310 subjects enrolled, 1,057 (24.5%) had T2DM (the DM group) and 3,253 (75.5%) did not (non-DM group). The home BP levels equivalent to clinic BP 140/90mm Hg were 135/84 and 135/83mm Hg in the DM and non-DM groups, respectively. The home SBP levels equivalent to clinic SBP 130/80mm Hg were 122/79mm Hg in the non-DM group and 129/78mm Hg in the DM group. CONCLUSIONS Regardless of diabetic status, the home BP level that corresponds to the clinic SBP 140/90mm Hg was 135/85mm Hg. In patients with T2DM, the home SBP level equivalent to clinic SBP 130/80mm Hg was 129/78mm Hg with regard to the extent of microvascular disease.