Home blood pressure level and decline in renal function among treated hypertensive patients: the J-HOME-Morning Study

We examined the association between home and office blood pressure (BP) levels and further decline in renal function among treated hypertensive patients with and without renal dysfunction. We calculated annual decline in estimated glomerular filtration rate (Delta eGFR) in 1535 treated hypertensive patients with home and office BP measurements. We defined Delta eGFR <0 as decline in renal function, and Delta eGFR >= 0 as non-decline in renal function based on 1.5 years of follow-up. For 520 patients with low eGFR at baseline, morning home, evening home and office systolic BP (SBP) levels and morning home diastolic BP (DBP) levels were positively associated with the risk of decline in renal function (trend P=0.003, 0.002, 0.003 and 0.004). Compared to patients with home SBP <125mmHg, the risk of decline in renal function was higher in those with home SBPs >= 135mmHg and between 130-135mmHg, while the risk was similar in those with home SBP of 125-130mmHg. For 1015 patients with normal eGFR at baseline, only morning home SBP level was positively associated with the risk of decline in renal function (trend P=0.004). Morning home BP might be useful for risk evaluation of decline in renal function even among treated hypertensive patients with normal renal function. Target levels of home BP control among treated hypertensive patients need to be further investigated.