Impact of office and home blood pressure control on cardiovascular events in relation to KDIGO risk categories: findings from the J-HOP study.

Chronic kidney disease (CKD) is a major risk factor for cardiovascular events, and controlling blood pressure (BP) is essential for reducing this risk in CKD patients. Although office BP is the standard for BP control in CKD, home BP monitoring more precisely predicts cardiovascular outcomes, especially across Kidney Disease: Improving Global Outcomes (KDIGO) risk categories. This study evaluated the differential impact of office and home BP control on cardiovascular event rates across KDIGO risk levels. Data from 4264 participants in the Japan Morning Surge-Home Blood Pressure study were analyzed. Participants were stratified by KDIGO risk and classified by BP control using office (<140/90 mmHg) and home (<135/85 mmHg) thresholds. The primary outcome was a composite of cardiovascular events, including myocardial infarction, stroke, heart failure hospitalization, and cardiovascular death. Cox proportional hazards models evaluated associations between BP control and cardiovascular risk within KDIGO strata. Over a median 6.2-year follow-up, 262 cardiovascular events occurred. In the high/very high KDIGO group, controlled home BP was associated with a lower event rate (10.3 vs. 31.8 per 1000 person-years; HR = 0.38, 95% CI 0.20-0.70; P < 0.001). The interaction between home BP and KDIGO risk was significant (P = 0.024). Office BP control showed no significant association with cardiovascular outcomes. Subgroup analysis revealed that morning and evening home BP control predicted reduced cardiovascular risk in high-risk individuals. Home BP control, not office BP control, was associated with reduced cardiovascular risk, especially in individuals with high KDIGO risk. These findings support integrating home BP monitoring into CKD-related hypertension care.