# Evening home pulse pressure predicted cardiovascular events and mortality in older adults with hypertension: findings based on the STEP trial

## TL;DR

Evening home pulse pressure better predicts cardiovascular events and death in older adults with high blood pressure compared to morning measurements.

## Contribution

This study identifies evening home pulse pressure as a novel predictor of cardiovascular risk in older hypertensive adults.

## Key findings

- Higher evening pulse pressure was associated with a 60% increased risk of cardiovascular events and mortality.
- Each 10 mmHg increase in evening pulse pressure raised event risk by 33%.
- Evening pulse pressure predicted outcomes better than morning systolic blood pressure or pulse pressure.

## Abstract

Hypertension is a key predictor of cardiovascular disease (CVD) and mortality. Home blood pressure monitoring (HBPM) is a cost-effective way to assess CVD risk, though existing research mainly focuses on morning systolic (SBP) and diastolic (DBP) blood pressure measurements. This study aimed to evaluate whether evening pulse pressure (PP) measured at home could better predict CVD risk and mortality in Chinese older adults with hypertension. Data from the STEP trial, a multicenter, randomized controlled trial, were analyzed. Morning and evening home BP was measured twice a day at least once a week from enrollment to 12 months of follow-up, based on which PP was calculated and categorized into tertiles. The primary outcome was a composite of cardiovascular events and all-cause mortality. Among 7703 participants included in this analysis, 284 composite events occurred during a median follow-up of 3.43 years. Compared to the first tertile evening PP group, the third tertile evening PP group exhibited a 60% (HR = 1.60; 95% CI: 1.12–2.29) higher risk of primary outcome in the final adjusted model. A 26% increased risk was observed with each tertile increment (HR = 1.26; 95% CI: 1.05–1.50, P
trend = 0.0112). For each 10 mmHg increase in evening PP, the risk of outcome events increased by approximately 33%. Higher evening home PP significantly predicts an increased risk of composite events (NRI: 0.16, 95% CI: 0.02–0.29), unlike morning SBP, PP, or evening SBP. Efforts to monitor evening home PP may be an effective strategy to improve BP control and prevent CVD and mortality. Trial Registration: STEP ClinicalTrials.gov number, NCT03015311.