supplemental digital content

(1)

SUPPLEMENTAL DIGITAL CONTENT

Home blood pressure predicts stroke incidence among older adults with impaired physical function: the Ohasama study

Keiko Murakami, Kei Asayama, Michihiro Satoh, Miki Hosaka, Ayako Matsuda, Ryusuke Inoue, Megumi Tsubota-Utsugi, Takahisa Murakami, Kyoko Nomura, Masahiro Kikuya, Hirohito Metoki, Yutaka Imai, Takayoshi Ohkubo

(2)

Supplementary Table 1. Seven groups according to the six-item physical function measure of the Medical Outcomes Study (MOS) Short-Form General Health Survey^23,24

Level Questionnaires

6 Able to perform vigorous activities

(e.g., lifting heavy objects, running, participating in strenuous sports) 5 Able to perform moderate activities

(e.g., moving a table, carrying groceries, bowling) 4 Able to walk uphill or climb a few flights of stairs 3 Able to bend, lift, or stoop

2 Able to walk one block

1 Able to perform self-care activities

(e.g., eating, dressing, bathing, using the toilet) 0 Unable to do anything unaided

The level of each participant was scored according to the highest physical task they answered as being not impaired at all.

(3)

Supplementary Table 2. Comparisons of baseline characteristics between participants and nonparticipants in the study on home BP measurements

Participants (n=501)

Nonparticipant s (n=1256)

P value^a

Age, mean (SD) 68.6 (6.0) 72.3 (8.0) <0.001

Women, n (%) 350 (69.9) 706 (56.2) <0.001

BMI, mean (SD) 23.1 (3.1) 23.4 (3.6) 0.21

Current smoker, n (%) 51 (10.2) 213 (17.0) <0.001

Current drinker, n (%) 126 (25.2) 401 (31.9) 0.005

Diabetes mellitus, n (%) 61 (12.2) 176 (14.0) 0.31

Hypercholesterolemia, n (%) 68 (13.6) 178 (14.2) 0.74

Heart disease, n (%) 32 (6.4) 167 (13.3) <0.001

Antihypertensive medication^b, n (%) 179 (35.7) 149 (36.1) 0.91 Office SBP^b, mean (SD) 133.0 (14.2) 133.5 (14.6) 0.66

Office DBP^b, mean (SD) 73.8 (8.8) 74.3 (9.3) 0.45

MOS score^c, mean (SD) 4.4 (1.6) 3.8 (2.1) <0.001

Impaired physical function^c, n (%) 152 (30.3) 507 (44.6) <0.001 BP, blood pressure; MOS, Medical Outcomes Study Short-form General Health Survey.

aP values for comparisons between participants and nonparticipants by Student’s t-test for continuous variables and the chi-square test for categorical variables.

bInformation on antihypertensive medication and office BP was available for 413 nonparticipants.

cMOS score was available for 1136 nonparticipants. Impaired physical function was defined as MOS score 0–4.

(4)

Supplementary Table 3. Hazard ratios for stroke incidence for 1-SD increase in SBP and DBP stratified by physical function, simultaneously adjusted for home BP and office BP

Hazard ratio (95% confidence interval) SBP

Normal physical function^a (n=349)

Home BP 1.81 (1.14–2.87)

Office BP 0.97 (0.64–1.46)

Impaired physical function^a (n=152)

Home BP 1.69 (0.97–2.94)

Office BP 1.10 (0.70–1.73)

DBP

Normal physical function^a (n=349)

Home BP 1.37 (1.04–1.80)

Office BP 1.16 (0.74–1.82)

Impaired physical function^a (n=152)

Home BP 1.32 (0.94–1.85)

Office BP 1.20 (0.78–1.84)

BP, blood pressure; MOS, Medical Outcomes Study Short-Form General Health Survey.

BP per 1-SD increase corresponded to 14.4 mmHg for home SBP, 14.2 mmHg for office SBP, 8.5 mmHg for home DBP, and 8.8 mmHg for office DBP measurements. Hazard ratios were adjusted for age, sex, BMI, smoking status, alcohol intake, diabetes mellitus, hypercholesterolemia, heart disease, and antihypertensive medication. Person-years in the follow-up period were counted from the more recent date of BP measurements.

aMOS score was dichotomized into normal (score, 5–6) and impaired (score, 0–4) physical function.

(5)

Supplementary Table 4. Hazard ratios for stroke incidence and all-cause mortality for 1-SD increase in home evening BP stratified by physical function (n=499)

Hazard ratio (95% confidence interval) P for interaction Stroke incidence

Home SBP in the evening 0.68

Normal physical function^a 1.68 (1.11–2.54)

Impaired physical function^a 1.74 (1.06–2.84)

Home DBP in the evening 0.68

All-cause mortality

Home SBP in the evening 0.36

Home DBP in the evening 0.36

The mean (SD) of home SBP in the evening were 120.4 (13.8) among those with normal physical function and 122.3 (13.0) among those with impaired physical function, respectively. The mean (SD) of home DBP in the evening were 72.6 (8.4) among those with normal physical function and 72.5 (8.6) among those with impaired physical function, respectively.

BP per 1-SD increase corresponds to 13.5 mmHg for home SBP and 8.4 mmHg for home DBP measurements. Hazard ratios were adjusted for age, sex, BMI, smoking status, alcohol intake, diabetes mellitus, hypercholesterolemia, heart disease, and antihypertensive medication. P denotes the significance of the interaction between physical function and each BP.

aMOS score was dichotomized into normal (score, 5–6) and impaired (score, 0–4) physical function.

(6)

Supplementary Table 5. Hazard ratios for stroke incidence for 1-SD increase in SBP and DBP among those with impaired physical function using different cutoff points of the MOS score

Hazard ratio (95% confidence interval) MOS score ≤3 (n=109)

Home SBP 2.07 (1.08–3.97)

Office SBP 1.11 (0.64–1.93)

Home DBP 1.54 (1.05–2.26)

Office DBP 1.39 (0.77–2.50)

MOS score ≤2 (n=85)

Home SBP 2.14 (1.05–4.36)

Office SBP 1.12 (0.64–1.96)

Home DBP 1.57 (1.03–2.40)

Office DBP 1.41 (0.78–2.54)

BP per 1-SD increase corresponded to 14.4 mmHg for home SBP, 14.2 mmHg for office SBP, 8.5 mmHg for home DBP, and 8.8 mmHg for office DBP measurements. Hazard ratios were adjusted for age, sex, BMI, smoking status, alcohol intake, diabetes mellitus, hypercholesterolemia, heart disease, and antihypertensive medication.