ORAL SESSIONS ORAL SESSION 2A BLOOD PRESSURE MEASUREMENT 1 2A.01 DECREASED MID PREGNANCY FALL IN HOME BLOOD PRESSURE IN RELATION TO INSULIN RESISTANCE: THE BOSHI STUDY M. Kawaguchi 1 , H. Metoki 1 , T Ohkubo 1 , Y Sato 1 , A Sasaki 1 , M Hoshikawa 1 , K Akutsu 1 , K Yagihashi 2 , T Hashimoto 1 , A Hara 1 , T Obara 1 , M Kikuya 1 , N Yaegashi 1 , K Okamura 3 , Y Matsubara 1 , S Mori 2 , M Suzuki 2 , Y Imai 1 . 1 Tohoku University, Sendai, Japan, 2 Suzuki Memorial Hospital, Iwanuma, Japan, 3 Tohoku Kosai Hospital, Sendai, Japan Objective: Relatively higher blood pressure (BP) levels in early pregnancy, absence of mid-pregnancy BP fall as well as individual components of the insulin resistance syndrome have been reported to be associated with greater risk of preeclampsia. Home BP is considered as theoretically ideal for monitoring changes in BP during pregnancy. The objective of this study was to evaluate association between trend in home BP level and insulin resistance during normotensive pregnancy. Methods: This study is a part of the BOSHI study, conducted in Suzuki Memorial Hospital, which is the only hospital specializing in obstetrics gynecology and in vitro fertilization the Sendai City area of Miyagi Pre- fecture, Japan. We enrolled 242 normotensive pregnant women (mean age, 31.0 years). They were asked to measure home BP every morning based on the Japanese society of hypertension guidelines for self-monitoring of BP at home. Plasma insulin concentration and HOMA-IR (Homeostasis model assessment insulin resistance) were used as insulin resistance indexes. The subjects were equally divided into quintile according to plasma insulin concentration and HOMA-IR, respectively (Q1-Q5). Home BP values among quintiles were compared by mixed liner model adjusting for pre- pregnancy BMI, age, and minimum outside temperature. Mid pregnancy fall in BP was obtained by subtracting BP values at 20th gestational week from that at 12th gestational week. Result: Mean  SD of plasma insulin concentration and HOMA-IR at 14  2 gestational weeks were 4.93.0 mU, 1.0  0.7, respectively. The women with higher plasma insulin concentration had significantly higher home systolic/ diastolic BP values during pregnancy (P ¼ 0.0001/0.0005). As increase in the plasma insulin concentration, the mid pregnancy fall in BP became smaller (Q1, 1.7/3.2mmHg; Q2, 2.9/3.2mmHg; Q3, 2.5/2.9mmHg; Q4, 1.1/ 0.5mmHg; Q5, 1.8/0.4mmHg; trend P ¼ 0.002/0.001). HOMA-IR showed a similar association. Conclusion: Women with higher plasma insulin concentration or higher HOMA-IR at first-trimester had significantly high home BP values during pregnancy and a decreased mid pregnancy fall in BP. In women with insulin resistance, BP management during pregnancy using home BP measurement might be important. 2A.02 HOME-MEASURED BLOOD PRESSURE IS A STRONGER PREDICTOR OF CARDIOVASCULAR RISK THAN OFFICE BLOOD PRESSURE: THE FINN-HOME STUDY T. Niiranen, M.R. Ha ¨nninen, J. Johansson, A. Reunanen, A. Jula. National Institute for Health and Welfare - Population Studies Unit, Turku, Finland Objective: Previous studies with some limitations have provided equivocal results for the prognostic significance of home-measured blood pressure (BP). We investigated whether home-measured BP is more strongly associ- ated with cardiovascular events and total mortality than is office BP. Design and Methods: A prospective nationwide study was initiated in 2000 – 2001 on 2081 randomly selected subjects aged 45 – 74 years. Home and office BP were determined at baseline along with other cardiovascular risk factors. The primary endpoint was incidence of a cardiovascular event (cardiovas- cular mortality, non-fatal myocardial infarction, non-fatal stroke, hospitaliz- ation for heart failure, percutaneous coronary intervention, and coronary artery bypass graft surgery). The secondary endpoint was total mortality. Results: After a mean follow-up of 6.8 years, 162 subjects had suffered a cardiovascular event and 118 subjects had died. In Cox proportional hazard models adjusted for other cardiovascular risk factors office BP (systolic/ diastolic hazard ratio [HR] per 10/5 mmHg increase in BP, 1.13/1.13; systolic/ diastolic 95% confidence interval [CI], 1.05–1.22/1.05–1.22) and home BP (HR, 1.23/1.18; 95% CI, 1.13–1.34/1.10–1.27) were predictive of cardiovas- cular events. However, when both BPs were simultaneously included in the models only home BP (HR, 1.22/1.15; 95% CI, 1.09 – 1.37/1.05 – 1.26), but not office BP (HR, 1.01/1.06; 95% CI, 0.92–1.12/0.97–1.16) was predictive of cardiovascular events. Systolic home BP was the sole predictor of total mortality (HR, 1.11; 95% CI, 1.01/1.23). Conclusions: Home-measured BP is prognostically superior to office BP. On the basis of the results from this and previous studies, it can be concluded that home BP measurement offers specific advantages over conventional office measurement. 2A.03 AMBULATORY ARTERIAL STIFFNESS INDEX PREDICTS CARDIOVASCULAR MORBIDITY AND MORTALITY IN TREATED HYPERTENSIVE PATIENTS – AN ANGLO- SCANDINAVIAN CARDIAC OUTCOME TRIAL SUB-STUDY E. Dolan 1 , M. Caulfield 2 , S. Thom 3 , G. McInnes 4 , D. Collier 2 , E. O’Brien 5 , A. Stanton 6 . 1 Connolly Hospital, Dublin, Ireland, 2 St. Barholomew ´s Hospital, Charterhouse Square, London, United Kingdom, 3 Imperial College School of Medicine, St. Mary´s QEQEM Wing, Paddington, London, United Kingdom, 4 Dept. of Medicine & Therapeutics, Western Infirmary, Glasgow, United Kingdom, 5 Con- way Institute, University College Dublin, Belfield, Dublin, Ireland, 6 RCSI Research Institute, Royal College of Surgeons in Ireland, Dublin, Ireland Background: Elevated systolic blood pressure (SBP) and/or a widened pulse pressure (PP), indicative of stiffened arterial walls, strongly predicts cardio- vascular events. We have previously described how a novel measure of arterial stiffness, ambulatory arterial stiffness index (AASI), can be calculated from ambulatory BP measurement (ABPM), by the regression of SBP on diastolic BP over 24 hours. We have also shown that AASI is an independent predictor of cardiovascular mortality in untreated hypertensive patients. The objective of this study was to test the hypothesis that AASI could also provide prognostic information in treated hypertensive patients. Methods: In addition to regular 6-monthly clinic blood pressure measure- ments (CBPM), 1,905 patients from four Anglo-Scandinavian Cardiac Out- come Trial (ASCOT) centers had repeated ABPM performed over a median follow-up period of 5.5 years. The primary end-point was a composite of all cardiovascular events (fatal and non-fatal, myocardial infarction and stroke) and procedures (angioplasty and bypass procedures) (n ¼ 173). Results: Using Cox proportional-hazards modelling, AASI predicted out- come in an unadjusted model with a hazard ratio (HR) of 1.31(1.17–1.46; p < 0.001) for a 0.1 increment. After adjustment for age, sex, smoking status, presence or absence of diabetes mellitus, serum cholesterol concentration, body-mass index, treatment group and clinic SBP, the corresponding HR was 1.24(1.10–1.41; p < 0.005). Substituting ambulatory SBP for clinic SBP gave a HR of 1.18(1.03–1.34; p < 0.05). There were similar results when stroke Abstracts e13 S A T U R D A Y O R A L S 0263-6352 ß 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins