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The aim of this study was to assess whether carotid intima–media thickness (IMT) is more strongly associated with home-measured blood pressure (BP) than clinic BP. Other risk factors associated with carotid atherosclerosis were also investigated.We studied a representative unselected sample of the Finnish adult population (758 subjects aged 45–74 years). Subjects included in the study underwent a clinical interview, carotid ultrasonography, and measurement of clinic BP (mean of two measurements using a mercury sphygmomanometer) and home BP (mean of 14 duplicate measurements during 1 week using a validated, automatic device). Fasting blood samples for serum lipids and glucose were drawn.The Pearson correlation coefficients for carotid IMT and home/clinic BP differed significantly in favour of home measurement for systolic BP (0.34 versus 0.25, P < 0.001), diastolic BP (0.20 versus 0.07, P < 0.001) and pulse pressure (0.37 versus 0.27, P < 0.001). In a linear regression model (R2 = 0.32, P < 0.001), age (P < 0.001), home systolic BP (P = 0.002), serum triglycerides (P = 0.006), male sex (P = 0.009), smoking (P = 0.017), diabetes (P = 0.035), and low-density lipoprotein cholesterol (P = 0.041) were independently associated with increased IMT. The association between home BP and carotid IMT did not increase with the number of home measurements.BP is one of the most important factors in the pathogenesis of atherosclerosis. Home-measured BP is more strongly associated with carotid atherosclerosis than clinic BP, even for a low number of measurements. These data support the application of home BP measurement in clinical practice.