Association between the morning–evening difference in home blood pressure and cardiac damage in untreated hypertensive patients

Matsui, Yoshio; Eguchi, Kazuo; Shibasaki, Seiichi; Shimizu, Motohiro; Ishikawa, Joji; Shimada, Kazuyuki; Kario, Kazuomi

doi:10.1097/hjh.0b013e3283260681

Cited by 40 publications

(34 citation statements)

References 45 publications

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“…3,7 In addition, BP instability, such as morning BP surge and morning-evening BP difference, were assessed by ambulatory and Home blood pressure variability and target organ protection S Hoshide et al HBP measurements, respectively. 18,19 All have been shown to give prognostic information, independentof that provided by average BP values. The intervention for these different components of BPV may reflect different mechanisms and have different clinical implications for cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

Is home blood pressure variability itself an interventional target beyond lowering mean home blood pressure during anti-hypertensive treatment?

et al. 2012

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It is unknown whether home blood pressure (BP) variability reduction is associated with target organ damage (TOD) protection independently of home mean BP reduction. We enrolled 310 hypertensive patients whose systolic BP (SBP) at home was over 135 mm Hg. The subjects measured their BP in the morning and evening for 7 days. In addition, we measured urinary albumin excretion (UAE) as a marker of TOD before and after 6 months of candesartan treatment ( þ thiazidediuretics). At baseline, UAE was associated with average home SBP (r ¼ 0.24, Po0.001), the s.d. of home SBP (r ¼ 0.15, P ¼ 0.011), and the maximum home SBP (r ¼ 0.27, Po0.001). During the intervention, significant reductions were found in average home SBP (146 ± 13 vs. 132 ± 12 mm Hg, Po0.001), s.d. of home SBP (12.9 ± 4.8 vs. 11.8 ± 4.4 mm Hg, Po0.001), and maximum home SBP (172.5±18.0 vs. 155.9±17.5 mm Hg, Po0.001). UAE levels were significantly reduced after 6months of therapy compared with baseline (18.9 vs. 12.1 mg g À1 Cre, Po0.001). In multiple regression analysis, the treatment-induced reduction in UAE was significantly associated with that of average home BP (P ¼ 0. Keywords: day-to-day blood pressure variability; home blood pressure; urinary albumin excretion INTRODUCTION Many studies have focused on the association between blood pressure (BP) variability (BPV) and target organ damage (TOD) or cardiovascular prognosis. 1-5 Studies based on ambulatory BP monitoring have provided evidence that BPV over 24 h was associated with the severity of organ damage and the rate of cardiovascular events. 6,7 Recently, in conventional office BP measurements, increased visit-tovisit variability, calculated as the s.d. of the mean of repeated recordings and maximum systolic BP (SBP) over a certain period, has been reported to indicate increased cardiovascular risk. 5 We have reported that not only office BPV but also day-to-day BPV evaluated by home BP (HBP) monitoring (HBPM) is associated with TOD (that is, cardiac hypertrophy and carotid artery remodeling) independently of average office or HBP levels. 8,9 Moreover, Kikuya et al. 4 reported that the increased day-to-day BPV, calculated as the s.d. of HBP, was associated with cardiovascular mortality in a community-dwelling population. However, it is not clear whether home BPV itself, beyond the mean HBP level, can contribute directly to the development of TOD. The treatment-induced change in TODs assessed by cardiovascular biomarkers, such as the level of urinary albumin excretion (UAE), is associated with prognosis; 10-12 therefore,

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Section: Discussionmentioning

confidence: 99%

Is home blood pressure variability itself an interventional target beyond lowering mean home blood pressure during anti-hypertensive treatment?

et al. 2012

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“…Nocturnal hypoxia is one of the determinants of increased ME-BP difference in BP, and an increase in ME-BP difference is associated with hypertensive heart disease, particularly concentric left ventricular hypertrophy and future stroke events in hypertensive patients independently of the average of morning and evening BPs. 21,22 NON-DIPPER/RISER IN NOCTURNAL BLOOD PRESSURE Non-dippers (reduced nocturnal BP fall) and risers (higher nocturnal BP than daytime BP) are at risk of hypertensive target organ damage and subsequent cardiovascular events. [23][24][25][26][27][28][29] The related conditions of non-dippers and risers are as follows: (1) reduced circulating volume (congestive heart failure, chronic kidney disease, etc), (2) autonomic nervous dysfunction (orthostatic hypotension, diabetes, etc) and (3) poor sleep quality (SAS, depression, etc) (Figure 2).…”

Section: Masked Hypertensionmentioning

confidence: 99%

Obstructive sleep apnea syndrome and hypertension: ambulatory blood pressure

2009

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Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for hypertension and cardiovascular disease. OSAS is the frequent underlying disease of secondary hypertension and resistant hypertension. OSAS increases both daytime and night-time ambulatory blood pressures through the activation of various neurohumoral factors including the sympathetic nervous system and the renin-angiotensin-aldosterone system. In particular, OSAS predominantly increases ambulatory BP during sleep compared with the awake period, with the result that OSAS is likely to be associated with the non-dipping pattern (diminished nocturnal BP fall) or riser pattern (higher sleep BP than awake BP) of nocturnal BP. An additional characteristic of ABP in OSAS is increased BP variability. The newly developed non-invasive hypoxia-trigger BP-monitoring system detected marked midnight BP surges (ranging from around 10 to 100 mm Hg) during sleep in OSAS patients. The exaggerated BP surge may trigger OSAS-related cardiovascular events occurring during sleep. Clinically, as nocturnal hypoxia is the determinant of morning minus evening BP difference (ME difference), OSAS should be strongly suspected when morning BP cannot be controlled o135/85 mm Hg with increased ME difference even by the specific antihypertensive medications targeting morning hypertension such as bedtime dosing of antihypertensive drugs. Understanding the characteristics of OSAS-related hypertension is essentially important to achieve perfect BP control over a 24-h period, including the sleep period, for more effective prevention of cardiovascular disease.

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“…The subjects in this study were recruited from the same population as those in our recent publication. 16 Hypertension was defined as an average office SBP of at least 140 mm Hg and/or diastolic BP (DBP) of at least 90 mm Hg or both at 2 different occasions (with at least a 2-week interval) during the run-in period (4 weeks). Subjects who had secondary hypertension, arrhythmia, a history of heart failure, a history of stroke or coronary artery disease, renal insufficiency (serum creatinine Ͼ2 mg/dL), mental disorders, severe noncardiovascular disease, or chronic inflammatory disease were excluded.…”

Section: Study Participantsmentioning

confidence: 99%

Maximum Value of Home Blood Pressure

et al. 2011

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Abstract-The maximum office systolic blood pressure (SBP) has been shown to be a strong predictor of cardiovascular events, independently of the mean SBP level. However, the clinical implications of maximum home SBP have never been reported. We investigated the association between the maximum home SBP and target organ damage (TOD). We assessed the left ventricular mass index (LVMI) and carotid intima-media thickness (IMT) using ultrasonography and the urinary albumin/creatinine ratio (UACR) as measures of TOD in 356 never-treated hypertensive subjects. Home BP was taken in triplicate in the morning and evening, respectively, for 14 consecutive days with a memory-equipped device. The maximum home SBP was defined as the maximum mean triplicate BP reading in the 14-day period for each individual and was significantly correlated with LVMI (rϭ0.51, PϽ0.001), carotid IMT (rϭ0.40, PϽ0.001), and UACR (rϭ0.29, PϽ0.001). The correlation coefficients with LVMI and carotid IMT were significantly larger for the maximum home SBP than the mean home SBP. In multivariate regression analyses, the maximum home SBP was independently associated with LVMI and carotid IMT, regardless of the mean home BP level. In the prediction of left ventricular hypertrophy and carotid atherosclerosis, the goodness-of-fit of the model was significantly improved when the maximum home SBP was added to the sum of the mean office and home BPs (Pϭ0.002 and PϽ0.001, respectively). These findings indicate that assessment of the maximum home SBP, in addition to the mean home SBP, might increase the predictive value of hypertensive TOD in the heart and artery. Key Words: maximum home systolic blood pressure Ⅲ mean home systolic blood pressure Ⅲ left ventricular mass index Ⅲ carotid intima-media thickness Ⅲ urinary albumin/creatinine ratio Ⅲ aging Ⅲ arterial stiffness I t has been believed that transient increases in blood pressure (BP) might be construed as noise and merely an obstacle to reliable estimation of usual BP (conceived as the true underlying average BP over a period of time). In this case, such increases would result in substantial underestimation of the strength of the real association between usual BP and cardiovascular risk, a so-called "regression dilution bias." 1 Rothwell et al 2 recently showed that the maximum systolic BP (SBP) reached in an office setting was a strong predictor of cardiovascular events, independently of the mean SBP over 12 to 36 months. Ko et al 3 also showed that the maximum SBP during the first 72 hours of acute ischemic stroke was strongly associated with the development of brain hemorrhagic transformation, independently of the mean SBP level. Thus, subjects with episodic high BP might be at a high cardiovascular risk.One drawback of the use of the maximum SBP in routine clinical management of hypertension is that obtaining it requires several office visits over a period of time. One possible way to solve this is to observe the maximum SBP derived from self-measurement at home, because this selfmeasurement makes it p...

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Association between the morning–evening difference in home blood pressure and cardiac damage in untreated hypertensive patients

Abstract: The MEdif is a significant determinant of LV hypertrophy, LV geometry, and diastolic function, and therefore, evaluation of the MEdif combined with the average of morning and evening SBP might be useful in the early stage assessment of hypertensive patients.

Cited by 40 publications

References 45 publications

Is home blood pressure variability itself an interventional target beyond lowering mean home blood pressure during anti-hypertensive treatment?

Is home blood pressure variability itself an interventional target beyond lowering mean home blood pressure during anti-hypertensive treatment?

Obstructive sleep apnea syndrome and hypertension: ambulatory blood pressure

Maximum Value of Home Blood Pressure

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