Association of Cardiovascular Outcomes With Masked Hypertension Defined by Home Blood Pressure Monitoring in a Japanese General Practice Population

Tomitani

Buranakitjaroen

et al. 2018

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A self‐measured home blood pressure (BP)‐guided strategy is an effective practical approach to hypertension management. The Asia BP@Home study is the first designed to investigate current home BP control status in different Asian countries/regions using standardized home BP measurements taken with the same validated home BP monitoring device with data memory. We enrolled 1443 medicated hypertensive patients from 15 Asian specialist centers in 11 countries/regions between April 2017 and March 2018. BP was relatively well controlled in 68.2% of patients using a morning home systolic BP (SBP) cutoff of <135 mm Hg, and in 55.1% of patients using a clinic SBP cutoff of <140 mm Hg. When cutoff values were changed to the 2017 AHA/ACC threshold (SBP <130 mm Hg), 53.6% of patients were well controlled for morning home SBP. Using clinic 140 mm Hg and morning home 135 mm Hg SBP thresholds, the proportion of patients with well‐controlled hypertension (46%) was higher than for uncontrolled sustained (22%), white‐coat (23%), and masked uncontrolled (9%) hypertension, with significant country/regional differences. Home BP variability in Asian countries was high, and varied by country/region. In conclusion, the Asia BP@Home study demonstrated that home BP is relatively well controlled at hypertension specialist centers in Asia. However, almost half of patients remain uncontrolled for morning BP according to new guidelines, with significant country/regional differences. Strict home BP control should be beneficial in Asian populations. The findings of this study are important to facilitate development of health policies focused on reducing cardiovascular complications in Asia.

Section: Discussionmentioning

confidence: 80%

Home blood pressure control status in 2017‐2018 for hypertension specialist centers in Asia: Results of the Asia BP@Home study

Tomitani

Buranakitjaroen

et al. 2018

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“…The increased stroke risk associated with masked hypertension was seen when the phenomenon was detected using ABPM and HBPM, ABPM only or HBPM only . Increased stroke risk in patients with masked hypertension was also documented in the J‐HOP study …”

Section: Masked Hypertension In Asiamentioning

confidence: 70%

“…Currently available evidence suggests that the cardiovascular risk associated with white‐coat hypertension in the absence of other coexisting risk factors is negligible . In the Japan Morning Surge‐Home Blood Pressure (J‐HOP) study, white‐coat hypertension detected using home blood pressure monitoring (HBPM) was not significantly associated with stroke risk over a median follow‐up duration of 3.9 years . Conversely, data from a population‐based study (also conducted in Japan) documented a significant independent association between white‐coat hypertension diagnosed based on elevated office BP and normal home or ambulatory BP and increased stroke risk .…”

Section: White‐coat Hypertension In Asiamentioning

confidence: 99%

Diversity of and initiatives for hypertension management in Asia—Why we need the HOPE Asia Network

Chia

Sukonthasarn

et al. 2019

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The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was set up to improve the management of hypertension in Asia with the ultimate goal of achieving "zero" cardiovascular events. Asia is a diverse continent, and the prevalence of hypertension has increased over the last 30 years. There are a number of Asia-specific features of hypertension and hypertension-related cardiovascular complications, which means that a region-specific approach is needed. White-coat hypertension will become more of an issue over time as Asian populations age, and masked hypertension is more prevalent in Asian than in Western countries.Medical writing assistance was provided by Nicola Ryan, independent medical writer. Editorial assistance was provided by Ayako

“…A recent study also demonstrated that morning home BP was more reproducible and better correlated with vascular indices than ambulatory BP . To date, there have been five general practitioner‐based home BP cohort studies (Table ), including the HOMED‐BP (Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure) study, the J‐HOP (Japan Morning Surge‐Home Blood Pressure) study, and the HONEST (Home Blood Pressure Measurement With Olmesartan Naive Patients to Establish Standard Target Blood Pressure) study . All of these showed that morning home BP was a better predictor of cardiovascular events than office BP.…”

Section: Hope Asia Networkmentioning

confidence: 99%

The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020

2020

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The impact of hypertension-related cardiovascular disease and target organ damage, and therefore the benefits of blood pressure (BP) control, is greater in Asian than in Western countries. Asia-specific features of hypertension and its effective management are important and active areas of research. The Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network was formed in 2016and is now a member of the World Hypertension League. The main goal of the HOPE Asia Network is to improve the management of hypertension and organ protection toward achieving "zero" cardiovascular events in Asia. Considerable work has already been done on the journey to achieving this goal. We have shown that BP control status in Asia differs between countries, and even between regions within the same country. Several expert panel consensus recommendations and clinical guidance papers are available to support the use of home and ambulatory BP monitoring in the region. In addition, the AsiaBP@Home study prospectively investigated home BP control status across 15 specialist centers using the same validated device and measurement schedule. We have also proposed the concept of systemic hemodynamic atherothrombotic syndrome (SHATS), a vicious cycle of BP variability and vascular disease on cardiovascular events and organ damage, and suggested a SHATS score for risk stratification for clinical practice. This special issue of the journal collates Asia-specific resources and data, contributing to advances in hypertension management and cardiovascular disease prevention in the region.