Control of Blood Pressure as Measured at Home and Office, and Comparison with Physicians' Assessment of Control among Treated Hypertensive Patients in Japan: First Report of the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) Study

Ohkubo, Takayoshi; Obara, Taku; Funahashi, Jin; Kikuya, Masahiro; Asayama, Kei; Metoki, Hirohito; Oikawa, Takuya; Takahashi, Hisaki; Hashimoto, Junichiro; Totsune, Kazuhito; Imai, Yutaka

doi:10.1291/hypres.27.755

Cited by 108 publications

(83 citation statements)

References 35 publications

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“…33 In the Japan Home Versus Office Blood Pressure Measurement Evaluation study, HBP values were not properly controlled in 75 and 24% of the patients, even when their physicians evaluated them as having 'fairly good control' and 'excellent control' , respectively. 34 Because, in line with the small difference in the HBP, the risks of primary and secondary outcomes were similar in the randomized groups, we pooled all patients in an attempt to refine estimates of the HBP at which cardiovascular risk is minimal. As in previous analyses, 24 we were careful in defining the on-treatment blood pressure excluding blood pressure levels within 6 months before an event.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure

et al. 2012

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Hypertension guidelines recommend blood pressure self-measurement at home (HBP), but no previous trial has assessed cardiovascular outcomes in hypertensive patients treated according to HBP. The multicenter Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP;-2010 trial involved 3518 patients (50% women; mean age 59.6 years) with an untreated systolic/diastolic HBP of 135-179/85-119 mm Hg. In a 2 Â 3 design, patients were randomized to usual control (125-134/80-84 mm Hg (UC)) vs. tight control (o125/o80 mm Hg (TC)) of HBP and to initiation of drug treatment with angiotensin converting enzyme inhibitors, angiotensin receptor blockers or calcium channel blockers. During follow-up, a computer algorithm automatically generated treatment recommendations based on HBP. At the last follow-up (median 5.3 years), TC patients used more antihypertensive drugs than UC patients (1.82 vs. 1.74 defined daily doses, P ¼ 0.045) and had a greater HBP reduction (21.3/13.1 mm Hg vs. 22.7/13.9 mm Hg, P ¼ 0.018/0.020), but they less frequently achieved the lower HBP targets (37.4 vs. 63.5%, Po0.0001). The primary end point, cardiovascular death plus stroke and myocardial infarction, occurred in 25 UC and 26 TC patients (hazard ratio, 1.02; 95% confidence interval, 0.59-1.77; P ¼ 0.94). Rates were similar (PX0.13) in the three drug groups. In all patients combined, the risk of the primary end point independently increased by 41% (6-89%; P ¼ 0.019) and 47% (15-87%; P ¼ 0.0020) for a 1-s.d. increase in baseline (12.5 mm Hg) and follow-up (13.2 mm Hg) systolic HBP. The 5-year risk was minimal (p1%) if on-treatment systolic HBP was 131.6 mm Hg or less. HOMED-BP proved the feasibility of adjusting antihypertensive drug treatment based on HBP and suggests that a systolic HBP level of 130 mm Hg should be an achievable and safe target.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure

et al. 2012

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“…In addition, many clinical reports indicate a close association between BP in the early morning and the occurrence of cardiovascular events such as myocardial infarction, cerebral apoplexy or sudden death (6)(7)(8). Recent investigations on the adequacy of BP control using HBP and office/clinic BP (OBP) performed in Japan clearly demonstrate that current antihypertensive therapy is inadequate to achieve the target goals (9,10).…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, cardiovascular complications originating from diabetes such as retinopathy, microangiopathy, macroangiopathy and nephropathy, are normally BP dependent and frequently progress into terminal stage renal failure. Despite effort such as dietary protein and salt restriction and the use of reninangiotensin system (RAS) inhibitors, treatment of renal diseases to retard the progression into a more advanced stage has not been successful (9)(10)(11). These unsuccessful interventions account for the growing number of patients with terminal renal failure who require dialysis.…”

Section: Introductionmentioning

confidence: 99%

Morning Blood Pressure Predicts Hypertensive Organ Damage in Patients with Renal Diseases: Effect of Intensive Antihypertensive Therapy in Patients with Diabetic Nephropathy

et al. 2005

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Blood pressure (BP) measured at home early in the morning (HBP) has been recognized as a useful predictor for organ damage and has been viewed as an important therapeutic target in patients with hypertension. The present study was aimed to determine whether this notion holds true in patients with progressive renal disease.The study enrolled patients with mild to moderate renal impairment. They were all directed to record selfmeasured HBP to evaluate the adequacy of BP control. In addition to the conventional antihypertensive therapy, intensive treatment to more efficiently reduce elevated morning HBP was applied, especially in patients with diabetic nephropathy. The results were as follows:1) The status of BP control assessed using HBP and office/clinic BP (OBP) shows predominance of morning hypertension. The prevalence of patients with well-controlled systolic HBP was 38%, those with poorly-controlled HBP 30%, masked hypertension 20% and white coat hypertension 12%. 2) Early morning systolic HBP in diabetics was significantly higher than that in non-diabetics. However, when evaluated on systolic OBP, both groups were comparable. 3) Logistic regression analysis showed that the predictive variables to explain morning hypertension (more than 130 mmHg and increased systolic HBP) were age, amount of daily urinary protein excretion and left ventricular mass index (LVMI). 4) Following conventional therapy, intensive antihypertensive therapy consisting of calcium channel blockers (CCB) and/or diuretics given in the morning, and angiotensin receptor blockers (ARB) given in the evening, together with 1-blockers given at bedtime, efficaciously reduced elevated HBP in the morning. This result was associated with significant reduction in daily urinary protein excretion and in serum plasminogen-activator inhibitor (PAI-1) concentration. The present study indicates that, regardless of ongoing conventional antihypertensive therapy, the majority of patients with renal disease had morning hypertension, suggesting that these patients are at a higher risk for cardiovascular disease. For the purpose of improving morning hypertension, intensive treatments with combined CCB, ARB and 1-blockers could have substantial benefit on the morbidity and prognosis in patients with diabetic nephropathy. (Internal Medicine 44: 1239-1246, 2005)

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“…Details of the methods used in this study have been described previously (11,12). Briefly, in March 2003, 7,354 physicians randomly selected from all over Japan were invited to take part in this project.…”

Section: Methods Patientsmentioning

confidence: 99%

Current Usage of Diuretics among Hypertensive Patients in Japan: The Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) Study

et al. 2006

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In the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) study, we examined the current situation with respect to the prescription of diuretics, including the prevalence of diuretic treatment and the dosages used for patients with essential hypertension in primary care settings. Of the 3,400 hypertensive patients included in the study, 315 (9.3%) patients (mean age: 66.9 ± 10.4 years; males: 43.5%) were prescribed diuretics. Compared with patients who were not using diuretics, those who were using diuretics were more obese and had more complications. The most commonly prescribed diuretic among the 331 prescriptions in the 315 diuretic users was trichlormethiazide (44%), followed by indapamide (15%) and spironolactone (14%). Among patients being treated with diuretics, monotherapy was used in only 5% of patients; in the majority of patients combination therapy including diuretics (95%) was used. Relatively low dosages of diuretics were generally used. There was a difference between the actual dosages prescribed and those recommended by the Japanese Society of Hypertension (JSH) guidelines or the product information approved in Japan. Compared with previous estimates of the prevalence of diuretic use in hypertensives in Japan (4.0-5.4%), the rate in the J-HOME study (9.3%) was higher. This may be attributable at least in part

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Control of Blood Pressure as Measured at Home and Office, and Comparison with Physicians' Assessment of Control among Treated Hypertensive Patients in Japan: First Report of the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) Study

Abstract: The Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME

Cited by 108 publications

References 35 publications

Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure

Cardiovascular outcomes in the first trial of antihypertensive therapy guided by self-measured home blood pressure

Morning Blood Pressure Predicts Hypertensive Organ Damage in Patients with Renal Diseases: Effect of Intensive Antihypertensive Therapy in Patients with Diabetic Nephropathy

Current Usage of Diuretics among Hypertensive Patients in Japan: The Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) Study

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