Morning and Evening Home Blood Pressure and Risks of Incident Stroke and Coronary Artery Disease in the Japanese General Practice Population

Abstract

Our aim is to determine the optimal time schedule for home blood pressure (BP) monitoring that best predicts stroke and coronary artery disease in general practice. The Japan Morning Surge-Home Blood Pressure (J-HOP) study is a nationwide practice-based study that included 4310 Japanese with a history of or risk factors for cardiovascular disease, or both (mean age, 65 years; 79% used antihypertensive medication). Home BP measures were taken twice daily (morning and evening) over 14 days at baseline. During a mean follow-up of 4 years (16 929 person-years), 74 stroke and 77 coronary artery disease events occurred. Morning systolic BP (SBP) improved the discrimination of incident stroke ( C statistics, 0.802; 95% confidence interval, 0.692–0.911) beyond traditional risk factors including office SBP (0.756; 0.646–0.866), whereas the changes were smaller with evening SBP (0.764; 0.653–0.874). The addition of evening SBP to the model (including traditional risk factors plus morning SBP) significantly reduced the discrimination of incident stroke ( C statistics difference, −0.008; 95% confidence interval: −0.015 to −0.008; P =0.03). The category-free net reclassification improvement (0.3606; 95% confidence interval, 0.1317–0.5896), absolute integrated discrimination improvement (0.015; SE, 0.005), and relative integrated discrimination improvement (58.3%; all P <0.01) with the addition of morning SBP to the model (including traditional risk factors) were greater than those with evening SBP and with combined morning and evening SBP. Neither morning nor evening SBP improved coronary artery disease risk prediction. Morning home SBP itself should be evaluated to ensure best stroke prediction in clinical practice, at least in Japan. This should be confirmed in the different ethnic groups. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr/ . Unique identifier: UMIN000000894.

Differences in Dynamic Diurnal Blood Pressure Variability Between Japanese and American Treatment-Resistant Hypertensive Populations

“…8 Furthermore, morning SBP surge is directly related to 24-h SBP variability and future cardiovascular events. 9 Prior research found morning SBP surge to be associated with stroke events independently of nocturnal BP falls and 24-h SBP in hypertensive patients.…”

Expert panel consensus recommendations for home blood pressure monitoring in Asia: the Hope Asia Network

“…Among these, the Japan Morning Surge-Home Blood Pressure study aimed to determine the optimal time schedule for HBPM to best predict stroke and coronary artery disease in over 4000 Japanese people with a history of, or risk factors for, CVD [22]. During a mean follow-up of 4 years, morning SBP was shown to improve the discrimination of incident stroke beyond traditional risk factors including office SBP; as such, the authors concluded that morning home SBP itself should be evaluated to ensure best stroke prediction in clinical practice.…”

Could 130/80 mm Hg Be Adopted as the Diagnostic Threshold and Management Goal of Hypertension in Consideration of the Characteristics of Asian Populations?

“…4,5 Four Asian studies have demonstrated that morning home BP is a better prognostic predictor of cardiovascular events than clinic BP. These were the general population-based Ohasama Study, 32 the general practitioner-based J-HOP study (Japan Morning Surge-Home Blood Pressure), 33 a hypertensive outpatient trial on medication (HOMED-BP, Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure), 34 and the largest nationwide Japanese real-world observational study (HONEST). 7,35 Indeed, in the HONEST study, a morning home SBP of ≈125 mm Hg was associated with minimal risk for both stroke and coronary artery disease events.…”