Sleep Blood Pressure Self‐Measured at Home as a Novel Determinant of Organ Damage: Japan Morning Surge Home Blood Pressure (J‐HOP) Study

Abstract

To study whether sleep blood pressure (BP) self‐measured at home is associated with organ damage, the authors analyzed the data of 2562 participants in the J‐HOP study who self‐measured sleep BP using a home BP monitoring (HBPM) device, three times during sleep (2 am, 3 am, 4 am), as well as the home morning and evening BPs. The mean sleep home systolic BPs (SBPs) were all correlated with urinary albumin/creatinine ratio (UACR), left ventricular mass index (LVMI), brachial‐ankle pulse wave velocity (baPWV), maximum carotid intima‐media thickness, and plasma N‐terminal pro‐hormone pro–brain‐type natriuretic peptide (NTproBNP) (all P<.001). After controlling for clinic SBP and home morning and evening SBPs, associations of home sleep SBP with UACR, LVMI, and baPWV remained significant (all P<.008). Even in patients with home morning BP <135/85 mm Hg, 27% exhibited masked nocturnal hypertension with home sleep SBP ≥120 mm Hg and had higher UACR and NTproBNP. Masked nocturnal hypertension, which is associated with advanced organ damage, remains unrecognized by conventional HBPM.

Comparative Effects of an Angiotensin II Receptor Blocker (ARB)/Diuretic vs. ARB/Calcium-Channel Blocker Combination on Uncontrolled Nocturnal Hypertension Evaluated by Information and Communication Technology-Based Nocturnal Home Blood Pressure Monitoring ― The NOCTURNE Study ―

“…However, we recently developed a nocturnal home BP monitoring (HBPM) device and demonstrated that nocturnal home BP measured with this device was comparable to nocturnal ABP, 7,8 and was significantly correlated with various measures of organ damage, such as the urinary albumin/creatinine ratio (UACR), N-terminal pro-B-type natriuretic peptide level (NT-proBNP), carotid intimamedia thickness, and left ventricular hypertrophy (LVH) diagnosed by echocardiography. 15, 16 We have also demonstrated using this device that the change in nocturnal HBP by antihypertensive drug treatment significantly correlated with the reduction in LVH. 17 However, there has not been a randomized controlled trial (RCT) using nocturnal HBPM to compare the nocturnal home BP-lowering effects of different antihypertensive drugs on nocturnal HT.…”

“…In our previous clinical practice-based registry, the JHOP (Japan Morning Surge-Home Blood Pressure) study, we used nocturnal HBPM (Medinote), which has the capacity to store data but lacks an ICT transmission system, and found that nocturnal home BP significantly correlated with measures of organ damage. 15, 16 In the NOCTURNE study, we assessed for the first time whether an ICT-based nocturnal HBPM 7,8 device could be successfully used by hypertensive patients who had no prior experience with the device. During the run-in period, 552 (89.6%) of the 616 registered patients measured their nocturnal home BP with 3G-enabled HBPM.…”

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

“…Nocturnal hypertension detected via HBPM has been less well investigated, but studies have shown that it is associated with hypertensive organ damage [40,41]. In the near future, basic home night-time BP monitoring devices should become more widely available.…”

White-coat hypertension and masked hypertension: an update

“…77 Home BP measurement could be useful in the diagnosis and in the prognostic stratification, also for the nocturnal period, 78 but ABPM seems to be the best method to make an accurate diagnosis. 79,80 In addition, the Ohasama study demonstrated, in a cohort of 843 subjects of the general population who performed ABPM, that the nocturnal BP values were the best predictor of future chronic kidney disease. 81 In the Japan Morning Surge Home Blood Pressure (J-HOP) Study, Kario et al developed a more comfortable device with respect to traditional ABPM device focused on the night time BP values of 02:00, 03:00, 04:00 a.m., which showed in 2562 subjects a strict correlation between nighttime BP values and TOD.…”

“…81 In the Japan Morning Surge Home Blood Pressure (J-HOP) Study, Kario et al developed a more comfortable device with respect to traditional ABPM device focused on the night time BP values of 02:00, 03:00, 04:00 a.m., which showed in 2562 subjects a strict correlation between nighttime BP values and TOD. 82 However, traditional ABPM devices remain the gold standard also for the evaluation of the night time period. 83 In conclusion, both WCHT and MHT increased the risk to produce sustained hypertension and TOD.…”