Status of Home Blood Pressure Measured in Morning and Evening: Evaluation in Normotensives and Hypertensives in Japanese Urban Population

Abstract

To assess home blood pressure status in a Japanese urban population, we analyzed home blood pressure values in normotensive subjects determined by casual blood pressure (<140/90 mmHg), hypertensive subjects without medication (≥140/90 mmHg) and treated hypertensive patients. The subjects (468 male, 232 female; mean age 41 years old) were recruited from a company located in Tokyo. Home blood pressure was measured with a semi-automatic device (Omron HEM-759P). Subjects were instructed to perform triplicate morning and evening measurements on 7 consecutive days. In the treated hypertensive group (n =70), there was a significant difference between morning (139 ± 12/88 ± 9 mmHg) and evening (130 ± 12/79 ± 8 mmHg) home blood pressure. In the normotensive group (n =558), however, only the diastolic blood pressure (DBP) component of the home blood pressure was significantly different between morning (115 ± 13/72 ± 9 mmHg) and evening (114 ± 12/68 ± 8 mmHg). In the nontreated hypertensive group (n =72), casual blood pressure (145±14/92 ± 9 mmHg) was higher than morning (138 ± 16/89 ± 11 mmHg) and evening (134 ± 16/83 ± 11 mmHg) home blood pressure, but no difference was seen between morning and evening systolic blood pressure (SBP). According to the reference value of the Japanese Society of Hypertension 2004 (SBP ≥135 mmHg and/or DBP ≥85 mmHg), 7.2% (systolic) and 8.7% (diastolic) of subjects in the normotensive group were classified as hypertensive by home blood pressure. Casual blood pressure in the treated hypertensive group was normal in 64.3% for SBP and 70.0% for DBP. However, their morning SBP (32.9%), morning DBP (40.0%), evening SBP (10.0%), and evening DBP (17.1%) were classified as hypertensive by home blood pressure. Furthermore, patients who were taking antihypertensive drug(s) only in the morning (n =52) showed higher morning SBP (6 mmHg, p =0.086) and morning DBP (6 mmHg, p =0.005) than patients taking drug(s) by other administration schedules (n =18), but no difference in evening home blood pressure was observed. In conclusion, a proportion of the subjects defined as normotensive by casual blood pressure Hypertens Res Vol. 28, No. 6 (2005) IntroductionSelf-measurement of blood pressure at home has developed enormously in recent years (1) and is useful in raising people's concern about hypertension. In the medical management of hypertensive patients, home blood pressure measurement raises their knowledge and consciousness of hypertension, and has become one of the important means of motivating patients to take an active, positive role in their medical treatment. However, there have been few reports on the status of home blood pressure values in normotensives and hypertensive patients (2, 3).It has been reported that only a small proportion of patients on antihypertensive drugs have well controlled blood pressure (4−6). It has also been suggested that this apparently poor blood pressure control is caused, at least in part, by the so-called "white-coat effect," since casual blood pressure taken in medi...

The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)

“…These factors usually decrease BP. 114,120 In the Ohasama study, in which evening BP was measured under the abovementioned conditions, BP in the morning was a few mm Hg higher than that in the evening. 121 This was especially true in the hypertensive population of Ohasama, for whom the difference in SBP was 10-20 mm Hg.…”

“…The frequency of masked hypertension based on home BP is reported to be about 10% in cohorts of the general population 103,104 and 11-33% in hypertensive patients under treatment. 108,113,114 3. Morning hypertension, and morning and evening home BP Although there is no precise definition of morning hypertension, a condition with a specifically high BP after waking early in the morning may be referred to as morning hypertension.…”

“…According to reports from Japan, home BP is higher in the morning than in the evening. 114,119 The major causes of this difference in BP between the morning and evening are reported to be antihypertensive treatment, alcohol intake and taking a bath. [120][121][122] Those who exhibit large morning-evening differences in BP have marked target organ damage, such as left ventricular hypertrophy.…”

Uncontrolled hypertension based on morning and evening home blood pressure measurements from the J-HOME study

“…[9][10][11][12] We also reported that not only morning home BP but also evening home BP was positively associated with the incidence of stroke. 8,13 Therefore, evening home BP has clinical significance. However, few studies have monitored both morning and evening home BP among treated patients under controlled conditions, 8,14 and no studies have clarified the factors that affect isolated uncontrolled morning hypertension (morning home BP is high but evening home BP is normal) or sustained uncontrolled hypertension (both morning and evening home BP are uncontrolled).…”

“Cocktail” Antihypertensive Chronotherapy for Perfect Control of Morning Hypertension in Diabetic Patients

“…Ambulatory blood pressure (BP) varies along with various physical and psychological factors and this BP variability may be a risk for cardiovascular events (2,3). In recent years, clinical research using ambulatory BP monitoring (ABPM) or self-measured home BP monitoring has clarified that morning BP and BP surge are more closely related to target organ damage and cardiovascular risk than clinic BP (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Also, in hypertensive patients treated with antihypertensive medication, even patients whose clinic BP is well controlled, the morning BP level prior to taking medication is often high (15)(16)(17).…”