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

Abstract

Imai, the J-HOME Study Group 7We evaluated the control condition of morning and evening home blood pressure (BP) and compared patients who had isolated uncontrolled morning hypertension and those who had sustained uncontrolled (morning and evening) hypertension using data from the Japan Home versus Office Blood Pressure Measurement Evaluation study. We evaluated 3303 treated hypertensive patients (mean age, 66.2 ± 10.5 years; men, 44.7%) in Japan. We classified patients into controlled hypertension, isolated uncontrolled evening hypertension, isolated uncontrolled morning hypertension and sustained uncontrolled hypertension, based on the cutoff value of 135/85 mm Hg for both morning and evening home BP. Of the 3303 patients evaluated, 24.6% had isolated uncontrolled morning hypertension, and 42.0% had sustained uncontrolled hypertension. Factors associated with isolated uncontrolled morning hypertension included taking evening BP measurement after drinking alcohol or bathing. Factors associated with sustained uncontrolled hypertension were male gender, diabetes mellitus and renal disease. The regimen of antihypertensive medication was more complex in patients with uncontrolled morning hypertension than in controlled hypertension. Determinants of the difference between patients with isolated uncontrolled morning hypertension and those with sustained uncontrolled hypertension were diabetes mellitus, renal disease and lower prevalence in measuring evening BP after drinking alcohol or bathing. More than a half of the treated patients were classified into uncontrolled morning hypertension, which were associated with poorer prognosis. Classification of morning hypertensive patients into groups with or without evening hypertension may be useful for evaluating patients' total cardiovascular disease risk. Physicians should also consider evening BP measuring condition for adequate evaluation of evening BP values.

Comparison of the efficacy and safety of azilsartan with that of candesartan cilexetil in Japanese patients with grade I–II essential hypertension: a randomized, double-blind clinical study

“…2, 3 Strict BP control over 24 h, including the night-time and early morning hours, is crucial, as the average BP level over 24 h, nocturnal and early morning BP are more closely associated with target organ damage and cardiovascular events than office BP. 4, 5, 6 In clinical practice, however, it is not infrequent that existing antihypertensive drugs fail to provide an adequate antihypertensive effect that is sustained over 24 h. 7 In the J-MORE (Jichi Morning Hypertension Research) study, 60.7% of treated hypertensives with well-controlled clinic BP were found to have masked morning hypertension (systolic BP (SBP) ⩾135 mm Hg; diastolic BP (DBP) ⩾85 mm Hg), and only 16.4% of patients overall had well-controlled clinic and morning BP levels. 8 These findings may be related to the limited BP-lowering effect and duration of action of some antihypertensives, highlighting the importance of treatments that control BP over a full 24-h period when administered once daily.…”

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

“…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. 119 Such differences were also confirmed in Western countries, while several reports confirmed a higher home BP in the evening than that in the morning.…”

“…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. [123][124][125][126] However, home BP measured in the evening also has a high prognostic significance.…”

Reduction in Morning Blood Pressure Is a Key Factor for Ameliorating Urinary Albumin Excretion in Patients With Morning Hypertension Irrespective of Treatment Regimen

“…4-8 On home BP self-measurement, morning hypertension was observed in >60% of patients receiving anti-hypertensive drugs. 9 It was suggested that the reduction in morning SBP reduced UAE and improved renal function in patients with diabetic and non-diabetic nephropathy. 10,11 Standard treatment for morning hypertension, however, has not been established.…”