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 were classified as hypertensive by home blood pressure in the present urban population. Furthermore, morning home blood pressure control in the treated hypertensive group classified as under control by casual blood pressure was insufficient, especially in patients who were taking medication only in the morning.
Similar content being viewed by others
Article PDF
References
Shirasaki O, Terada H, Niwano K, et al: The Japan Home-Health Apparatus Industrial Association: investigation of home-use electronic sphygmomanometers. Blood Press Monit 2001; 6: 303–307.
Mancia G, Sega R, Milesi C, Cesana G, Zanchetti A : Blood-pressure control in the hypertensive population. Lancet 1997; 349: 454–457.
Hozawa A, Ohkubo T, Kikuya M, et al: Blood pressure control assessed by home, ambulatory and conventional blood pressure measurements in the Japanese general population: the Ohasama Study. Hypertens Res 2002; 25: 57–63.
Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure : The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1997; 157: 2413–2446.
Burt VL, Whelton P, Roccella EJ, et al: Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 1995; 25: 305–313.
Colhoun HM, Dong W, Poulter NR : Blood pressure screening, management and control in England: results from the health survey for England 1994. J Hypertens 1998; 16: 747–752.
Guideline Sub-Committee : 1999 World Health Organization–International Society of Hypertension Guidelines for the Management of Hypertension. J Hypertens 1999; 17: 151–183.
Sega R, Cesana G, Milesi C, Grassi G, Zanchetti A, Mancia G : Ambulatory blood pressure normality in the elderly. Data from the PAMELA population. Hypertension 1997; 30: 1–6.
Japanese Society of Hypertension Subcommittee for the Management of Hypertension : Guidelines for the Management of Hypertension (JSH 2004). Tokyo, Life Science Publication, 2004 ( in Japanese).
Kawabe H, Saito I, Saruta T : Influence of repeated measurement on one occasion, on successive days, and on workdays on home blood pressure values. Clin Exp Hypertens 2005; 27: 215–222.
Kario K, Schwartz JE, Gerin W, Robayo N, Maceo E, Pickering TG : Psychological and physical stress-induced cardiovascular reactivity and diurnal blood pressure variation in women with different work shifts. Hypertens Res 2002; 25: 543–551.
Imai Y, Otsuka K, Kawano Y, et al, on behalf of the Japanese Society of Hypertension : Japanese Society of Hypertension (JSH) guidelines for self-monitoring of blood pressure at home. Hypertens Res 2003; 26: 771–782.
Imai Y, Nishiyama A, Sekino M, et al: Characteristics of blood pressure measured at home in the morning and in the evening: the Ohasama Study. J Hypertens 1999; 17: 889–898.
Stergiou GS, Skeva II, Zourbaki AS, Mountokalakis TD : Self-monitoring of blood pressure at home: how many measurements are needed? J Hypertens 1998; 16: 725–731.
de Gaudemaris R, Chau NP, Mallion J-M, for the Groupe de la Mésure, French Society of Hypertension : Home blood pressure: variability, comparison with office readings and proposal for reference values. J Hypertens 1994; 12: 831–838.
Hond ED, Celis H, Fagard R, et al, on behalf of the THOP investigators : Self-measured versus ambulatory blood pressure in the diagnosis of hypertension. J Hypertens 2003; 21: 717–722.
Kawano Y, Pontes CS, Abe H, Takishita S, Omae T : Effects of alcohol consumption and restriction on home blood pressure in hypertensive patients: serial changes in the morning and evening records. Clin Exp Hypertens 2002; 24: 33–39.
Mancia G : Reversed white-coat hypertension: definition, mechanisms and prognostic implications. J Hypertens 2002; 20: 579–581.
Pickering TG, Davidson K, Gerin W, Schwartz JE : Masked hypertension. Hypertension 2002; 40: 795–796.
Uchida H, Nakamura Y, Kaihara M, et al: Practical efficacy of telmisartan for decreasing morning home blood pressure and pulse wave velocity in patients with mild-to-moderate hypertension. Hypertens Res 2004; 27: 545–550.
Kuroda T, Kario K, Hoshide S, et al: Effects of bedtime vs. morning administration of the long-acting lipophilic angiotensin-converting enzyme inhibitor trandolapril on morning blood pressure in hypertensive patients. Hypertens Res 2004; 27: 15–20.
Munakata M, Saito Y, Nunokawa T, Ito N, Fukudo S, Yoshinaga K : Clinical significance of blood pressure response triggered by a doctor's visit in patients with essential hypertension. Hypertens Res 2002; 25: 343–349.
Saito I, Kawabe H, Tsujioka M, Hirose H, Shibata H : Trends in pharmacologic management of hypertension in Japan one year after the publication of the JSH 2000 guidelines. Hypertens Res 2002; 25: 175–178.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kawabe, H., Saito, I. & Saruta, T. Status of Home Blood Pressure Measured in Morning and Evening: Evaluation in Normotensives and Hypertensives in Japanese Urban Population. Hypertens Res 28, 491–498 (2005). https://doi.org/10.1291/hypres.28.491
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1291/hypres.28.491
Keywords
This article is cited by
-
Nocturnal hypoxia and the difference in morning and evening blood pressure measured at home
Hypertension Research (2023)
-
Clinical significance of home blood pressure and its possible practical application
Clinical and Experimental Nephrology (2014)
-
Effect of the angiotensin II receptor antagonist olmesartan on morning home blood pressure in hypertension: HONEST Study at 16 weeks
Journal of Human Hypertension (2013)
-
The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)
Hypertension Research (2012)
-
Uncontrolled hypertension based on morning and evening home blood pressure measurements from the J-HOME study
Hypertension Research (2009)