Abstract
Morning blood pressure is reported to be more closely related to hypertensive organ damages such as left ventricular mass index, microalbuminuria and silent cerebral infarcts, than blood pressure at other times of the day. Morning blood pressure may play an important role in the pathogenesis of hypertensive target organ damage. Increased sympathetic nerve activity is reported to be one of the mechanisms of morning hypertension; however, there are no available data that show whether strict home blood pressure control, especially in the morning period, can reduce target organ damage. The Japan Morning Surge-1 (JMS-1) study includes hypertensive outpatients with elevated morning systolic blood pressure (≥135 mmHg) as assessed by self-measured blood pressure monitoring at home. All enrolled patients are under stable antihypertensive medication status. Exclusion criteria are arrhythmia, chronic inflammatory disease, and taking α-blockers or β-blockers. The target number of patients to be enrolled in the JMS-1 study is 600, and the aim is to evaluate differences in the markers of hypertensive target organ damage, such as brain natriuretic peptide and the urinary albumin excretion/creatinine ratio. All of the patients are randomized to an experimental group or a control group, with randomization to be carried out by telephone interviews with the patients' physicians. In the experimental group, patients begin taking additional antihypertensive medication just before going to bed. This consists of doxazosin 1 mg/day, which then is increased to 2 mg/day and 4 mg/day, with a β-blocker added after a 1-month interval until the morning systolic blood pressure is controlled to less than 135 mmHg. Patients in the control group continue the treatment they are receiving at the enrollment for 6 months. Blood pressure levels, adverse effects, and hypertensive target organ damage before and after the study are evaluated. In the JMS-1 study, we will evaluate whether strict morning blood pressure control by sympathetic nervous system blockade using an α-blocker, doxazosin, and with the addition of a β-blocker if needed, can reduce hypertensive target organ damage.
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Kuwajima I, Mitani K, Miyao M, Suzuki Y, Kuramoto K, Ozawa T : Cardiac implications of the morning surge in blood pressure in elderly hypertensive patients: relation to arising time. Am J Hypertens 1995; 8: 29–33.
Ikeda T, Gomi T, Shibuya Y, et al: Morning rise in blood pressure is a predictor of left ventricular hypertrophy in treated hypertensive patients. Hypertens Res 2004; 27: 939–46.
Kamoi K, Miyakoshi M, Soda S, Kaneko S, Nakagawa O : Usefulness of home blood pressure measurement in the morning in type 2 diabetic patients. Diabetes Care 2002; 25: 2218–2223.
Kario K, Pickering TG, Umeda Y, et al: Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation 2003; 107: 1401–1406.
Tachibana R, Tabara Y, Kondo I, Miki T, Kohara K : Home blood pressure is a better predictor of carotid atherosclerosis than office blood pressure in community-dwelling subjects. Hypertens Res 2004; 27: 633–639.
Marfella R, Gualdiero P, Siniscalchi M, et al: Morning blood pressure peak, QT intervals, and sympathetic activity in hypertensive patients. Hypertension 2003; 41: 237–243.
Kario K, Pickering TG, Hoshide S, et al: Morning blood pressure surge and hypertensive cerebrovascular disease: role of the alpha adrenergic sympathetic nervous system. Am J Hypertens 2004; 17: 668–675.
Pickering TG, Levenstein M, Walmsley P, Hypertension and Lipid Trial Study Group: Nighttime dosing of doxazosin has peak effect on morning ambulatory blood pressure. Results of the HALT Study. Am J Hypertens 1994; 7: 844–847.
Staessen JA, Den Hond E, Celis H, et al: Antihypertensive treatment based on blood pressure measurement at home or in the physician's office: a randomized controlled trial. JAMA 2004; 291: 955–964.
Kario K : Time for focus on morning hypertension: pitfall of current antihypertensive medication. Am J Hypertens 2005; 18: 149–151.
Ishikawa J, Kario K, Hoshide S, et al: Determinants of exaggerated difference in morning and evening blood pressure measured by self-measured blood pressure monitoring in medicated hypertensive patients: Jichi Morning Hypertension Research (J-MORE) Study. Am J Hypertens 2005; 18: 958–965.
Nishikimi T, Yoshihara F, Morimoto A, et al: Relationship between left ventricular geometry and natriuretic peptide levels in essential hypertension. Hypertension 1996; 28: 22–30.
Lubien E, DeMaria A, Krishnaswamy P, et al: Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings. Circulation 2002; 105: 595–601.
Mak GS, DeMaria A, Clopton P, Maisel AS : Utility of B-natriuretic peptide in the evaluation of left ventricular diastolic function: comparison with tissue Doppler imaging recordings. Am Heart J 2004; 148: 895–902.
Redfield MM, Rodeheffer RJ, Jacobsen SJ, Mahoney DW, Bailey KR, Burnett JC Jr : Plasma brain natriuretic peptide to detect preclinical ventricular systolic or diastolic dysfunction: a community-based study. Circulation 2004; 109: 3176–3181.
Kistorp C, Raymond I, Pedersen F, Gustafsson F, Faber J, Hildebrandt P : N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA 2005; 293: 1609–1616.
Wang TJ, Evans JC, Meigs JB, et al: Low-grade albuminuria and the risks of hypertension and blood pressure progression. Circulation 2005; 111: 1370–1376.
Pascual JM, Rodilla E, Gonzalez C, Perez-Hoyos S, Redon J : Long-term impact of systolic blood pressure and glycemia on the development of microalbuminuria in essential hypertension. Hypertension 2005; 45: 1125–1130.
Kohara K, Tabara Y, Tachibana R, Nakura J, Miki T : Microalbuminuria and arterial stiffness in a general population: the Shimanami Health Promoting Program (J-SHIPP) study. Hypertens Res 2004; 27: 471–477.
Cirillo M, Senigalliesi L, Laurenzi M, et al: Microalbuminuria in nondiabetic adults: relation of blood pressure, body mass index, plasma cholesterol levels, and smoking: the Gubbio Population Study. Arch Intern Med 1998; 158: 1933–1939.
Borch-Johnsen K, Feldt-Rasmussen B, Strandgaard S, Schroll M, Jensen JS : Urinary albumin excretion: an independent predictor of ischemic heart disease. Arterioscler Thromb Vasc Biol 1999; 19: 1992–1997.
Klausen KP, Scharling H, Jensen G, Jensen JS : New definition of microalbuminuria in hypertensive subjects: association with incident coronary heart disease and death. Hypertension 2005; 46: 33–37.
Imai Y, Otsuka K, Kawano Y, et al: Japanese Society of Hypertension (JSH) guidelines for self-monitoring of blood pressure at home. Hypertens Res 2003; 26: 771–782.
Anwar YA, Giacco S, McCabe EJ, Tendler BE, White WB : Evaluation of the efficacy of the Omron HEM-737 IntelliSense device for use on adults according to the recommendations of the Association for the Advancement of Medical Instrumentation. Blood Press Monit 1998; 3: 261–265.
Chobanian AV, Bakris GL, Black HR, et al: The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.
Cifkova R, Erdine S, Fagard R, et al: Practice guidelines for primary care physicians: 2003 ESH/ESC hypertension guidelines. J Hypertens 2003; 21: 1779–1786.
Whitworth JA : 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003; 21: 1983–1992.
Staessen JA, Bieniaszewski L, Buntinx F, et al: The trough-to-peak ratio as an instrument to evaluate antihypertensive drugs. Hypertension 1995; 26: 942–949.
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 2005; 28: 491–498.
Pickering TG, Davidson K, Gerin W, Schwartz JE : Masked hypertension. Hypertension 2002; 40: 795–796.
Liu JE, Roman MJ, Pini R, Schwartz JE, Pickering TG, Devereux RB : Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Ann Intern Med 1999; 131: 564–572.
Bobrie G, Chatellier G, Genes N, et al: Cardiovascular prognosis of “masked hypertension” detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA 2004; 291: 1342–1349.
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.
Sega R, Facchetti R, Bombelli M, et al: Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) Study. Circulation 2005; 111: 1777–1783.
White WB : Ambulatory blood-pressure monitoring in clinical practice. N Engl J Med 2003; 348: 2377–2378.
Otto ME, Svatikova A, Barretto RBdM, et al: Early morning attenuation of endothelial function in healthy humans. Circulation 2004; 109: 2507–2510.
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.
Ohkubo T, Hozawa A, Yamaguchi J, et al: Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study. J Hypertens 2002; 20: 2183–2189.
Hoshide S, Kario K, Hoshide Y, et al: Associations between nondipping of nocturnal blood pressure decrease and cardiovascular target organ damage in strictly selected community–dwelling normotensives. Am J Hypertens 2003; 16: 434–438.
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Ishikawa, J., Hoshide, S., Shibasaki, S. et al. The Japan Morning Surge-1 (JMS-1) Study: Protocol Description. Hypertens Res 29, 153–159 (2006). https://doi.org/10.1291/hypres.29.153
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DOI: https://doi.org/10.1291/hypres.29.153
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