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Perfect 24-h management of hypertension: clinical relevance and perspectives

Abstract

Out-of-office blood pressure (BP) measured by home BP monitoring, or ambulatory BP monitoring, was demonstrated to be superior to office BP for the prediction of cardiovascular events. The J-HOP study of a nationwide Japanese cohort demonstrated that morning home BP is the best stroke predictor. In the prospective HONEST study of >21 000 hypertensives, on-treatment morning home BP was shown to be a strong predictor both of future coronary artery disease and stroke events. In subjects whose office BP was maintained at 150 mm Hg, there was no increase in cardiovascular events when their morning systolic BP was well-controlled at <125 mm Hg. Since Asians show greater morning BP surges, it is particularly important for Asians to achieve ‘perfect 24-hr BP control,’ that is, the 24-h BP level, nocturnal BP dipping and BP variability including morning surge. The morning BP surge and the extremes of disrupted circadian rhythm (riser and extreme dipper patterns) are independent risks for stroke in hypertensives. A morning BP-guided approach is thus the first step toward perfect 24-h BP control, followed by the control of nocturnal hypertension. In the resonance hypothesis, the synergistic resonance of BP variability phenotypes would produce an extraordinary large ‘dynamic BP surge’ that can trigger a cardiovascular event, especially in high-risk patients with systemic hemodynamic atherothrombotic syndrome, a vicious cycle of exaggerated BP variability and vascular disease. In the future, information and communications technology and artificial intelligence technology with the innovation of wearable continuous surge BP monitoring will contribute to ‘anticipation medicine’ with the goal of zero cardiovascular events.

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Acknowledgements

I sincerely thank the three academic fathers of my research, Kazuyuki Shimada, Takefumi Matsuo and the late Thomas G Pickering, who continuously supported me. I also wholeheartedly thank my colleagues who worked with me: S Hoshide, K Eguchi, T Kabutoya, T Komori, M Fukutomi, Y Imaizumi, H Mizuno, T Fujiwara, Y Yano, J Ishikawa, Y Matsui, S Shibasaki, N Tomitani, K Saito, H Hamasaki, Y Matsumoto, H Suwa and A Okura. This study was financially supported in part by a grant from JSPS KAKENHI grant numbers 26293192; the Foundation for Development of the Community (Tochigi); Banyu Life Science Foundation International.

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Correspondence to K Kario.

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This paper was presented in part at the Presidential Lecture entitled ‘Evidence and Perspectives on the 24-h Management of Hypertension: Hemodynamic Biomarker-initiated 'Anticipation Medicine' for Zero Cardiovascular Event' at the Hypertension Forum 2016 — 5th Spring Scientific Meeting of the Japanese Society of Hypertension, Tokyo.

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Kario, K. Perfect 24-h management of hypertension: clinical relevance and perspectives. J Hum Hypertens 31, 231–243 (2017). https://doi.org/10.1038/jhh.2016.65

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