Abstract
Little is known about the relationship of the difference between morning and evening systolic blood pressure (BP) (MEdif) in home BP with cardiovascular disease (CVD) incidence. To assess this relationship, we used data from the nationwide practice-based J-HOP (Japan Morning Surge-Home BP) study, which recruited 4258 cardiovascular risk participants (mean age 64.9 years; 46.8% men; 79.2% using antihypertensive medications) who underwent morning and evening home BP monitoring using a validated, automated device for 14 consecutive days. During a mean ± SD follow-up of 6.2 ± 3.8 years (26,295 person-years), 269 CVD events occurred. Adjusted Cox models suggested that higher MEdif (≥20 mmHg) was associated with higher CVD risks than was medium MEdif (0–20 mmHg) independent of the average morning and evening (MEave) home systolic BP (SBP) (adjusted hazard ratio [HR]: 1.40; 95% confidence interval [CI] 1.02–1.91). We also divided participants into four BP phenotype groups as follows: “both non-elevated” (MEdif < 20 mmHg and MEave SBP < 135 mmHg), “elevated-MEdif” (MEdif ≥ 20 mmHg and MEave SBP < 135 mmHg), “elevated-MEave” (MEdif < 20 mmHg and MEave SBP ≥ 135 mmHg), and “both elevated” (MEdif ≥ 20 mmHg and MEave SBP ≥ 135 mmHg). The cumulative incidence of CVD events was higher in patients with the “elevated-MEdif,” “elevated-MEave,” and “both elevated” phenotypes than in those with the “both non-elevated” phenotype. After adjusting for covariates, the “both elevated” phenotype was associated with higher CVD risk than the “both non-elevated” phenotype (adjusted HR: 1.64; 95% CI: 1.09–2.46). This is the first study demonstrating a direct correlation between CVD outcomes and the difference between morning and evening home SBP.
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References
Sega R, Facchetti R, Bombelli M, Cesana G, Corrao G, Grassi G, et al. Prognostic value of ambulatory and home blood pressure compared with office blood pressure in the general population: follow-up results from the Pression Arteriose Monitorate e Loro Assocoazioni (PAMELA) study. Circulation. 2005;111:1777–83.
Niiranen TJ, Hanninen MR, Johansson J, Reunanen A, Jula AM. Home-measured blood pressure is a stronger predictor of cardiovascular risk than office blood pressure: the Finn-Home Study. Hypertension. 2010;55:1346–51.
Kario K, Saito I, Kushiro T, Teramukai S, Tomono Y, Okuda Y, et al. Morning home blood pressure is a strong predictor of coronary artery disease: the HONEST Study. J Am Coll Cardiol. 2016;67:1519–27.
Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–324.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.
Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH2019). Hypertens Res. 2019;42:1235–481.
Wang JG, Bu PL, Chen LY, Chen X, Chen YY, Cheng WL, et al. 2019 Chinese hypertension league guidelines on home blood pressure monitoring. J Clin Hypertens. 2020;22:378–83.
Kario K, Park S, Chia YC, Sukonthasarn A, Turana Y, Shin J, et al. 2020 consensus summary on the management of hypertension in Asia from the HOPE Asia network. J Clin hypertens. 2020;22:351–62.
Hoshide S, Yano Y, Haimoto H, Yamagiwa K, Uchiba K, Nagasaka S, et al. Morning and evening home blood pressure and risks of incident stroke and coronary artery disease in the Japanese general practice population: the Japan Morning Surge-Home Blood Pressure Study. Hypertension. 2016;68:54–61.
Asayama K, Ohkubo T, Kikuya M, Obara T, Metoki H, Inoue R, et al. Prediction of stroke by home “morning” versus “evening” blood pressure values: the Ohasama study. Hypertension. 2006;48:737–43.
Asayama K, Tabara Y, Oishi E, Sakata S, Hisamatsu T, Godai K, et al. Recent status of self-measured home blood pressure in the Japanese general population: a modern database on self-measured home blood pressure (MDAS). Hypertens Res. 2020;43:1403–12.
Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M, et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation. 2003;107:1401–6.
Li Y, Thijs L, Hansen TW, Kikuya M, Boggia J, Richart T, et al. International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes Investigators. Prognostic value of the morning blood pressure surge in 5645 subjects from 8 populations. Hypertension. 2010;55:1040–8.
Gong S, Liu K, Ye R, Li J, Yang C, Chen X. Nocturnal dipping status and the association of morning blood pressure surge with subclinical target organ damage in untreated hypertensives. J Clin Hypertens. 2019;21:1286–94.
Sogunuru GP, Kario K, Shin J, Chen CH, Burankitjaroen P, Chia YC, et al. HOPE Asia Network. Morning surge in blood pressure and blood pressure variability in Asia: evidence and statement from the HOPE Asia Network. J Clin Hypertens. 2019;21:324–34.
Ishikawa J, Kario K, Hoshide S, Eguchi K, Morinari M, Kaneda R, 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;18:958–65.
Matsui Y, Eguchi K, Shibasaki S, Shimizu M, Ishikawa J, Shimada K, et al. Association between the morning-evening difference in home blood pressure and cardiac damage in untreated hypertensive patients. J Hypertens. 2009;27:712–20.
Ishikawa J, Hoshide S, Shibasaki S, Matsui Y, Kabutoya T, Eguchi K, et al. Relationship between morning hypertension identified by home blood pressure monitoring and brain natriuretic peptide and estimated glomerular filtration rate: The Japan Morning Surge 1 (JMS-1) Study. J Clin Hypertens. 2008;10:34–42.
Imai Y, Otsuka K, Shimada K, Hayashi H, Tochikubo O, Miyakawa M, et al. Japanese Society of Hypertension (JSH) Guidelines for Self-monitoring of Blood Pressure at Home. Hypertens Res. 2003;26:771–82.
Kario K, Ishikawa J, Pickering TG, Hoshide S, Eguchi K, Morinari M, et al. Morning hypertension: the strongest independent risk factor for stroke in elderly hypertensive patients. Hypertens Res. 2006;29:581–7.
Shimamoto K, Ando K, Fujita T, Hasebe N, Higaki J, Horiuchi M, et al. Japanese Society of Hypertension Committee for Guidelines for the Management of Hypertension. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2014). Hypertens Res. 2014;37:253–253.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, 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;289:2560–72.
D’Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117:743–53.
Imai Y, Nishiyama A, Sekino M, Aihara A, Kikuya M, Ohkubo T, et al. Characteristics of blood pressure measured at home in the morning and in the evening: the Ohasama study. J Hypertens. 1999;17:889–98.
Johansson JK, Niiranen TJ, Pukka PJ, Jula AM. Factors affecting the difference between morning and evening home blood pressure: the Finn-Home study. Blood Press. 2011;20:27–36.
Carter BL, Chrischilles EA, Rosenthal G, Gryzlak BM, Einstein EL, Vander, et al. Efficacy and safety of nighttime dosing of antihypertensives: review of the literature and design of a pragmatic clinical trial. J Clin Hypertens. 2014;16:115–21.
Hermida RC, Ayala DE, Mojón, Fernández JR. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study. Chronobiol Int. 2010;27:1629–51.
Hermida RC, Crespo JJ, Domínguez-Sardiña M, Otero A, Moyá A, Ríos MT, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygira Chronotherapy Trial. Eur Heart J. 2019. https://doi.org/10.1093/eurheartj/ehz754.
Acknowledgements
We gratefully acknowledge the numerous study investigators and participants in the J-HOP study.
Sources of funding
This study was financially supported, in part, by a grant from the 21st Century Center of Excellence Project run by Japan’s Ministry of Education, Culture, Sports, Science, and Technology (MEXT); a grant from the Foundation for Development of the Community (Tochigi); a grant from Omron Healthcare Co., Ltd.; a Grant-in-Aid for Scientific Research (B; 21390247) from The Ministry of Education, Culture, Sports, Science, and Technology of Japan, 2009 to 2013; and funds from the MEXT-supported program for the Strategic Research Foundation at Private Universities, 2011 to 2015 Cooperative Basic and Clinical Research on Circadian Medicine (S1101022) to KK. Funding sponsors had no role in the design or performance of the study; in the collection, management, analysis, or interpretation of the data; in the preparation of the article; or in the decision to submit the article for publication.
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KK received research funding from Omron Healthcare Co., Fukuda Denshi, and A&D Co. and honoraria from Omron Healthcare Co. The other authors report no conflicts.
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Narita, K., Hoshide, S. & Kario, K. Difference between morning and evening home blood pressure and cardiovascular events: the J-HOP Study (Japan Morning Surge-Home Blood Pressure). Hypertens Res 44, 1597–1605 (2021). https://doi.org/10.1038/s41440-021-00686-2
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DOI: https://doi.org/10.1038/s41440-021-00686-2
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