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Impact of diabetic status and contribution of office and home blood pressure across diabetic status for cardiovascular disease: the J-HOP study

Hypertension Research volume 46, pages 1684–1693 (2023)Cite this article

Abstract

Few studies have investigated whether the prognostic power of home blood pressure (BP) for cardiovascular disease (CVD) events differs across subjects with different diabetic status. We used the dataset of the J-HOP (Japan Morning Surge-Home Blood Pressure) study, which enrolled patients having cardiovascular risks to investigate relationships between home BP and CVD events. We classified the patients as having diabetes mellitus (DM), prediabetes or normal glucose metabolism (NGM) as follows: for DM, a self-reported history of physician-diagnosed DM and/or use of DM medication, a fasting plasma glucose ≥126 mg/dL, a casual plasma glucose level ≥200 mg/dL or hemoglobin A1c (HbA1c) ≥6.5% (n = 1034); for prediabetes, HbA1c of 5.7–6.4% (n = 1167), and for NGM, those who remained (n = 2024). CVD outcome was defined as coronary artery disease, stroke or heart failure. During a median 6.2 ± 3.8 years of follow-up, 259 CVD events occurred. Analysis found both prediabetes (Unadjusted Hazard ratio [uHR], 1.43; 95% confidence interval [CI], 1.05–1.95), and DM (uHR, 2.13; 95% CI, 1.59–2.85) as risks of CVD compared to NGM. In DM, patients with a 10-mmHg elevation of office systolic BP (SBP) and morning home SBP had 16% and 14% higher risks for CVD events. In the prediabetes group, only an elevated morning home SBP conferred a risk of CVD events (uHR, 1.15; 95% CI, 1.00–1.31), but this association did not hold for the adjusted model. Like DM, prediabetes should be recognized as a risk for CVD events, albeit weakly. Elevated home BP contributes to increased CVD risk in diabetes.

Our study demonstrated the impact of prediabetes and diabetes on CVD and the impact of office and home BP on CVD events in each group.

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Acknowledgements

We gratefully acknowledge the numerous study investigators, fellows, nurses, and research coordinators at each of the study sites who participated in the J-HOP study. The physicians who participated in the study and the participating centers are present in the data supplement. We thank Kimiyo Saito for the coordination and data management of this study and Ayako Okura for editorial assistance.

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 (to KK); a grant from the Foundation for Development of the Community (Tochigi, Japan); a grant from Omron Healthcare; a Grant-inAid for Scientific Research (B) (21390247) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) 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).

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-159 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan

    Daisuke Suzuki, Satoshi Hoshide & Kazuomi Kario

  2. Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan

    Daisuke Suzuki

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Correspondence to Kazuomi Kario.

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KK received research funding from Omron Healthcare, Fukuda Denshi, and A&D.

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Suzuki, D., Hoshide, S. & Kario, K. Impact of diabetic status and contribution of office and home blood pressure across diabetic status for cardiovascular disease: the J-HOP study. Hypertens Res 46, 1684–1693 (2023). https://doi.org/10.1038/s41440-023-01242-w

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