Abstract 11752: Home Blood Pressure Variability or Instability is not Therapeutic Target During Anti-hypertensive Treatment: the Japan Morning Surge-Target Organ Protection (J-TOP) study
Introduction: Home BP monitoring has been recognized and widely adopted. Not only mean home BP but also day-by-day BP variability or instability is associated with target organ damage (TOD) and cardiovascular mortality. Hypothesis: However, it is unknown whether or not home BP variability reduction is associated with TOD protection independently of home mean BP reduction.
Methods: We enrolled 310 hypertensive patients whose systolic BP (SBP) at home was over 135 mmHg from J-TOP study. The subjects measured their BP in the morning and evening for 7 days. Day-by-day BP variability and BP instability were defined as the SD of SBP and maximum SBP at home, respectively. In addition, we measured urinary albumin excretion (UAE) as a marker of TOD before and after 6 months of candesartan treatment (+thiazide diuretics).
Results: At baseline, UAE was associated with average home SBP (r=0.24, p<0.001), standard deviation (SD) of home SBP (r=0.15, p=0.011), and maximum home SBP (r=0.27, p<0.001). During the intervention, significant reductions were found in average home SBP (146±13 vs. 132±12mmHg, p<0.001), SD of home SBP (12.9±4.8 vs. 11.8±4.4mmHg, p<0.001), and maximum home SBP (172.5±18.0 vs. 155.9±17.5mmHg, p<0.001). UAE levels were significantly reduced after 6 months of therapy compared with baseline (18.9 vs. 12.1mg/gCre, p<0.001). In multiple linear regression analysis, the treatment-induced reduction in UAE was significantly associated with that of average home BP (β=0.28, p=0.003) but was not associated with that of SD of home SBP (β=0.03, p=0.652) or that of maximum home SBP (β=-0.04, p=0.679).
Conclusion: Our finding would show that it is important for practicing physicians to first control average home BP level without concern that the possibility of variability occurring every day might increase the risk of cardiovascular damage.
- © 2012 by American Heart Association, Inc.