Abstract 13459: Sleep Blood Pressure Self-measured at Home as Independent Determinant of Target Organ Damage: the Japan Morning Surge Home Blood Pressure (J-HOP) Study
Background: Recent population-based and clinical studies using ambulatory blood pressure (BP) monitoring (ABPM) demonstrated that sleep BP is a better predictor of cardiovascular disease than awake BP.
Methods: To study whether sleep BP self-measured at home is associated with target organ damage independently of clinic BP and home BPs measured in the morning and evening, we analyzed the data of 2562 participants of the Japan Morning Surge Home Blood Pressure (J-HOP) Study, who self-measured sleep BP using a semiautomatic home BP monitoring (HBPM) device with data memory, 3 times during sleep (2:00AM, 3:00AM, 4:00AM), as well as 3 times each in the morning and evening for 14 days.
Results: There was no difference between the sleep home systolic BP (HSBP) levels at 2:00AM and 3:00AM, while that at 4:00AM was slightly higher by 1.5mmHg (p<0.0001). Even in those with well-controlled morning HSBP<135mmHg, 27% exhibited masked nocturnal hypertension with sleep HSBP>120mmHg (Figure A). The mean, the highest and the lowest sleep HSBPs were all significantly correlated with the urinary albumin/creatinine ratio (UACR) (Figure B), left ventricular mass index (LVMI), brachial-ankle pulse wave velocity (baPWV), maximum carotid intima-media thickness, and plasma N-terminal pro-hormone BNP and high-sensitive cardiac troponin T levels (all p<0.001). After controlling for clinic SBP, and morning and evening HSBPs, associations of sleep HSBP with UACR, LVMI, and baPWV remained significant (all p<0.008).
Conclusions: This is the first study to demonstrate that self-measurement of sleep HBP is feasible in a large cohort, and sleep HBP is significantly correlated with target organ damage independently of clinic BP and morning and evening HBPs. Masked nocturnal hypertension, which is present in one-fourth of well-controlled morning hypertensives, remains unrecognized by conventional HBPM without sleep BP monitoring.
- © 2013 by American Heart Association, Inc.