Abstract 14165: Nocturnal Blood Pressure Detected by Home Blood Pressure Monitoring as a Novel Independent Predictor Oo Cardiovascular Events in the Japanese General Practice Population: The J-HOP Study
Background: Nocturnal blood pressure (BP) measured by ambulatory BP monitoring has been shown as a robust predictor of incident cardiovascular disease (CVD) in high-risk populations. However, the clinical relevance of nocturnal BP measured by home BP monitoring (HBPM) in general practice remains unknown.
Objective: To study whether nocturnal HBP is associated with CVD risk independently of clinic BP and morning and evening HBPs in general practice.
Methods: We used data from the nationwide practice-based Japan Morning Surge-Home Blood Pressure (J-HOP) Nocturnal BP Study that included 2545 Japanese with a history of or risk factors for CVD, or both (mean age 63.3 years; 82.9% on antihypertensive medications). Patients measured their nocturnal HBP at 3 time points during sleep (AM2:00, AM3:00, AM4:00) using our automatic Medinote HBPM device.
Results: Ninety-three CVD events (46 stroke, 47 coronary events) occurred during the 4.0-year follow-up period. A 10-mmHg increase in nocturnal home systolic BP (HSBP) (average of the values at AM2:00 and AM3:00) was associated with a significant increase in CVD events of 26.9% (p=0.007) by Cox regression analysis, even after controlling for covariates including both clinic and morning HBPs. These associations were stronger for stroke than coronary events. Compared with the well-controlled group with morning HSBP<135mmHg and nocturnal HSBP<115mmHg, CVD events were increased in the uncontrolled nocturnal HSBP groups (>115mmHg) both with (HR=2.43, p=0.012) or without (HR=2.39, p=0.021) morning HSBP<135mmHg (Figure).
Conclusion: Higher nocturnal SBP detected by HBPM, regardless of office or morning SBP level, is a strong and independent risk for CVD events in the general practice population. Nocturnal HBPM is useful in identifying those at higher risk of developing adverse CVD outcomes in clinical practice.
Author Disclosures: K. Kario: Research Grant; Significant; Teijin Pharma Limited, OMRON HEALTHCARE Co., Ltd., FUKUDA DENSHI, Bayer Yakuhin Ltd., A &D Co., Ltd., DAIICHI SANKYO COMPANY, LIMITED., MOCHIDA PHARMACEUTICAL CO., LTD, EA pharma, Otsuka Pharmaceutical Co., Ltd., Boehringer Ingelheim Japan Inc., Mitsubishi Tanabe Pharma Corporation., Medtronic Japan Co., Ltd.. Honoraria; Modest; Mitsubishi Tanabe Pharma Corporation., Kyowa Hakko Kirin Co., Ltd., Bayer Yakuhin Ltd., Pfizer Japan Inc., Shionogi & Co., Ltd., Astellas Pharma Inc, AstraZeneca K.K., Boehringer Ingelheim Japan Inc., Sanofi K.K., TERUMO CORPORATION, Bristol-Myers K.K., Kowa Pharmaceutical Co. Ltd., SANWA KAGAKU KENKYUSHO CO.,LTD., MSD K.K., Actelion Pharmaceuticals Japan, Abott Japan, OMRON HEALTHCARE Co., Ltd., Century Medical Inc., TOA EIYO LTD., MOCHIDA PHARMACEUTICAL CO., LTD, Sumitomo Dainippon Pharma Co., Ltd.. Honoraria; Significant; Takeda Pharmaceutical Company Limited., DAIICHI SANKYO COMPANY, LIMITED., OMRON HEALTHCARE Co., Ltd.. S. Hoshide: None. Y. Okawara: None. N. Tomitani: None. Y. Yano: None. K. Eguchi: None.
- © 2016 by American Heart Association, Inc.