Characteristics of blood pressure measured at home in the morning and in the evening

Imai, Yutaka; Nishiyama, Akimitsu; Sekino, Makoto; Aihara, Akiko; Kikuya, Masahiro; Ohkubo, Takayoshi; Matsubara, Mistunobu; Hozawa, Atsushi; Tsuji, Ichiro; Ito, Sadayoshi; Satoh, Hiroshi; Nagai, Kenichi; Hisamichi, Shigeru

doi:10.1097/00004872-199917070-00004

Cited by 97 publications

(79 citation statements)

References 18 publications

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“…However, with the advancement and popularity of hospital-based, 24-hour, ambulatory BP monitoring devices as well as homebased self-monitoring devices, the importance of the use of ambulatory BP, especially those measurements taken at home have gained attention (1)(2)(3)(4)(5)(6)(7)(8). HBP obtained early in the morning at home by self-measurement is specifically highlighted as having a substantial impact on cardiovascular risk.…”

Section: State Of Bp Controlmentioning

confidence: 99%

“…Indeed, HBP obtained early in the morning has been shown to have a substantial impact on the awareness of cardiovascular risks (1)(2)(3)(4)(5). In addition, many clinical reports indicate a close association between BP in the early morning and the occurrence of cardiovascular events such as myocardial infarction, cerebral apoplexy or sudden death (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

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Morning Blood Pressure Predicts Hypertensive Organ Damage in Patients with Renal Diseases: Effect of Intensive Antihypertensive Therapy in Patients with Diabetic Nephropathy

et al. 2005

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Blood pressure (BP) measured at home early in the morning (HBP) has been recognized as a useful predictor for organ damage and has been viewed as an important therapeutic target in patients with hypertension. The present study was aimed to determine whether this notion holds true in patients with progressive renal disease.The study enrolled patients with mild to moderate renal impairment. They were all directed to record selfmeasured HBP to evaluate the adequacy of BP control. In addition to the conventional antihypertensive therapy, intensive treatment to more efficiently reduce elevated morning HBP was applied, especially in patients with diabetic nephropathy. The results were as follows:1) The status of BP control assessed using HBP and office/clinic BP (OBP) shows predominance of morning hypertension. The prevalence of patients with well-controlled systolic HBP was 38%, those with poorly-controlled HBP 30%, masked hypertension 20% and white coat hypertension 12%. 2) Early morning systolic HBP in diabetics was significantly higher than that in non-diabetics. However, when evaluated on systolic OBP, both groups were comparable. 3) Logistic regression analysis showed that the predictive variables to explain morning hypertension (more than 130 mmHg and increased systolic HBP) were age, amount of daily urinary protein excretion and left ventricular mass index (LVMI). 4) Following conventional therapy, intensive antihypertensive therapy consisting of calcium channel blockers (CCB) and/or diuretics given in the morning, and angiotensin receptor blockers (ARB) given in the evening, together with 1-blockers given at bedtime, efficaciously reduced elevated HBP in the morning. This result was associated with significant reduction in daily urinary protein excretion and in serum plasminogen-activator inhibitor (PAI-1) concentration. The present study indicates that, regardless of ongoing conventional antihypertensive therapy, the majority of patients with renal disease had morning hypertension, suggesting that these patients are at a higher risk for cardiovascular disease. For the purpose of improving morning hypertension, intensive treatments with combined CCB, ARB and 1-blockers could have substantial benefit on the morbidity and prognosis in patients with diabetic nephropathy. (Internal Medicine 44: 1239-1246, 2005)

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Section: State Of Bp Controlmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Morning Blood Pressure Predicts Hypertensive Organ Damage in Patients with Renal Diseases: Effect of Intensive Antihypertensive Therapy in Patients with Diabetic Nephropathy

et al. 2005

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“…121 This was especially true in the hypertensive population of Ohasama, for whom the difference in SBP was 10-20 mm Hg. 119 Such differences were also confirmed in Western countries, while several reports confirmed a higher home BP in the evening than that in the morning. 128,129 This may reflect the differences in lifestyles between Japanese and Western populations.…”

Section: ) Measurement Procedures In the Eveningmentioning

confidence: 73%

“…According to reports from Japan, home BP is higher in the morning than in the evening. 114,119 The major causes of this difference in BP between the morning and evening are reported to be antihypertensive treatment, alcohol intake and taking a bath. [120][121][122] Those who exhibit large morning-evening differences in BP have marked target organ damage, such as left ventricular hypertrophy.…”

Section: Masked Hypertensionmentioning

confidence: 99%

The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)

et al. 2012

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INTRODUCTIONSince Riva-Rocci invented indirect brachial cuff sphygmomanometry in 1896 1 and Korotkoff proposed the auscultatory method in 1905, 2 the method for blood pressure (BP) measurements has remained essentially unchanged for the past 100 years.In 1969, Posey et al. 3 identified mean BP on the basis of the cuff-oscillometric method. With subsequent theoretical and technical improvements, the method to determine systolic and diastolic BP (S and D, respectively) was introduced to the cuff-oscillometric method. As a result, many of the automatic electronic sphygmomanometers available today have adopted this method, and those different from the auscultatory method have begun to be used in general clinical practice. Since the advent of indirect methods for sphygmomanometry, the past century has developed the practical and clinical sciences of hypertension. However, BP information necessary for the diagnosis and treatment of hypertension is still obtained essentially on the basis of casual measurements at the outpatient clinic (clinic BP). However, the reliability of clinic BP was called into question 40 years after the advent of indirect sphygmomanometry. In 1940, Ayman and Goldshine 4 widely adopted the concept of self-BP measurements in the field of clinic BP measurements and demonstrated discrepancies between clinic BP and self-BP measurements. Bevan, 5 in the United Kingdom, first reported the results of ambulatory BP (ABP) monitoring (ABPM) using a direct arterial BP measurement method in 1969, and showed that human BP changes markedly with time. The quantity and quality of BP information vary greatly according to different methods, and the problem of interpreting clinic BP, which is obtained specifically in a medical environment, has been an issue in the clinical practice of hypertension during the past 50 years.However, the practice and epidemiology of hypertension still depend entirely on BP information obtained in a medical environment (clinic BP/BP at a health examination), resulting in the

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“…However, for clinical purposes, two measurements in the morning and in the evening for at least 3 days have been advised, 12,13 but important aspects still remain to be clarified. Since a circadian variation in blood pressure exists, 14,15 it may be important at which time of day the blood pressure is measured. No studies are available comparing the accuracy of HBP readings taken at different times of day.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of telemedical home blood pressure measurement in the diagnosis of hypertension

et al. 2003

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This study was conducted to compare the accuracy of clinic blood pressure (CBP) and telemedical home blood pressure (HBP) measurement in the diagnosis of hypertension in primary care. The study subjects were 411 patients with average CBP X140 mmHg systolic or X90 mmHg diastolic, who performed telemedical HBP measurement (5 days, four times daily) and ambulatory blood pressure (ABP) monitoring in random order. Main outcome measure was the agreement of CBP and HBP with daytime ABP. CBP was much higher than daytime ABP and average HBP (Po0.001) with no difference between the latter two. The correlation between CBP and ABP was weak (systolic: r ¼ 0.499, diastolic: r ¼ 0.543), whereas strong correlations existed between HBP and ABP (systolic: r ¼ 0.847, diastolic: r ¼ 0.812). A progressive improvement in the strength of the linear regression between average HBP of single days and ABP was obtained from day 1 to day 4, with no further benefit obtained on the fifth day. The HBP readings taken at noon and in the afternoon showed significantly stronger correlations with ABP than the blood pressures measured in the morning and in the evening. In conclusion, the accuracy of telemedical HBP measurement was substantially better than that of CBP in the diagnosis of hypertension in primary care. HBP most accurately reflected ABP on the fourth day of monitoring, and the readings at noon and in the afternoon seemed to be most accurate.

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Characteristics of blood pressure measured at home in the morning and in the evening

Abstract: Qualitative and quantitative differences in home blood pressure measurement, due to the differential time of measurement, should be taken into consideration in clinical use of home blood pressure measurements.

Cited by 97 publications

References 18 publications

Morning Blood Pressure Predicts Hypertensive Organ Damage in Patients with Renal Diseases: Effect of Intensive Antihypertensive Therapy in Patients with Diabetic Nephropathy

Morning Blood Pressure Predicts Hypertensive Organ Damage in Patients with Renal Diseases: Effect of Intensive Antihypertensive Therapy in Patients with Diabetic Nephropathy

The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)

Accuracy of telemedical home blood pressure measurement in the diagnosis of hypertension

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