Morning Home Blood Pressure and Cardiovascular Events in Japanese Hypertensive Patients

Abstract

SPRINT (Systolic Blood Pressure Intervention Trial) demonstrated the benefit of achieving strict blood pressure control with a lower target blood pressure level in high-risk patients with hypertension. The aim of this post hoc analysis was to investigate the relationship between the 2-year average on-treatment home blood pressure and cardiovascular disease risk in subgroups stratified by risk status using data from the HONEST study (Home Blood Pressure Measurement With Olmesartan Naive Patients to Establish Standard Target Blood Pressure). Participants in the HONEST study (n=21 591) were stratified according to risk level as follows: SPRINT population (n=5823)—patients (≥50 years of age) without diabetes mellitus or prior stroke, with SPRINT-defined cardiovascular risk and systolic blood pressure (SBP) of ≥130 mm Hg; SPRINT-excluded high-risk population (n=5481)—patients with diabetes mellitus or prior stroke; and non-SPRINT low-risk population—all other patients in the HONEST study (n=10 287). Cardiovascular disease event risk was 6.32 events per 1000 person-years in the SPRINT population, which was higher than in the non-SPRINT low-risk (3.39; P <0.001) and lower than the SPRINT-excluded high-risk (12.41; P <0.001) populations. In the SPRINT and the SPRINT-excluded high-risk populations, a lower home SBP achieved was associated with lower cardiovascular disease risk, with the lowest risk in patients with a home SBP <125 mm Hg. The non-SPRINT low-risk population showed a J-curve association between on-treatment home SBP and cardiovascular disease risk with the lowest risk at a home SBP of 135 to <145 mm Hg. Intensive therapy targeting home SBP of <125 mm Hg would be beneficial for high-risk hypertensive patients. Clinical Trial Registration— URL: http://www.umin.ac.jp/ctr/index.htm . UMIN Clinical Trials Registry, trial no.: UMIN000002567.

Target blood pressure and control status in Asia

“…The three‐step approach is to lower morning home SBP to 145 mm Hg (first step) then to 130 mm Hg (second step) and to 125 mm Hg (third step). This is consistent with Asian data from the Japan Morning Surge‐Home Blood Pressure (J‐HOP) and Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure (HONEST) studies indicating that morning home BP should be controlled to at least <145 mm Hg to reduce the risk of cardiovascular events and that achieving a SBP <125 mm Hg should reduce the CVD event rate even further.…”

The HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020

“…Key findings were as follows: (a) morning BP is a more important risk factor of stroke than evening BP; (b) day‐by‐day home BPV is significant predictor of cardiovascular events independent of the average of home BP level; and (c) nocturnal home BP is a risk factor for cardiovascular events independent of office and morning home BP . The HONEST study, the largest nationwide Japanese observational trial, confirmed morning home BP as a strong predictor of both coronary artery disease and stroke events, and showed that morning home SBP <125 mm Hg was associated with minimal risk of cardiovascular events in high‐risk patients with diabetes or history of stroke . As a result, we recommend that target morning home SBP should be <125 mm Hg (if tolerated), especially in high‐risk hypertensive patients …”

“…A recent study also demonstrated that morning home BP was more reproducible and better correlated with vascular indices than ambulatory BP . To date, there have been five general practitioner‐based home BP cohort studies (Table ), including the HOMED‐BP (Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure) study, the J‐HOP (Japan Morning Surge‐Home Blood Pressure) study, and the HONEST (Home Blood Pressure Measurement With Olmesartan Naive Patients to Establish Standard Target Blood Pressure) study . All of these showed that morning home BP was a better predictor of cardiovascular events than office BP.…”

Asian management of hypertension: Current status, home blood pressure, and specific concerns in Japan

“…Overall, cardiovascular event risk was lowest in patients with morning home SBP of 124 mm Hg, and morning home SBP > 144 mm Hg was significantly associated with an increase in the rate of cardiovascular events . In a risk‐stratified sub‐analysis of the HONEST study population, lower achieved home SBP was associated with reduced cardiovascular disease risk, and the lowest risk was seen in patients with a home SBP < 125 mm Hg . Based on the results of these studies, we propose that morning home BP should be controlled <145 mm Hg.…”