Morning Rise in Blood Pressure Is a Predictor of Left Ventricular Hypertrophy in Treated Hypertensive Patients

Ikeda, Toshio; Gomi, Tomoko; Shibuya, Yuko; Matsuo, Kiyoko; Kosugi, Takeshi; Oku, Nami; Uetake, Yuzaburo; Kinugasa, Satoshi; Furutera, Rie

doi:10.1291/hypres.27.939

Cited by 48 publications

(46 citation statements)

References 25 publications

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“…Kazuomi KARIO 1) , Joji ISHIKAWA 1) , Thomas G. PICKERING 2) , Satoshi HOSHIDE 1) , Kazuo EGUCHI 1) , Masato MORINARI 1) , Yoko HOSHIDE 1) , Toshio KURODA 1) , and Kazuyuki SHIMADA 1) Introduction Ambulatory blood pressure monitoring (ABPM) is now available for the clinical management of hypertensive patients, which enables the assessment of the relative importance of different parameters of blood pressure (BP) measured over 24 h. In addition, self-monitoring of home BP is now widely used in clinical practice for hypertensive patients (1)(2)(3). However, it remains unclear which BP-monitoring times (e.g., morning vs. evening) are the most powerful predictors of stroke events.…”

Section: Morning Hypertension: the Strongest Independent Risk Factor mentioning

confidence: 99%

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Morning Hypertension: The Strongest Independent Risk Factor for Stroke in Elderly Hypertensive Patients

et al. 2006

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Stroke occurs most frequently in the morning hours, but the impact of the morning blood pressure (BP) level on stroke risk has not been fully investigated in hypertensives. We studied stroke prognosis in 519 older hypertensives in whom ambulatory BP monitoring was performed, and who were followed prospectively. During an average duration of 41 months (range: 1-68 months), 44 stroke events occurred. The morning systolic BP (SBP) was the strongest independent predictor for stroke events among clinic, 24-h, awake, sleep, evening, and pre-awake BPs, with a 10 mmHg increase in morning SBP corresponding to a relative risk (RR) of 1.44 (p <0.0001). The average of the morning and evening SBP (Av-ME-SBP; 10 mmHg increase: RR =1.41, p =0.0001), and the difference between the morning and evening SBP (Di-ME-SBP; 10 mmHg increase: RR =1.24, p =0.0025) were associated with stroke risks independently of each other. The RR of morning hypertension (Av-ME-SBP ≥ 135 mmHg and Di-ME-SBP≥20 mmHg) vs. sustained hypertension (Av-ME-SBP ≥135 mmHg and Di-ME-SBP <20 mmHg) for stoke events was 3.1 after controlling for other risk factors (p =0.01). In conclusion, morning hypertension is the strongest independent predictor for future clinical stroke events in elderly hypertensive patients, and morning and evening BPs should be monitored in the home as a first step in the treatment of hypertensive patients. (Hypertens Res 2006; 29: 581-587)

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Section: Morning Hypertension: the Strongest Independent Risk Factor mentioning

confidence: 99%

“…Smokers were defined as current smokers. Body mass index (BMI) was calculated as weight (kg)/height (m) 2 .…”

Section: Subjectsmentioning

confidence: 99%

Morning Hypertension: The Strongest Independent Risk Factor for Stroke in Elderly Hypertensive Patients

et al. 2006

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“…Nocturnal decline of BP in patients with essential hypertension is often diminished as the severity progresses, and frequently inverts to a nocturnal elevation (so-called non-dipper and inverted dipper hypertension) (19,20). This type of hypertension has a strong association with a morning rise in BP (sustained type morning hypertension) (21).…”

Section: Morning Hypertension and Organ Damagementioning

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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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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“…8 Previous reports showed, in detail, the usefulness of the classification using both morning and evening home BPs to characterize morning hypertension. [9][10][11][12] We also reported that not only morning home BP but also evening home BP was positively associated with the incidence of stroke. 8,13 Therefore, evening home BP has clinical significance.…”

Section: Introductionmentioning

confidence: 84%

Uncontrolled hypertension based on morning and evening home blood pressure measurements from the J-HOME study

et al. 2009

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Imai, the J-HOME Study Group 7We evaluated the control condition of morning and evening home blood pressure (BP) and compared patients who had isolated uncontrolled morning hypertension and those who had sustained uncontrolled (morning and evening) hypertension using data from the Japan Home versus Office Blood Pressure Measurement Evaluation study. We evaluated 3303 treated hypertensive patients (mean age, 66.2 ± 10.5 years; men, 44.7%) in Japan. We classified patients into controlled hypertension, isolated uncontrolled evening hypertension, isolated uncontrolled morning hypertension and sustained uncontrolled hypertension, based on the cutoff value of 135/85 mm Hg for both morning and evening home BP. Of the 3303 patients evaluated, 24.6% had isolated uncontrolled morning hypertension, and 42.0% had sustained uncontrolled hypertension. Factors associated with isolated uncontrolled morning hypertension included taking evening BP measurement after drinking alcohol or bathing. Factors associated with sustained uncontrolled hypertension were male gender, diabetes mellitus and renal disease. The regimen of antihypertensive medication was more complex in patients with uncontrolled morning hypertension than in controlled hypertension. Determinants of the difference between patients with isolated uncontrolled morning hypertension and those with sustained uncontrolled hypertension were diabetes mellitus, renal disease and lower prevalence in measuring evening BP after drinking alcohol or bathing. More than a half of the treated patients were classified into uncontrolled morning hypertension, which were associated with poorer prognosis. Classification of morning hypertensive patients into groups with or without evening hypertension may be useful for evaluating patients' total cardiovascular disease risk. Physicians should also consider evening BP measuring condition for adequate evaluation of evening BP values.

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Morning Rise in Blood Pressure Is a Predictor of Left Ventricular Hypertrophy in Treated Hypertensive Patients

Cited by 48 publications

References 25 publications

Morning Hypertension: The Strongest Independent Risk Factor for Stroke in Elderly Hypertensive Patients

Morning Hypertension: The Strongest Independent Risk Factor for Stroke in Elderly Hypertensive Patients

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

Uncontrolled hypertension based on morning and evening home blood pressure measurements from the J-HOME study

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