Prevalence of Masked Hypertension in Subjects Treated with Antihypertensive Drugs as Assessed by Morning versus Evening Home Blood Pressure Measurements: The J-HOME Study

Abstract

To investigate the relationship between morning and evening home blood pressure (BP) measurements to make a diagnosis of masked hypertension, we collected information on the characteristics of 3,303 essential hypertensive outpatients receiving antihypertensive medication in Japan using a physician, self-administered questionnaire. All patients were asked to measure their home BP once every morning and once every evening for two weeks. Morning and evening home BP values of each patient were defined as the average of all morning and all evening home BP values, respectively. The mean BP values of all study subjects were 142.8/80.6 mmHg for office BP, 139.8/81.8 mmHg for morning home BP, 133.7/76.9 mmHg for evening home BP, and 136.8/79.3 mmHg for the average of the morning and evening home BPs. Masked hypertension was defined as an office BP < 140/90 mmHg and a home BP > or = 135/85 mmHg. The prevalence of masked hypertension diagnosed using morning home BP (23.1%) was higher than that diagnosed by evening home BP (14.7%); the prevalence was 19.0% when diagnosed using the average of the morning and evening home BPs. Among the 1,386 patients with a normal office BP, the diagnosis of masked hypertension based on morning and evening home BP values differed in 28.8% of patients for systolic BP and 20.9% for diastolic BP (kappa coefficient = 0.43). The present study showed that the prevalence of masked hypertension was underestimated when the diagnosis of masked hypertension was made on the basis of evening home BP.

Determinants of masked hypertension in hypertensive patients treated in a primary care setting

“…More than 95% of the HBPM measurements of our study were done in the morning, but the timing compared to the time of waking, having breakfast or taking the medications is not known. While the prevalence of MH has been shown to be underestimated when the diagnosis is made on the basis of evening HBPM, 31 most previous studies of MH are based on the morning HBPM, the average of the morning and evening HBPM, or ABPM. Although disagreement in the diagnosis of MH between the ABPM and HBPM methods is not uncommon, both have been shown to be appropriate for detection of MH 32 .…”

Management of morning hypertension: a consensus statement of an Asian expert panel

“…In patients with treated hypertension who had controlled clinic BP (<140/90 mm Hg), the prevalence of masked uncontrolled morning hypertension defined according to home BP in the morning (≥135/85 mm Hg) was 23.1% (n = 3303) in a Japanese study 24 and 55.9% (n = 2043) in a European study. 25 Regardless of the level of clinic BP, patients with morning hypertension had a significantly increased risk of cardiovascular events.…”

“…In patients with treated hypertension who had either controlled or uncontrolled clinic BP, the prevalence of morning hypertension defined according to ABPM or home BP ranged from 15.9% (n = 173) and 17.5% (n = 1312) in two Korean studies to 43.6% (n = 181) and 60.7% (n = 1087) in two Japanese studies. In patients with treated hypertension who had controlled clinic BP (<140/90 mm Hg), the prevalence of masked uncontrolled morning hypertension defined according to home BP in the morning (≥135/85 mm Hg) was 23.1% (n = 3303) in a Japanese study and 55.9% (n = 2043) in a European study …”

Home and Office Blood Pressure Control among Treated Hypertensive Patients in Japan: Findings from the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) Study

“…The proportions of masked hypertension and white-coat hypertension have been reported widely [13,14]. Their proportions were very different because of the difference in conditions of antihypertensive treatment, different types of out-of-office BP measurement (home BP measurement/ambulatory BP measurement), differences in cut-off criteria of out-of-office and office BPs, and differences in conditions of BP measurements (especially evening home BP measurement).…”