Associations between day-by-day variability in blood pressure measured at home and antihypertensive drugs: the J-HOME-Morning study.

We identified the factors associated with home blood pressure (BP) variability in 1933 patients treated with hypertensive drugs (mean age, 67 years; women, 55%). Multivariate regression analysis showed that female gender, advanced age, home BP value, and home heart rate variability were positively associated with home BP variability, whereas home heart rate, body mass index, and duration of antihypertensive treatment were negatively associated with home BP variability. Moreover, not being medicated with amlodipine and being medicated with angiotensin II receptor blockers were associated with increased home systolic BP variability only among patients who were treated for less than 12 months.

Low-dose and very low-dose spironolactone in combination therapy for essential hypertension: evaluation by self-measurement of blood pressure at home.

Low-dose (25 mg) or very low-dose (12.5 mg) spironolactone were added among 86 uncontrolled hypertensive patients who were undergoing monotherapy with calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin AT1-receptor blockers (ARBs). Morning home systolic/diastolic blood pressure (BP) reduction was similar among the CCB (n = 30, -8.2/-2.6 mmHg), ACEI (n = 22, -13.0/-4.7 mmHg), and ARB (n = 34, -11.5/-5.1 mmHg) groups. An increase in serum potassium correlated positively with the decline in morning systolic BP. Even very low-dose (12.5 mg) spironolactone is clinically effective, although serum potassium should be carefully monitored.

Electrocardiographic abnormalities and home blood pressure in treated elderly hypertensive patients: Japan home versus office blood pressure measurement evaluation in the elderly (J-HOME-Elderly) study.

This study compares relationships between each of morning home blood pressure (BP), evening home BP and office BP with electrocardiographic (ECG) abnormalities among treated hypertensive Japanese patients. We defined ECG left ventricular hypertrophy (LVH) as Sokolow-Lyon voltage and/or Cornell voltage duration product. Abnormal T waves and ST segment depression were categorized based on the Minnesota code. Office BP was calculated as the mean of four readings taken during two visits. Morning and evening home BP were calculated as the mean of five readings measured once each morning and evening for 5 days, respectively. Multivariate analysis showed that ECG-LVH in 747 hypertensives (mean age: 72 years; women: 63%) was more closely associated with morning home BP than with either office or evening home BP. Even the first reading of morning home BP on day 1 was significantly associated with ECG-LVH independently of office BP. The association between home BP and ECG-LVH increased with the cumulative number of home BP measurements. The results for abnormal T waves were similar. Home and office BP did not significantly differ between patients with and without ST segment depression. Morning home BP was more closely associated with ECG-LVH and abnormal T waves than either office or evening home BP among treated hypertensive Japanese patients.

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

We 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.

Influence of home blood pressure measuring conditions in the evening on the morning-evening home blood pressure difference in treated hypertensive patients: the J-HOME study.

OBJECTIVE: The objective of this study was to clarify the factors affecting the morning-evening home systolic blood pressure (BP) difference (home systolic ME dif) in treated hypertensive patients, including evening home BP measuring conditions, based on the data from the Japan Home versus Office BP Measurement Evaluation study. METHODS: The study participants were 3303 essential hypertensive patients (mean age 66.2+/-10.5 years; females 55.3%) treated using antihypertensive drug therapy in primary care settings in Japan. Multivariate regression analysis including the variables that were significantly associated with the home systolic ME dif on the univariate analysis was performed. RESULTS: The mean of the home systolic/diastolic ME dif was 6.1+/-10.8/4.8+/-6.5 mmHg. The proportion of patients measuring evening BP after drinking alcohol was 20.5%, and the proportion of patients measuring evening BP after bathing was 76.8%. Uncontrolled morning systolic BP (morning systolic BP > or =135 mmHg), controlled evening systolic BP (evening systolic BP <135 mmHg), older age (> or =65 years), measurement of evening BP after drinking, and measurement of evening BP after bathing were positively associated with the home systolic ME dif on multivariate regression analysis. CONCLUSION: Measurement of evening BP after drinking and measurement of evening BP after bathing were strongly associated with an increased home systolic ME dif, independent of morning and evening home BP levels. Therefore, evening home BP measuring conditions (before or after drinking alcohol and bathing) should be taken into account while evaluating the home systolic ME dif.