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Difference between morning and evening home blood pressure and cardiovascular events: the J-HOP Study (Japan Morning Surge-Home Blood Pressure)

Abstract

Little is known about the relationship of the difference between morning and evening systolic blood pressure (BP) (MEdif) in home BP with cardiovascular disease (CVD) incidence. To assess this relationship, we used data from the nationwide practice-based J-HOP (Japan Morning Surge-Home BP) study, which recruited 4258 cardiovascular risk participants (mean age 64.9 years; 46.8% men; 79.2% using antihypertensive medications) who underwent morning and evening home BP monitoring using a validated, automated device for 14 consecutive days. During a mean ± SD follow-up of 6.2 ± 3.8 years (26,295 person-years), 269 CVD events occurred. Adjusted Cox models suggested that higher MEdif (≥20 mmHg) was associated with higher CVD risks than was medium MEdif (0–20 mmHg) independent of the average morning and evening (MEave) home systolic BP (SBP) (adjusted hazard ratio [HR]: 1.40; 95% confidence interval [CI] 1.02–1.91). We also divided participants into four BP phenotype groups as follows: “both non-elevated” (MEdif < 20 mmHg and MEave SBP < 135 mmHg), “elevated-MEdif” (MEdif ≥ 20 mmHg and MEave SBP < 135 mmHg), “elevated-MEave” (MEdif < 20 mmHg and MEave SBP ≥ 135 mmHg), and “both elevated” (MEdif ≥ 20 mmHg and MEave SBP ≥ 135 mmHg). The cumulative incidence of CVD events was higher in patients with the “elevated-MEdif,” “elevated-MEave,” and “both elevated” phenotypes than in those with the “both non-elevated” phenotype. After adjusting for covariates, the “both elevated” phenotype was associated with higher CVD risk than the “both non-elevated” phenotype (adjusted HR: 1.64; 95% CI: 1.09–2.46). This is the first study demonstrating a direct correlation between CVD outcomes and the difference between morning and evening home SBP.

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Acknowledgements

We gratefully acknowledge the numerous study investigators and participants in the J-HOP study.

Sources of funding

This study was financially supported, in part, by a grant from the 21st Century Center of Excellence Project run by Japan’s Ministry of Education, Culture, Sports, Science, and Technology (MEXT); a grant from the Foundation for Development of the Community (Tochigi); a grant from Omron Healthcare Co., Ltd.; a Grant-in-Aid for Scientific Research (B; 21390247) from The Ministry of Education, Culture, Sports, Science, and Technology of Japan, 2009 to 2013; and funds from the MEXT-supported program for the Strategic Research Foundation at Private Universities, 2011 to 2015 Cooperative Basic and Clinical Research on Circadian Medicine (S1101022) to KK. Funding sponsors had no role in the design or performance of the study; in the collection, management, analysis, or interpretation of the data; in the preparation of the article; or in the decision to submit the article for publication.

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Correspondence to Kazuomi Kario.

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KK received research funding from Omron Healthcare Co., Fukuda Denshi, and A&D Co. and honoraria from Omron Healthcare Co. The other authors report no conflicts.

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Narita, K., Hoshide, S. & Kario, K. Difference between morning and evening home blood pressure and cardiovascular events: the J-HOP Study (Japan Morning Surge-Home Blood Pressure). Hypertens Res 44, 1597–1605 (2021). https://doi.org/10.1038/s41440-021-00686-2

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