Abstract
Morning home blood pressure (BP) levels are more closely associated with cardiovascular risk than clinic BP levels. However, control of morning home BP has been worse than that of clinic BP in clinical practice. We examined the effects of olmesartan-based treatment using data (n=21 341) from the first 16 weeks of the Home BP measurement with Olmesartan Naive patients to Establish Standard Target blood pressure (HONEST) study, a prospective observational study for olmesartan-naive patients with essential hypertension. After 16-week olmesartan-based treatment, the clinic and morning home systolic BP (SBP) lowered from 151.6±16.4 and 153.6±19.0 mm Hg to 135.0±13.7 and 135.5±13.7 mm Hg, respectively (P<0.0001). The achievement percentage of target morning home SBP (<135 mm Hg) in all patients, those with diabetes mellitus (DM), and those with chronic kidney disease (CKD) increased from 13.5, 16.4 and 17.2% to 50.8, 47.9 and 48.8%, respectively, and the proportion of patients with well-controlled hypertension (clinic SBP<140 mm Hg and morning home SBP<135 mm Hg) increased from 7.9, 9.2 and 10.2% to 38.9, 34.5 and 36.3%, respectively. After 16-week olmesartan-based treatment, the proportion of patients with masked and white coat hypertension changed from 11.8 to 24.2% and 5.6 to 11.9%. In conclusion, both clinic and morning home BP in all, DM and CKD patients improved with 16-week olmesartan-based treatment in the ‘real world', and the results showed a sustained 24-hour BP-lowering effect of olmesartan. Decrease in clinic and home BP resulted in an increased rate of masked and white coat hypertension, and further management is needed in those patients.
Highlights
Hypertension is a well-known risk factor for cardiovascular disease
Our findings were essentially the same in both patient groups defined in the present study and in untreated hypertensive patients without pre-existing cardiovascular disease
adverse drug reactions (ADRs) associated with excessive blood pressure (BP) lowering, which consisted of dizziness, decreased BP, hypotension, dizziness, and postural and orthostatic hypotension, occurred in 0.48% of the patients
Summary
Hypertension is a well-known risk factor for cardiovascular disease To reduce this risk, strict control of blood pressure (BP) is recommended by various guidelines for hypertension treatment.[1,2,3]. It is important to identify patients in these groups, because masked hypertension has a cardiovascular risk at least equal to that of poor-controlled hypertension.[10,11] white coat hypertension can be a risk factor for stroke in the long term, according to a pooled analysis of ambulatory blood pressure monitoring (ABPM) data from an international collaborative study.[12]. We used measurements of morning home BP at the first measurement and clinic BP from the first 16 weeks of the HONEST study to evaluate the antihypertensive efficacy of olmesartan and the sustained 24-hour BP-lowering effect in patients with diabetes mellitus (DM) and chronic kidney. We investigated the effects of olmesartan on morning hypertension
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