LB03.01

Abstract

Objective: Blood pressure (BP) self-measured at home is a more accurate prognosticator than conventionally measured BP. Home blood pressure (BP), which is mainly measured in morning and evening, is prognositically superior to office BP. Although morning BP, per se, is an important prognostic factor, much less information about this association is available in ambulatory patients. Design and method: In the Japan Morning Surge Home Blood Pressure (J-HOP) study, 4310 Japanese patients (mean age, 64.8 [SD, 10.9] years; 47% men) who had one or more than risk factor were recruited and followed up by their physicians, and measured home BP in the morning and evening on 14 consecutive days at baseline. Cardiovascular events were the combination of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, aortic dissection, and hospitalization for heart failure or angina performed with coronary angioplasty or coronary artery bypass graft surgery. Results: At the end of follow-up, clinical status was known for 99.4% of patients. During 3.9 years of follow-up (median), at least 1 cardiovascular events had occurred in 192 (incidence, 11.7/1000 patient-years), and 75 stroke events (4.3/1000 patient-years) and 122 cardiac and other vascular events (7.2/1000 patient-years) occurred. When we divided morning systolic BP (MSBP) into four groups (<135mmHg [n = 1948], 135–145mmHg [n = 1037], 145–155mmHg [n = 684], >155mmHg [n = 586]), the risk of cardiovascular events was increased in >155mmHg of MSBP compared with < 135mmHg (1.82; 95%CI [1.19–2.80]) after adjusted by covariates, and MSBP was not risk for cardiac and other vascular events. The risk for stroke events was higher in the group with 135–145mmHg (relative risk [RR], 2.48; 95% confidence interval [CI], 1.19–5.15), 145–155mmHg (2.71; 95%CI [1.25–5.85]), >155mmHg (4.13; 95%CI [1.92–8.90]) than those with <135mmHg. This association was similar after adjusting evening systolic BP. Conclusions: Uncontrolled morning BP assessed by home BP is associated with stroke in Japanese ambulatory patients.