ME 01-2 ASSESSMENT AND TREATMENT OF MORNING HYPERTENSION

Abstract

Abstract The essential benefit of the management of is derived from the blood pressure (BP) lowering per se, indicating the importance of throughout 24 hours. Recent guidelines stressed the importance of home for the diagnosis and management of hypertension. It is well-known that cardiovascular events occur more frequently in the levels have been shown to increase during the period from night to early morning. Clinical research using ambulatory monitoring (ABPM) or home monitoring has clarified that and are more closely related to the cardiovascular risk than office (Kario et al. Circulation 2003;107:1401-1406).The importance of on-treatment HBPM for the cardiovascular prognosis of hypertensive individuals was recently revealed in the largest real-world prospective study, the Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure (HONEST) study which enrolled more than 21 000 hypertensive patient. In prospective results of the HONEST study, in hypertensive patients treated with antihypertensive medication, even patients whose office is well-controlled, on-treatment uncontrolled prior to taking medication frequently remains high risk for both stroke and coronary disease (Kario, et al. Hypertension 2014;64:989-996; J Am Coll Cardiol 2016;67:1519-1527). In our nationwide Japanese cohort, the Japan Morning Surge Home Blood Pressure (J-HOP) Study, home was the best predictor of stroke event (Hoshide, Kario, et al. Hypertension 2016;68:54-61). Since Asians show greater surges (Hoshide, Kario, Parati et al. Hypertension 2016;68:54-61), it is particularly important for Asians to control as the first step to achieve 'perfect 24-hr control,' i.e., the 24-hr level, nocturnal dipping, and variability including (Kario. Ann Glob Health 2016;82:254-273).The first definition of morning hypertension was defined as the average of BPs >135 mmHg for systolic BP, or >85mmHg for diastolic BP, regardless of office BPs with the definition of >135/85 mmHg regardless office in Clinician's Manual on Early Morning Risk Management in Hypertension in 2004 (Science Press, London, UK, 2004). Masked hypertension may be used for with office <140/90 mmHg. Morning could be measured by both ABPM (2 hour-average of ambulatory BPs after arsing) and home monitoring (the average of 2 measurements in the during 3 or more days). Morning could be diagnosed not only by home monitoring, but also by ABPM (ambulatory hypertension). When information on the time of arising is not available, the highest 1 hour moving average of consecutive systolic BPs between 6am and 10am could be calculate as the Moving peak systolic BP (Kario. Essential manual of 24 hour blood pressure management. Wiley, UK, pp.1-158.2015). The risk of may be underestimated by monitoring device with intermittent measurements. The innovation of wearable surge monitoring which could measure continuously will clarify the risk of (Kario. Prog Cardiovasc Dis 2016, in press).We are now proposing a three-step strategy for the BP-guided management of using home monitoring as follows. Step 1: Morning systolic <145 mmHg should be achieved by treatment; Step 2: The guideline level of 135 mmHg systolic should then be reached, and Step 3: Approx. 125 mmHg or less, which presents the lowest risk of cardiovascular events, should be achieved and maintained (Kario. Essential manual of 24 hour blood pressure management. Wiley, UK, pp.1-158.,2015). Non-specific medication for controlling includes long-acting drugs. Once-daily dosing antihypertensive agents, now widely used as conventional antihypertensive medication, has decreased the patient burden and contributed to increased patient compliance. However, conventional antihypertensive medication using once-daily use of antihypertensive drugs was insufficient for controlling hypertension. Specific treatment includes the time of dosing of antihypertensive drugs and selecting the specific class of antihypertensive drugs, such as inhibitors of sympathetic activity or the renin-angiotensin system (RAS). Practically, bedtime dosing of antihypertensive drug, especially calcium channel blocker, alpha-blocker, RAS inhibitors suppress exaggerated without excessive nocturnal hypotension during sleep. These treatments also effective for nocturnal hypertension. On the other hand, specific drug for reducing nocturnal is diuretics including thiazide-type diuretics, indapamide, and aldosterone blockers. These drugs are effective for with non-dipper/riser pattern of nocturnal BP. The renal denervation is effective for reducing and the moving peak in the combination analysis of the HTN-3 and the HTN-Japan as well as nocturnal (Kario, Bakris, et al. Hypertension 2015;66:1130-1137).The BP-guided approach using home monitoring is the most promising first step leading to the anticipation medicine for the most effective antihypertensive treatment for cardiovascular disease (Kario. Prog Cardiovasc Dis 2016, in press).