PS-C28-2: STROKE RISK OF THE ELDERLY PATIENTS WITH NOCTURNAL HYPERTENSION DEFINED USING HOME BLOOD PRESSURE MONITORING IN JAPANESE GENERAL PRACTICE POPULATION

Abstract

Objective: To investigate the association between nocturnal hypertension defined using home blood pressure (BP) monitoring (HBPM) and the prevalence, extent of cardiovascular target organ damage (TOD), and cardiovascular disease (CVD) event risks in participants with ≧ 65 years in general clinical practice. Design and method: We used the dataset of the Japan Morning Surge-Home BP (J-HOP) Study that recruited 4,310 participants with cardiovascular risk factors. Among them, we assessed the participants with ≧ 65 years who measured nocturnal home BP (n = 1,349, mean age 72.0 year, 48.6% men). We define nocturnal hypertension as nocturnal systolic (SBP) ≧ 120 mmHg or diastolic (DBP) ≧ 70 mmHg, using HBPM. Nocturnal home BP was automatically measured at least 1 day within the 14 days (2 AM, 3 AM, and 4 AM). We use the average of all nocturnal home BP values. N-terminal pro-brain natriuretic peptide (NT-proBNP) and urine albumin: creatinine ratio (UACR) were used as surrogate markers of TOD. The CVD outcomes were incident stroke and coronary heart disease (CHD) events. Results: The prevalence of nocturnal hypertension defined by HBPM was 61.7% of all study participants with ≧ 65 years. The participants with nocturnal hypertension defined by HBPM presented higher levels of log-transformed NT-proBNP and UACR at baseline compared to those with controlled nocturnal BP group. Over a median 4.0-year follow-up (5,453 person-years), 36 stroke events and 31 CHD events occurred, respectively. The nocturnal hypertension group had a higher incidence rate of stroke events compared with the controlled BP group. Concerning CHD, the incidence rate of CHD was similar between two groups (Figure). Cox model results suggested that the participants with nocturnal hypertension had a higher risk of stroke compared to those with controlled nocturnal BP group after adjustments for log-transformed NT-proBNP and UACR levels (adjusted hazard ratio 3.42; 95% confidence interval 1.15–10.19). Conclusions: In this Japanese population with ≧ 65 years, the participants with nocturnal hypertension defined by HBPM was significantly associated with stroke risk, independently of the extent of TOD.