Japan Morning Surge-Home Blood Pressure Research Articles

PEAK NOCTURNAL HOME BLOOD PRESSURE AS AN EARLY AND STRONG NOVEL RISK FACTOR FOR STROKE: THE PRACTITIONER-BASED NATIONWIDE J-HOP NOCTURNAL BP STUDY

Objective: Recent evidence suggests a correlation between nighttime blood pressure BP) measured through ambulatory BP monitoring (ABPM), the nocturnal BP dipping phenotype, and cardiovascular risk. However, the clinical implications of elevated peak nighttime home BP are currently unknown. This analysis investigated the association between peak nighttime home systolic BP (SBP) and cardiovascular events in outpatients with one or more cardiovascular risk factors. Design and method: In the Japan Morning Surge-Home Blood Pressure (J-HOP) study, nighttime home BP was automatically measured three times every night for 14 days using a nighttime home BP monitoring device (HEM-5001, Omron Healthcare) at baseline. Peak nighttime home SBP was defined as average of the highest three values recoded during the 14-night measurement period. Cardiovascular events (stroke, coronary artery disease, heart failure, aortic dissection) were tracked over a mean 7.1 years’ follow-up period. Results: This analysis included 2545 individuals (mean age 63.3±10.3 years, 49% male) with their nighttime home BPs. After adjustment for covariates (including age, sex, and average office, morning, evening, and nighttime home SBP), individuals with peak nighttime home systolic blood pressure (SBP) in the highest quintile (Q5, >=149.0 mmHg) demonstrated a significantly elevated risk of stroke compared to those in the lowest quintile (Q1, <119.3 mmHg) (hazard ratio [HR] 4.24, 95% confidence interval [CI] 1.07–16.77; p=0.039 overall and 8.92, 1.49–53.43; p=0.017 in the subgroup with >=6 nighttime home SBP measurements). Even when controlling for average real variability of nighttime BP, peak nighttime home SBP remained an independent predictor of stroke risk. On spline regression analysis, the average peak nighttime home SBP cut-off value for predicting an increased risk of incident stroke was 136 mmHg. Conclusions: We propose exaggerated peak nighttime home SBP determined from >=6 measurements as a novel risk factor for stroke, independent of conventional office and home BP values.

Potential Long-Term Benefit of Home Systolic Blood Pressure Below 125 mm Hg for Cardiovascular Risk Reduction: The J-HOP Study Extended.

The long-term benefit of achieving the Japanese Society of Hypertension home systolic blood pressure (SBP) target of <125 mm Hg has not been fully evaluated. This study investigated the long-term risk of cardiovascular disease events in individuals with home SBP <125 versus 125 to <135 or ≥135 mm Hg who participated in the J-HOP study (Japan Morning Surge-Home Blood Pressure). The J-HOP study enrolled outpatients with ≥1 cardiovascular risk factor between 2005 and 2012, with follow-up until March 2015 and extended follow-up from December 2017 to May 2018. Cardiovascular disease events (stroke, coronary artery disease, congestive heart failure, and aortic dissection) were compared between home SBP subgroups. During mean 5.9 years of follow-up in 4231 participants (mean age, 65 years), cardiovascular events included stroke (n=89), coronary artery disease (n=116), congestive heart failure (n=37), and aortic dissection (n=8). The adjusted 10-year risk of total cardiovascular disease was slightly higher, and stroke risk was significantly higher when baseline home SBP was ≥135 versus <125 mm Hg (adjusted hazard ratio, 1.39 [95% CI, 0.97-2.00] for overall cardiovascular disease and 2.68 [95% CI, 1.34-5.38] for stroke; this was largely due to between-group differences in the first 5 years of follow-up, which were maintained over the subsequent 5 years). Findings were similar in the subgroup of high-risk patients (those with diabetes or stroke history). These data highlight the potential long-term benefit of strict home SBP control and validate this as an appropriate Japanese Society of Hypertension guideline target although confirmation in larger populations is needed. URL: https://www.umin.ac.jp/ctr/; University Hospital Medical Information Network Clinical Trials Registry; Unique identifier: UMIN000000894 (Japan Morning Surge-Home Blood Pressure study).

Abstract 14892: Sex Difference in the Prognostic Power of Growth Differentiation Factor 15 for Cardiovascular Event: The Japan Morning Surge-Home Blood Pressure Study

Introduction: Growth differentiation factor 15 (GDF-15), a cytokine secreted in response to cellular stress and inflammation, has been associated with cardiovascular event. Although previous studies have reported that there was a close association between sex hormones and GDF-15, data are sparse about sex difference in the prognostic power of GDF-15 for cardiovascular event. Hypothesis: We hypothesized that there is the differential prognostic power of GDF-15 for cardiovascular outcome according to gender. Methods: This prospective practitioner-based cohort study was conducted between 2005 and 2012 and included participants in the Japan Morning Surge-Home Blood Pressure Study with a history of at least one cardiovascular event who had GDF-15 measurements at baseline. Results: The study included 4066 participants (mean age 64.8 years; men, n=1897; women, n=2169). During an average 6.2 years follow-up, 249 cardiovascular events (coronary artery disease, stroke and heart failure) occurred. GDF-15 levels were significantly higher in the male vs. the female group (median [interquartile], 1014 [741.3-1432] ng/L vs. 909.9 [671.6-1257] ng/L; P&lt;0.001). In women, multivariate Cox analysis revealed that after adjusting other potential predictors, log-transformed GDF-15 was independently associated with cardiovascular events (Hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.31-3.35; P=0.002), whereas this association was not found in men. In women, higher GDF-15 (≥1200 ng/L) was independently associated with cardiovascular event (HR, 2.23; 95%CI, 1.41-3.53; P=0.001), whereas this association was not found in men. The interaction between higher GDF-15 and cardiovascular event according to sex tended to be significant (P=0.087). Conclusions: There is a sex difference in the prognostic power of GDF-15 for cardiovascular event.

Abstract 16605: Differential Impact of Nighttime Home Blood Pressure on Between Patients With and Without Subclinical Heart Failure

Introduction: Nighttime blood pressure (BP) has stronger association with cardiovascular events than office BP, 24-hr BP, and awake BP. However, it was not clear whether the impact of nighttime BP is different for patients with or without heart failure (HF). Hypothesis: Nighttime home BP has stronger association with cardiovascular events in patients with HF. Methods: We analyzed the data from the Japan Morning Surge-Home Blood Pressure study with NT-proBNP and nighttime home BP measurement. We enrolled 2494 patients who had at least one cardiovascular risk factor. Morning, evening, and nighttime home BP were measured and cardiovascular events were followed up. Results: During 7.1 years follow-up, 168 events occurred. When NT-proBNP of 125pg/ml was used as cutoff, the patients with NT-proBNP&gt;125pg/ml was higher daytime home SBP and nighttime home SBP than the patients with NT-proBNP≤125pg/ml (137±16 vs 132±13 mmHg, p&lt;0.01, 126±18 vs 120±14 mmHg, p&lt;0.01, respectively). In Cox regression analysis adjusting for significant covariates, daytime and nighttime home SBP were significant predictor for the outcome in the patients with NT-proBNP&gt;125pg/ml (HR 1.02, 95%CI:1.01-1.03, p&lt;0.01, HR 1.02, 95%CI:1.00-1.03, p=0.045, respectively). On the other hands, only nighttime home SBP was remained as a predictor for the outcome in the patients with NT-proBNP≤125pg/ml (HR 1.02, 95%CI:1.00-1.03, p=0.01). Conclusions: Nighttime home BP was associated with prognosis in patients with and without subclinical HF. Daytime home BP was associated with prognosis in patients with subclinical HF but not in the without subclinical HF.

Abstract 15801: Nighttime Hypertension is a Risk Factor for Cardiovascular Events in Stage B Heart Failure Patients

Background: Nighttime blood pressure (BP) was reported to have a stronger association with cardiovascular outcome and hypertensive organ damage than clinic BP, 24-hour BP, and daytime BP in hypertensives. However, the significance of nighttime BP was not established in stage B heart failure (HF) patients. We hypothesized that nighttime BP measured by home BP monitoring device was associated with cardiovascular outcome in stage B HF patients. Method: We used the dataset of Japan Morning Surge-Home Blood Pressure study (J-HOP study), and selected 417 of stage B HF patients. The definition of stage B HF was based on Universal definition of HF. The patients with history of HF hospitalization were excluded. BP was measured on waking, before bedtime and during the night. The cardiovascular event was followed. Result: Mean follow-up period was 6.6±3.8 years, and 59 cardiovascular events were occurred. When nighttime hypertension was defined as nighttime BP &gt;120mmHg, nighttime HT group showed higher BMI, serum creatinine, HbA1c, and higher prevalence of diabetes, atrial fibrillation, and chronic kidney disease, and lower HDL-cholesterol than nighttime normotension (NT) group. With regard to BP, nighttime HT group, clinic BP, home morning BP, home evening BP, and home nighttime BP were higher in nighttime HT group than in nighttime NT group. In Kaplan-Meier analysis, nighttime HT group had a higher incident of cardiovascular event than nighttime NT group (P&lt;0.01). In Cox multivariate analysis, nighttime HT was significant predictor for cardiovascular event adjusting by significant variables (Hazard ratio 1.84, 95% Confidence interval: 1.01-3.36, P=0.046). Conclusions: Nighttime HT was a prognostic factor in stage B HT patients. Nighttime BP was a therapeutic target to improve the outcome in stage B HT patients.

Nighttime blood pressure and glucose control impacts on left ventricular hypertrophy: The Japan Morning Surge Home Blood Pressure (J-HOP) Study.

Several studies investigated the association between nighttime blood pressure (BP) and left ventricular hypertrophy (LVH) in diabetes, but since most of these studies were conducted in diabetes populations only, they did not compare differences in the impact of nighttime BP on LVH in subjects without diabetes. Moreover, data about the impact of glucose control in diabetes on the relationship between nighttime BP and LVH are sparse. We classified 1277 adults (age 64.7 ± 11.8 years) performing ambulatory BP monitoring while enrolled as part of the Japan Morning Surge Home Blood Pressure (J-HOP) study into groups according to the control status of daytime BP (systolic BP [SBP] < 135 mmHg or ≥135 mmHg), nighttime BP (SBP < 120 mmHg or ≥120 mmHg), and diabetes (HbA1c < 7.0% or ≥7.0%). LVH was assessed by echocardiography. LVH according to echocardiographic criteria was identified in 33.7% of the participants. The group with poorly controlled diabetes plus uncontrolled nighttime BP (n = 90) had a 2.1-fold higher risk of LVH compared to the group with controlled nighttime BP and non-diabetes (n = 505) (odds ratio [OR] 2.10, 95% confidence interval [CI]: 1.29-3.44). No association was observed between uncontrolled daytime BP and diabetes for LVH. In the participants with poorly controlled diabetes (n = 146), uncontrolled nighttime BP posed a 3.1-fold higher risk of LVH compared to controlled nighttime BP (OR 3.12, 95%CI: 1.47-6.62). This association was not found in controlled diabetes. Uncontrolled nighttime BP was associated with a risk of LVH, especially among individuals with poorly controlled diabetes.

Prognosis of a malignant phenotype of obesity defined by a cardiac biomarker in hypertension: the Japan Morning Surge-Home Blood Pressure study.

Obesity with increased high-sensitive cardiac troponin T (hs-cTnT) has been reported to be more likely to progress cardiovascular disease (CVD) events, which suggests that hs-cTnT may identify a "malignant" phenotype of obesity. We classified 3513 hypertensive patients from the Japan Morning Surge-Home Blood Pressure (J-HOP) study into groups based on body mass index (BMI) (normal weight: <25 kg/m2, overweight: 25-29.9 kg/m2, obesity: ≥30 kg/m2) and elevations in biomarker levels (hs-cTnT ≥3 ng/mL: 51.3%, 54.9%, 53.3%, and N-terminal pro-brain natriuretic peptide [NT-ProBNP] ≥55 pg/mL: 51.1%, 40.7%, 36.0% in each BMI category). We evaluated the independent and combined associations of BMI and each hs-cTnT/NT-proBNP or both with CVD events (fatal and nonfatal coronary artery disease, stroke, and hospitalized heart failure). During the mean 6.4 ± 3.9-year follow-up, 232 CVD events occurred. Obesity with elevated hs-cTnT was associated with a risk of CVD events compared to normal weight without elevated hs-cTnT (hazard ratio 3.22, 95% confidence interval: 1.83-5.68). A similar pattern of results was also observed across the status of obesity and elevated NT-proBNP. There was a significant interaction between hs-cTnT and CVD events according to the obesity status (p = 0.039), while this association was marginal in NT-proBNP (p = 0.060). The magnitude of the mediation of hs-cTnT for the association between obesity and CVD risk was 41.2%, and that for NT-proBNP was 8.1%. In this Japanese hypertensive population, the elevation of hs-cTnT identified obese patients at particularly high risk for developing CVD events, suggesting that hs-cTnT may identify a 'malignant' phenotype of obesity.

Home systolic blood pressure time in therapeutic range and cardiovascular risk: the practitioner-based nationwide J-HOP study extended.

Time in therapeutic range (TTR) for office systolic blood pressure (SBP) is an independent predictor of major cardiovascular events. However, the clinical implications of TTR for home SBP have not yet been investigated. This study determined the association between TTR of home SBP and cardiovascular events in individuals with ≥1 cardiovascular risk factor who were enrolled in The Japan Morning Surge-Home Blood Pressure (J-HOP) study. The therapeutic range for home SBP was defined as home SBP of 100-135 mmHg during the 13-day baseline period of the J-HOP study. Participants were divided into subgroups based on quartiles of TTR for home SBP, and the risk of cardiovascular events was determined in each quartile. During a mean 6.3 years of follow-up in 4070 participants (mean age 65 years), cardiovascular events included stroke in 92, coronary artery disease in 119, heart failure in 41 and aortic dissection in 8. The adjusted hazard ratio (95% confidence interval) for the risk of total cardiovascular events in participants with home SBP TTR in the lowest (100%) versus highest quartile (<15.3%) was 1.74 (1.16-2.61); the corresponding hazard ratio for stroke events was 2.11 (1.06-4.21). A 10% decrease in home SBP TTR was associated with a 4% increase in the risk of total cardiovascular events (p = 0.033) and a 9% increase in the risk of stroke (p = 0.004). The significant association seen between home SBP TTR and the occurrence of cardio- and cerebrovascular events highlights the importance of achieving stable reductions in home SBP and minimizing day-by-day home BP variability.Clinical Trial Registration: University Hospital Medical Information Network Clinical Trials Registry, UMIN000000894 (J-HOP study).

Comparison of Ambulatory and Home Blood Pressure Variability for Cardiovascular Prognosis and Biomarkers.

Although blood pressure variability (BPV) is reported to be associated with cardiovascular prognoses, it has not been established whether ambulatory BPV (ABPV; ie, short-term 24-hour BPV) or home BPV (HBPV; day-to-day BPV) is a superior clinical marker. We analyzed the associations of ABPV and HBPV with cardiovascular prognoses and biomarkers in 1314 hypertensive outpatients who underwent both home and ambulatory BP measurements in the J-HOP study (Japan Morning-Surge Home Blood Pressure). BPV was evaluated by the SD, coefficient of variation, and average real variability of the patients' 24-hour ambulatory and home systolic BP values. During the median 7.0-year follow-up, 109 cardiovascular events occurred. All SD, coefficient of variation, and average real variability values of the HBPV were significantly associated with cardiovascular risk even after adjusting by average 24-hour ambulatory systolic BP and each ABPV value: 1 SD of hazard ratio (95% CI) for the SD, 1.36 (1.14-1.63); coefficient of variation, 1.38 (1.16-1.66); and average real variability 1.29 (1.10-1.51) of HBPV. The ABPV parameters did not exhibit comparable relationships. The cardiovascular risk spline curves showed a trend toward increased risks with increasing HBPV parameters. There were no differences between ABPV and HBPV in the relationships with B-type natriuretic peptide and the urine albumin-creatine ratio. In this comparative analysis of ambulatory and home BP monitoring values in individuals with hypertension, ABPV was not significantly associated with cardiovascular prognosis adjusted by average BP level, and HBPV was suggested to have modest superiority in predicting cardiovascular prognosis compared with ABPV.

PEAK HOME BLOOD PRESSURE AS AN EARLIER AND STRONG NOVEL RISK FACTOR FOR STROKE: THE PRACTITIONER-BASED NATIONWIDE J-HOP STUDY EXTENDED

Objective: While home blood pressure (BP) measurement is recommended for hypertension management, the clinical implications of peak home BP values have not been well studied. This study investigated the association between pathological threshold or frequency of peak home BP and cardiovascular events in patients with &gt; = 1 cardiovascular risk factor. Design and method: The Japan Morning Surge-Home Blood Pressure(J-HOP) study enrolled participants from 2005–2012 with extended follow-up from December 2017 to May 2018, which generated the dataset for this analysis. Average peak home systolic BP (SBP) was defined as average of the highest three BP values on 14-day measurement period. Patients were divided into quintiles of peak home BP, and the risk of stroke, coronary artery disease (CAD) and atherosclerotic cardiovascular disease (ASCVD; stroke+CAD) was determined. Results: In 4231 patients (mean 65 years) followed for 6.2years there were 94strokes and 124CAD events. The adjusted hazard ratio (HR) (95% CI) for the risk of stroke and ASCVD in patients with average peak home SBP in the highest versus lowest quintile was 4.39(1.85–10.43) and 2.04(1.24–3.36), respectively. Risk was greatest for stroke in the first 5 years: HR 22.66(2.98–172.1). The pathological threshold of average peak home SBP for 5-year stroke risk was 176 mmHg. There was a linear association between the number of times peak home SBP &gt;175 mmHg and stroke risk. Conclusions: Peak home BP was a strong risk factor for stroke, especially within the first 5 years. We propose exaggerated peak home SBP &gt;175 mmHg as an early and strong novel risk factor for stroke.

ELEVATED GROWTH AND DIFFERENTIATION FACTOR 15 (GDF-15) LEVELS AMPLIFIES THE ASSOCIATION BETWEEN HOME BLOOD PRESSURE VARIABILITY AND CARDIOVASCULAR OUTCOME

Objective: Growth and differentiation factor 15 (GDF-15) is a marker of cell senescence. Although age is strongly determinant of GDF-15 level, several studies suggest that GDF-15 reflects biological age rather than chronological age. Since age is also associated with increased blood pressure variability, we hypothesized that the association between day-by-day home blood pressure variability (HBPV) and cardiovascular outcome may be steeper in patients with elevated GDF-15. Design and method: We analyzed 4030 patients from a practitioner-based population (mean±SD age 64.9±10.9 years: 79.0% taking antihypertensive medication) with at least one cardiovascular risk factor who underwent home blood pressure monitoring in the Japan Morning Surge-Home Blood Pressure Study. The standard deviation was assessed as indexes of day-by-day home systolic blood pressure variability. We divided patients into elevated (1200 ng/L or more) and non-elevated GDF-15 (less than 1200 ng/L) groups. Results: During a mean follow-up of 6.2 years, 247 cardiovascular events occurred. Participants with the highest HBPV tertile without elevated GDF-15 (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.03-2.23) or those with elevated GDF-15 without the highest BPV tertile (HR, 1.52; 95%CI, 1.03-2.16) had approximately 1.5-fold higher risk of cardiovascular events compared with those with low HBPV without elevated GDF-15. Adjusted risk of cardiovascular events was approximately 2.3-fold higher among participants with elevated GDF-15 and the highest HBPV tertile, compared with those with low HBPV without elevated GDF-15 (HR, 2.34; 95%CI, 1.58-3.45). Conclusions: We conclude that elevated GDF-15 contributes to the association between home BP variability and cardiovascular events.

ASSOCIATION OF AMBULATORY AND HOME BLOOD PRESSURE VARIABILITY FOR CARDIOVASCULAR OUTCOMES

Objective: Although blood pressure (BP) variability (BPV) is reportedly associated with cardiovascular prognosis, there is no evidence that either ambulatory BPV (ABPV) or home BPV (HBPV) is a superior clinical marker. Design and method: We analyzed the association of ABPV and HBPV with cardiovascular prognosis in 1,319 hypertensive outpatients who underwent both home and ambulatory BP measurements in the Japan Morning Surge-Home Blood Pressure (J-HOP) study. BPV is evaluated by standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) of 24-h ambulatory and average morning and evening home systolic BP. Results: During the median 6.9 years of follow-up, 109 cardiovascular events occurred. All SD, CV, and ARV of HBPV were significantly associated with cardiovascular risk even after adjusted by ABPV (1-SD of HR [95%CI] in SD, CV, and ARV of HBPV: 1.47 [1.23–1.75]; 1.48 [1.24–1.75]; and 1.33 [1.14–1.54]). In the model improvement using goodness-of-fit, HBPV values significantly improved the model predictability when adding to the model including confounding factors and mean 24-h ambulatory SBP and ABPV values. However, these relationships were not shown in ABPV parameters. Conclusions: Based on the findings from this study using both ambulatory and home BP monitoring in the same individuals, HBPV, i.e., day-to-day BPV, was suggested to have superiority in predicting for cardiovascular incidence compared to ABPV, i.e., short-term BPV through 24-hours.

RISK STRATIFICATION OF STAGE B HEART FAILURE USING HOME BLOOD PRESSURE MONITORING AND EFFECT ON THE INCIDENCE OF HEART FAILURE

Objective: Recently, the international guideline recommends use of the universal definition of Stage B heart failure (HF) based on cardiac biomarkers for risk stratification of asymptomatic HF. There is a few study reporting the association between home blood pressure (BP) and the stage B of HF. We thus assessed this issue by using the dataset of the nationwide prospective study regarding home BP monitoring, the Japan Morning Surge Home BP (J-HOP) study. Design and method: In the J-HOP study, 4,310 outpatients with cardiovascular risk were enrolled and underwent a consecutive 14-days home BP monitoring in morning and evening. In the present study, we assessed 3,218 participants after excluding participants with pre-history of HF and other cardiovascular diseases and lack of data in biomarkers. NT-proBNP 125pg/ml or Hs-cTnT &gt;0.014ng/ml in women, &gt;0.022ng/ml in men were defined as the Stage B of HF based on the guideline (n = 604). Results: In the multivariable logistic model, increase of morning home systolic BP was significantly associated with the risk of the stage B of HF (adjusted OR per 10mmHg, 1.25; 95%CI, 1.16–1.33). After followed-up of median 6 years, 19 patients were hospitalized for HF. The stage B of HF was at greater risk of developing heart failure than the stage A patients (adjusted HR, 3.76; 95% CI, 1.40–10.06) in the multivariable Cox model. Conclusions: From our findings, morning home BP might be useful for risk stratification of early stage of HF.

Peak home blood pressure as an earlier and strong novel risk factor for stroke: the practitioner-based nationwide J-HOP study extended.

While home blood pressure (BP) measurement is recommended for hypertension management, the clinical implications of peak home BP values have not been well studied. This study investigated the association between pathological threshold or frequency of peak home BP and cardiovascular events in patients with ≥1 cardiovascular risk factor. The Japan Morning Surge-Home Blood Pressure (J-HOP) study enrolled participants from 2005-2012 with extended follow-up from December 2017 to May 2018, which generated the dataset for this analysis. Average peak home systolic BP (SBP) was defined as average of the highest three BP values on 14-day measurement period. Patients were divided into quintiles of peak home BP, and the risk of stroke, coronary artery disease (CAD) and atherosclerotic cardiovascular disease (ASCVD; stroke+CAD) was determined. In 4231 patients (mean 65 years) followed for 6.2 years there were 94 strokes and 124 CAD events. The adjusted hazard ratio (HR) (95% CI) for the risk of stroke and ASCVD in patients with average peak home SBP in the highest versus lowest quintile was 4.39 (1.85-10.43) and 2.04 (1.24-3.36), respectively. Risk was greatest for stroke in the first 5 years: HR 22.66 (2.98-172.1). The pathological threshold of average peak home SBP for 5-year stroke risk was 176 mmHg. There was a linear association between the number of times peak home SBP > 175 mmHg and stroke risk. Peak home BP was a strong risk factor for stroke, especially within the first 5 years. We propose exaggerated peak home SBP > 175 mmHg as an early and strong novel risk factor for stroke.

Impact of diabetic status and contribution of office and home blood pressure across diabetic status for cardiovascular disease: the J-HOP study.

Few studies have investigated whether the prognostic power of home blood pressure (BP) for cardiovascular disease (CVD) events differs across subjects with different diabetic status. We used the dataset of the J-HOP (Japan Morning Surge-Home Blood Pressure) study, which enrolled patients having cardiovascular risks to investigate relationships between home BP and CVD events. We classified the patients as having diabetes mellitus (DM), prediabetes or normal glucose metabolism (NGM) as follows: for DM, a self-reported history of physician-diagnosed DM and/or use of DM medication, a fasting plasma glucose ≥126 mg/dL, a casual plasma glucose level ≥200 mg/dL or hemoglobin A1c (HbA1c) ≥6.5% (n = 1034); for prediabetes, HbA1c of 5.7-6.4% (n = 1167), and for NGM, those who remained (n = 2024). CVD outcome was defined as coronary artery disease, stroke or heart failure. During a median 6.2 ± 3.8 years of follow-up, 259 CVD events occurred. Analysis found both prediabetes (Unadjusted Hazard ratio [uHR], 1.43; 95% confidence interval [CI], 1.05-1.95), and DM (uHR, 2.13; 95% CI, 1.59-2.85) as risks of CVD compared to NGM. In DM, patients with a 10-mmHg elevation of office systolic BP (SBP) and morning home SBP had 16% and 14% higher risks for CVD events. In the prediabetes group, only an elevated morning home SBP conferred a risk of CVD events (uHR, 1.15; 95% CI, 1.00-1.31), but this association did not hold for the adjusted model. Like DM, prediabetes should be recognized as a risk for CVD events, albeit weakly. Elevated home BP contributes to increased CVD risk in diabetes. Our study demonstrated the impact of prediabetes and diabetes on CVD and the impact of office and home BP on CVD events in each group.

Evening home blood pressure and pulse rate: age-specific associations with nocturia severity.

Previous studies have reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology associated with pulse rate (PR) remains unclear. In the Japan Morning Surge-Home Blood Pressure Study, a self-administered nocturia questionnaire and evening home blood pressure (BP) and PR measurements (taken on a mean of 11.2 days) were performed on 4310 patients with one or more cardiovascular risk factors (mean: 64.9 years old; 47% male). According to the number of nighttime voids, the study population was divided into three groups (no voids: n = 2382; 1 void: n = 847; ≥2 voids per night: n = 1082). In the multinomial logistic regression analysis adjusted for confounders, diuretic use (OR, 1.23; 95%CI, 1.01-1.50; p < 0.05) was significantly associated with one nocturnal void, whereas evening home systolic BP (SBP) (OR per 1 SD, 1.14; 95%CI, 1.05-1.24; p < 0.01) and evening home PR (OR per 1 SD, 1.12; 95%CI: 1.02-1.24; p < 0.05) were significantly associated with multiple nocturnal voids. In the younger group (<65 years), only evening home PR was significantly related to multiple nighttime voids (p < 0.01), whereas in the older group (≥65 years), only evening home SBP was significantly related to multiple nighttime voids (p = 0.02). In this study, both higher evening home PR and higher evening home SBP were associated with multiple nighttime voids, with the former playing a greater role in the younger participants, and the latter more often associating the older group. An age-stratified approach to reduce the burden of BP or PR might be important to improve sleep quality.

PS-BPC03-5: OFFICE AND HOME BLOOD PRESSURE AND CARDIOVASCULAR DISEASE IN PATIENTS WITH DIABETES, PREDIABETES AND NORMAL GLUCOSE METABOLISM

Objective: Few studies have investigated whether the association between home blood pressure (BP) and cardiovascular disease (CVD) events is different according to prediabetes and diabetes populations. The main purpose of this study is to clarify the impact of home BP and office BP on CVD events in prediabetes and diabetes. Design and method: We used the database of the J-HOP (Japan Morning Surge-Home Blood Pressure) study, which enrolled 4,310 patients having at least one cardiovascular risk. We classified the patients with a self-reported clinical history of a physician's diagnosis, using of medication of diabetes mellitus, a fasting plasma glucose greater than or equal to 126 mg/dL, a casual plasma glucose level greater than or equal to 200 mg/dL or hemoglobin A1c (HbA1c;NGSP) greater than or equal to 6.5 % as diabetes (n = 1,034), those with HbA1c 5.7–6.4 % as prediabetes (n = 1,167), and the remaining patients as the patients with normal glucose metabolism (NGM) (n = 2,024). Outcome was measured against composite CVD outcome (first occurrence of coronary artery disease, stroke and heart failure). Results: During a median 6.2 ± 3.8 year follow-up, 259 CVD events occurred. Prediabetes was a risk of CVD events (Unadjusted Hazard ratios [uHR],1.43; 95% confidence interval [CI], 1.05–1.95) and this association was followed by diabetes (uHR, 2.13; 95%CI, 1.59–2.85) compared to NGM. In NGM group, the adjusted HR expressing the risk of composite CVD events, were 1.15 (95%CI, 1.01–1.31) and 1.18 (95%CI, 1.03–1.36), 1.01(95%CI, 0.88–1.15) per 10 mmHg increase of morning and evening home systolic BP (SBP), office SBP, respectively. In diabetes, increased home SBP as a risk of composite CVD events had similar tendency and office SBP was also associated with a risk of CVD (adjusted HR, 1.16; 95%CI, 1.02–1.31). In prediabetes group, only morning home SBP was associated with a risk of CVD events (uHR, 1.15; 95%CI, 1.00–1.31), but was not in adjusted model. Conclusion: Prediabetes was a risk for CVD events as well as diabetes. Increased home BP contributes to CVD risk in diabetes, albeit weakly in prediabetes.

PS-BPC03-2: NIGHTTIME HOME BLOOD PRESSURE WAS ASSOCIATED WITH ADVERSE OUTCOMES IN SUBCLINICAL HEART FAILURE PATIENTS

Objective: Nighttime blood pressure (BP) has stronger association with target organ damage and cardiovascular outcome than office BP, 24-hr BP, and awake BP in hypertensives. However, clinical significance of nocturnal BP, especially home nocturnal BP, was not established in heart failure (HF) patients. We hypothesized that nighttime home BP was associated with adverse outcome and investigated the association between nighttime home BP and the outcome in subclinical HF patients. Design and method: We analyzed 394 patients with NT-proBNP &gt; 125pg/ml from a practitioner-based population with at least one cardiovascular risk factor who underwent home BP monitoring in the Japan Morning Surge-Home Blood Pressure study. Morning, evening and nighttime home BP were measured by validated, automatic, and oscillometric home BP devices, and cardiovascular events were followed up. Results: During a mean follow-up of 4.2 years, 43 cardiovascular events occurred. Morning home SBP, evening home SBP and nighttime home SBP were higher in event group than in non-event group (150 ± 23 vs 140 ± 17 mmHg, p = 0.01, 142 ± 22 vs 131 ± 16 mmHg, p &lt; 0.01, 133 ± 22 vs 125 ± 17 mmHg, p &lt; 0.01, respectively). In multivariate Cox regression analysis adjusting for significant variables, average of evening home SBP, and nighttime home SBP were significant predictors of the outcome (HR 1.02, 95%CI: 1.01–1.04, p = 0.01, HR 1.02, 95%CI: 1.01–1.04, p = 0.03, respectively). When nighttime home SBP of 120mmHg was used as cutoff, nighttime home SBP &gt; 120mmHg was significantly associated with the outcome (HR 2.46, 95%CI 1.06–5.68, p = 0.04). Conclusions: Elevated nighttime home BP was significant predictor of cardiovascular outcomes in subclinical HF patients.

AW-AD-1: SEASONAL VARIATION IN DAY-BY-DAY BLOOD PRESSURE VARIABILITY AND ITS EFFECT ON CARDIOVASCULAR OUTCOMES

Although day-by-day home blood pressure (BP) variability has been associated with cardiovascular disease (CVD) risk, it remains unclear whether this association differs from season to season. The present study aimed to assess seasonal variation in day-by-day home BP variability (BPV) and its association with CVD risk. We analyzed the data from a nationwide, prospective observational study, the J-HOP (Japan Morning Surge-Home Blood Pressure) study, in which 14 consecutive days of home BP monitoring were conducted. The values of standard deviation (SDSBP), coefficient of variation (CVSBP), and average real variability (ARVSBP) of home systolic BP (SBP) were used as indices of day-by-day home BPV. Among 4231 participants (mean age, 64.9 ± 10.9 years, 46.7% male, 91.5% hypertensives), all three day-by-day home BPV indices were lower in summer than winter after adjusting for confounding factors. In winter, SDSBP, CVSBP, and ARVSBP were significantly associated with increased risk of CVD events (coronary artery disease, stroke, heart failure, and aortic dissection) (adjusted HR [95%CI] per 1-SD of SDSBP, 1.27 [1.03, 1.56]; CVSBP, 1.25 [1.03, 1.53]; ARVSBP, 1.44 [1.18, 1.77]). These relationships were also observed in the analysis of quartiles of BPV parameters (adjusted HR [95%CI] compared to the 1st quartile, 4th quartile of SDSBP 2.25 [1.05, 4.81]; CVSBP 2.91 [1.40, 6.03]; ARVSBP 2.71 [1.25, 5.89]). In other seasons, however, there were no significant associations between day-by-day home BPV and CVD event risk. Our findings indicate that day-by-day home BPV measured in winter is more strongly associated with future CVD incidence than that measured in other seasons.

S-37-3: NIGHTTIME AND DAYTIME HOME BLOOD PRESSURE AND THE CARDIOVASCULAR DISEASE INCIDENCE IN TREATMENT-RESISTANT HYPERTENSION

Introduction: Individuals with treatment-resistant hypertension (TRH) often concurrently have obesity, diabetes, or sleep apnea, conditions that confer a high risk of cardiovascular disease (CVD) and are related to nocturnal hypertension. We therefore hypothesized that nighttime home BP may be a superior predictor of CVD events compared to daytime home BP in patients with TRH. Methods: We conducted the present study of 297 patients with TRH, which was defined as uncontrolled office BP (≧140/90 mmHg) with using three classes of medications including diuretics or using ≧4 classes of medications with controlled or uncontrolled BP levels. The patients were among the original 2,545 outpatients in the J-HOP (Japan Morning Surge-Home Blood Pressure) Nocturnal BP study, a nationwide practitioner-based study of nighttime home BP monitoring (HBPM), and underwent consecutive 14-day daytime (morning and evening) HBPM and nighttime HBPM using a device programmed to take nighttime BP measurements at 2:00, 3:00, and 4:00 a.m. (one measurement at each time point, for a total of three readings). The primary CVD outcome during the follow-up period was defined as the development of coronary artery disease, stroke, aortic dissection, or heart failure hospitalization. Result: The mean age of the 297 patients was 65.2 ± 10.5 years; 50.8% were male, and the mean number of antihypertensive medication classes was 3.6 ± 0.6. During a mean follow-up of 6.5 years, 41 CVD events occurred. The primary CVD outcome occurred more frequently in the group of patients with both uncontrolled nighttime home BP (≧120/70 mmHg) and uncontrolled daytime home BP (≧135/85 mmHg) (Figure). The model performance assessed by the C-statistic tended to be improved by adding nighttime home SBP to the base model including confounding factors and office SBP (C-statistic [95%CI], 0.712 [0.652, 0.830] to 0.748 [0.686, 0.851], P = 0.078) and to the model that included the base model and daytime home SBP (C-statistic, 0.714 [0.660, 0.835] to 0.747 [0.702, 0.857], P = 0.065). Adding daytime home SBP did not improve the performance of the base model (C-statistic, 0.712 [0.652, 0.830] to 0.714 [0.660, 0.835], P = 0.872). Conclusion: Our results indicate that nighttime BP measured by the home BP device was associated with an increased risk of CVD events even after adjustment for the daytime home BP level in patients with TRH.