Nighttime Blood Pressure Measured by Home Blood Pressure Monitoring as an Independent Predictor of Cardiovascular Events in General Practice: The J-HOP Nocturnal Blood Pressure Study
Open accessAbstract
We developed an innovative automated home blood pressure (BP) monitoring method that measures BP while asleep repeatedly over several days. Our aim was to assess the predictive ability of nighttime BP obtained using the home BP device for incident cardiovascular disease (CVD) in general practice patients. We used data from the nationwide practice-based J-HOP (Japan Morning Surge–Home Blood Pressure) Nocturnal BP Study, which recruited 2545 Japanese with a history of or risk factors for CVD (mean age 63 years; antihypertensive medication use 83%). The associations between nighttime home BPs (measured at 2:00, 3:00, and 4:00 am using validated, automatic, and oscillometric home BP devices) and incident CVD, including coronary disease and stroke events, were assessed with Cox proportional hazards models. The mean±SD office, morning home, and nighttime home systolic BP (SBP)/diastolic BP were 140±15/82±10, 137±15/79±10, and 121±15/70±9 mm Hg, respectively. During a follow-up of 7.1±3.8 years (18,116 person-years), 152 CVD events occurred. A 10-mm Hg increase of nighttime home SBP was associated with an increased risk of CVD events (hazard ratios [95% CIs]: 1.201 [1.046–1.378]), after adjustments for covariates including office and morning home SBPs. The model fit assessed by the change in Goodness-of-Fit was improved when we added nighttime home SBP into the base models including office and morning home SBPs (Δ6.838 [5.6%]; P =0.009). This is among the first and largest nationwide practice-based study demonstrating that nighttime SBP obtained using a home device is a predictor of incident CVD events, independent of in-office and morning in-home SBP measurement. Clinical Trial Registration—: URL: http://www.umin.ac.jp/icdr/index.html . Unique identifier: UMIN000000894.
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The measurement of asleep BP is made possible by a few models of HBPM, which is better tolerated and provides nocturnal BP readings and predicts cardiovascular events similar to those observed using ABPM.
“However, the measurement of asleep BP is made possible by a few models of HBPM, which is better tolerated and provides nocturnal BP readings and predicts cardiovascular events similar to those observed using ABPM. 48,61”
From Effect and Acceptability of Mindfulness-Based Stress Reduction Program on Patients With Elevated Blood Pressure or Hypertension: A Meta-Analysis of Randomized Controlled Trials (2020) · cites this paper as [48]
The Methods (BP Measurements) describe an HBPM device that takes asleep BP readings, and the Discussion reports that nighttime home BP predicted cardiovascular events, with predictive values that seemed similar to those reported for ABPM. The Discussion and Study Limitations also say the methods were not directly compared and that comparable prognostic prediction remains uncertain. The paper describes discomfort with ABPM but does not establish that the HBPM device was better tolerated or that several models have this capability. (LLM, conf=0.87)
Experimental — accuracy not yet measuredHBPM with automated atrial fibrillation detector might be useful for early detection of asymptomatic atrial fibrillation in elderly individuals with hypertension.
“Two studies have shown that HBPM with automated atrial fibrillation detector might be useful for early detection of asymptomatic atrial fibrillation in elderly individuals with hypertension [219,220].”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [220]
The Methods (BP Measurements; page unavailable) describe an automated device for measuring blood pressure, not an atrial-fibrillation detector. The Methods (Study Subjects; page unavailable) mention atrial fibrillation only as a pre-existing cardiovascular risk factor. A search for atrial fibrillation and automated detection found no passage about early detection of asymptomatic atrial fibrillation. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Kwon, Y., Wiles, C., Parker, B. E., Clark, B. R., Sohn, M., Mariani, S., Hahn, J., Jacobs, D. R., Stein, J. H., Lima, J. A. C., et al. (2021) · Thorax · doi:10.1136/thoraxjnl-2020-216399 · Cited by 33 · see citing works
Kario, K., Nishizawa, M., Kato, M., Ishii, H., Uchiyama, K., Nagai, M., Takahashi, N., Asakura, T., Shiraiwa, T., Yoshida, T., et al. (2023) · Hypertension Research · doi:10.1038/s41440-023-01292-0 · Cited by 28 · see citing works
Self-citationUmishio, W., Ikaga, T., Kario, K., Fujino, Y., Hoshi, T., Ando, S., Suzuki, M., Yoshimura, T., Yoshino, H., & Murakami, S. (2020) · Journal of Hypertension · doi:10.1097/hjh.0000000000002535 · Cited by 27 · see citing works
Self-citationKario, K., Rakugi, H., Yarimizu, D., Morita, Y., Eguchi, S., & Iekushi, K. (2023) · Journal of the American Heart Association · doi:10.1161/jaha.122.027612 · Cited by 27 · see citing works
Self-citationIhm, S., Park, J., Kim, J., Kim, J. H., Kim, K., Lee, E. M., Lee, H.-Y., Park, S., Shin, J.-H., & Kim, C. (2022) · Clinical Hypertension · doi:10.1186/s40885-022-00218-1 · Cited by 31 · see citing works
Hoshide, S., Kario, K., Tomitani, N., Kabutoya, T., Chia, Y. C., Park, S., Shin, J., Turana, Y., Tay, J. C., Buranakitjaroen, P., et al. (2019) · Journal of Clinical Hypertension · doi:10.1111/jch.13763 · Cited by 23 · see citing works
Self-citationNarita, K., Hoshide, S., & Kario, K. (2021) · Hypertension · doi:10.1161/hypertensionaha.121.18534 · Cited by 25 · see citing works
Self-citationKario, K., Tomitani, N., Hoshide, S., Nishizawa, M., Yoshida, T., Kabutoya, T., Fujiwara, T., Mizuno, H., Okawara, Y., Kanegae, H., et al. (2023) · Hypertension · doi:10.1161/hypertensionaha.123.21578 · Cited by 25 · see citing works
Self-citationAsian Expert Consensus on Nocturnal Hypertension Management
Liu, J., Li, Y., Asayama, K., Zhang, X. Y., Cheng, H., Park, S., Kario, K., Mirrakhimov, E. M., & Wang, J. (2025) · Hypertension · doi:10.1161/hypertensionaha.124.24026 · Cited by 26 · see citing works
Self-citationEffect of different treatments for obstructive sleep apnoea on blood pressure
Kou, C., Zhao, X., Lin, X., Fan, X., Wang, Q., & Yu, J. (2022) · Journal of Hypertension · doi:10.1097/hjh.0000000000003131 · Cited by 24 · see citing works
Digital hypertension towards to the anticipation medicine
Kario, K. (2023) · Hypertension Research · doi:10.1038/s41440-023-01409-5 · Cited by 24 · see citing works
Self-citationNocturnal blood pressure surge in seconds is a new determinant of left ventricular mass index
Kokubo, A., Kuwabara, M., Ota, Y., Tomitani, N., Yamashita, S., Shiga, T., & Kario, K. (2021) · Journal of Clinical Hypertension · doi:10.1111/jch.14383 · Cited by 23 · see citing works
Self-citationClinical significance of nocturnal home blood pressure monitoring and nocturnal hypertension in Asia
Fujiwara, T., Hoshide, S., Tomitani, N., Cheng, H., Soenarta, A. A., Turana, Y., Chen, C., Minh, H. V., Sogunuru, G. P., Tay, J. C., et al. (2021) · Journal of Clinical Hypertension · doi:10.1111/jch.14218 · Cited by 23 · see citing works
Self-citationSaeed, S., Romarheim, A., Solheim, E., Bjorvatn, B., & Lehmann, S. (2022) · Expert Review of Cardiovascular Therapy · doi:10.1080/14779072.2022.2081547 · Cited by 20 · see citing works
Hannemann, J., Laing, A., Middleton, B., Cridland, J., Staels, B., Marx, N., Grant, P. J., Federici, M., Stenberg, D., Skene, D. J., et al. (2021) · Journal of Hypertension · doi:10.1097/hjh.0000000000002848 · Cited by 20 · see citing works
Accurate nighttime blood pressure monitoring with less sleep disturbance
Tomitani, N., Hoshide, S., & Kario, K. (2021) · Hypertension Research · doi:10.1038/s41440-021-00745-8 · Cited by 20 · see citing works
Self-citationThe HOPE Asia Network activity for “zero” cardiovascular events in Asia: Overview 2020
Kario, K. (2020) · Journal of Clinical Hypertension · doi:10.1111/jch.13750 · Cited by 18 · see citing works
Self-citationHuang, Y., Chen, L., Li, C., Peng, J., Hu, Q., Sun, Y., Ren, H., Lyu, W., Jin, W., Tian, J., et al. (2024) · Communications Engineering · doi:10.1038/s44172-024-00326-w · Cited by 18 · see citing works
Kabutoya, T., Hoshide, S., & Kario, K. (2019) · Journal of Clinical Hypertension · doi:10.1111/jch.13713 · Cited by 18 · see citing works
Self-citationKario, K. (2019) · Korean Circulation Journal · doi:10.4070/kcj.2019.0246 · Cited by 17 · see citing works
Self-citationXing, Y., Sun, Y., Wang, S., Feng, F., Zhang, D., & Li, H. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02406-4 · Cited by 17 · see citing works
Kario, K., Okawara, Y., Kanegae, H., Tomitani, N., & Hoshide, S. (2024) · Hypertension Research · doi:10.1038/s41440-024-01866-6 · Cited by 16 · see citing works
Self-citationKario, K., Hoshide, S., Kabutoya, T., Nishizawa, M., Yamagiwa, K., Kawashima, A., Fujiwara, T., Nakazato, J., Yoshida, T., Negishi, K., et al. (2024) · Hypertension Research · doi:10.1038/s41440-024-01922-1 · Cited by 16 · see citing works
Self-citationTomitani, N., Kanegae, H., & Kario, K. (2021) · Journal of Clinical Hypertension · doi:10.1111/jch.14237 · Cited by 16 · see citing works
Self-citationNarita, K., Hoshide, S., Ae, R., & Kario, K. (2022) · Journal of Hypertension · doi:10.1097/hjh.0000000000003175 · Cited by 16 · see citing works
Self-citationNighttime Home Blood Pressure in Children
Stambolliu, E., Kollias, A., Bountzona, I., Ntineri, A., Servos, G., Vazeou, A., & Stergiou, G. (2021) · HYPERTENSION · doi:10.1161/hypertensionaha.121.17016 · Cited by 11 · see citing works
Management of hypertension in the digital era: Perspectives and future directions
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Self-citationHuang, P., Huang, C., Lin, S., & Chen, J. (2022) · Journal of Clinical Hypertension · doi:10.1111/jch.14524 · Cited by 14 · see citing works
Cost‐Effectiveness of Radiofrequency Renal Denervation for Uncontrolled Hypertension in Japan
Kario, K., Cao, K. N., Tanaka, Y., Ryschon, A. M., & Pietzsch, J. B. (2024) · Journal of Clinical Hypertension · doi:10.1111/jch.14922 · Cited by 13 · see citing works
Self-citationPerspectives of renal denervation from hypertension to heart failure in Asia
Kario, K., & Wang, T. (2021) · Hypertension Research · doi:10.1038/s41440-021-00751-w · Cited by 13 · see citing works
Self-citationDigital hypertension – what we need for the high-quality management of hypertension in the new era
Kario, K., Asayama, K., Arima, H., Matsumoto, C., Nakagawa, N., Nomura, A., Satoh, M., Shinohara, K., Tomitani, N., Yamamoto, K. I., et al. (2025) · Hypertension Research · doi:10.1038/s41440-025-02307-8 · Cited by 12 · see citing works
Self-citationAltay, S., Fırat, S., Peker, Y., & Collaborators, T. T. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12124144 · Cited by 11 · see citing works
Tomitani, N., Hoshide, S., & Kario, K. (2024) · Hypertension Research · doi:10.1038/s41440-024-02059-x · Cited by 11 · see citing works
Self-citationNocturnal blood pressure: the dark side of white-coat hypertension
Cuspidi, C., Paoletti, F., Tadic, M. V., Sala, C., Gherbesi, E., Dell’Oro, R., Grassi, G. M., & Mancia, G. (2020) · Journal of Hypertension · doi:10.1097/hjh.0000000000002541 · Cited by 12 · see citing works
de la Sierra, A., Ruilope, L. M., Staplin, N., Stergiou, G. S., & Williams, B. (2024) · Journal of Hypertension · doi:10.1097/hjh.0000000000003950 · Cited by 10 · see citing works
Lin, Y., Zeidan, R. S., Lapierre, S., Costello, H. M., Anton, S. D., Buford, T. W., Christou, D. D., Gumz, M. L., Leeuwenburgh, C., Martens, C. R., et al. (2025) · GeroScience · doi:10.1007/s11357-025-01815-2 · Cited by 12 · see citing works
Drozd, A., Kotlęga, D., Nowacki, P., Ciećwież, S. M., Trochanowski, T., & Szczuko, M. (2022) · Biomedicines · doi:10.3390/biomedicines10092200 · Cited by 10 · see citing works
Kokubo, A., Kuwabara, M., Tomitani, N., Yamashita, S., Shiga, T., & Kario, K. (2024) · Hypertension Research · doi:10.1038/s41440-024-01631-9 · Cited by 10 · see citing works
Self-citationFujiwara, T., Hoshide, S., Sheppard, J. P., McManus, R. J., & Kario, K. (2024) · JACC Advances · doi:10.1016/j.jacadv.2024.101352 · Cited by 9 · see citing works
Self-citationFujiwara, T., Hoshide, S., Tomitani, N., Kanegae, H., & Kario, K. (2021) · Journal of Clinical Hypertension · doi:10.1111/jch.14199 · Cited by 8 · see citing works
Self-citationKwon, Y., Baruch, M., Stafford, P. L., Bonner, H., Cho, Y., Mazimba, S., Logan, J. G., Shimbo, D., Park, S.-H., Lin, G.-M., et al. (2021) · Journal of Hypertension · doi:10.1097/hjh.0000000000003041 · Cited by 9 · see citing works
Panula, T., Sirkiä, J., & Kaisti, M. (2023) · IEEE Transactions on Instrumentation and Measurement · doi:10.1109/tim.2023.3267378 · Cited by 9 · see citing works
Perfect 24-hr Blood Pressure Control: Up-to-Date 2020.
Kario, K. (2020) · Current hypertension reviews · doi:10.2174/157340211601191226162545 · Cited by 5 · see citing works
Self-citationState-of-the-art rapid review of the current landscape of digital hypertension
Kario, K., Harada, N., & Okura, A. (2022) · Connected Health · doi:10.20517/ch.2022.02 · Cited by 9 · see citing works
Self-citationToward a personalized chronotherapy of blood pressure
Cornélissen, G., Watanabe, Y., Beaty, L. A., & Otsuka, K. (2025) · Biomedical Journal · doi:10.1016/j.bj.2025.100849 · Cited by 8 · see citing works
Influence of Photoplethysmogram Signal Quality on Pulse Arrival Time during Polysomnography
Rinkevičius, M., Charlton, P. H., Bailón, R., & Marozas, V. (2023) · Sensors · doi:10.3390/s23042220 · Cited by 8 · see citing works
Tomitani, N., Hoshide, S., & Kario, K. (2020) · The Journal of Clinical Hypertension · doi:10.1111/jch.14122 · Cited by 6 · see citing works
Self-citationHome blood pressure monitoring: what does the evidence say?
Khong, T. K., & Fok, H. (2021) · Drug and Therapeutics Bulletin · doi:10.1136/dtb.2021.000025 · Cited by 8 · see citing works
Ito, H., Seki, T., Kawazoe, Y., Takiguchi, T., Akagi, Y., Kubota, K., Miyake, K., OKADA, M., & Ohe, K. (2025) · Hypertension Research · doi:10.1038/s41440-025-02249-1 · Cited by 7 · see citing works
Sun, Q., Pan, Y., Zhao, Y., Liu, Y., & Jiang, Y. (2022) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2022.814756 · Cited by 7 · see citing works
Yang, Y., Pan, Y., Cao, F., Chen, H., & Wang, L. (2025) · Sleep Medicine · doi:10.1016/j.sleep.2025.106667 · Cited by 6 · see citing works
Zhao, D., Liu, H., & Dong, P. (2020) · The American Journal of the Medical Sciences · doi:10.1016/j.amjms.2020.07.031 · Cited by 6 · see citing works
Miniaturization of a Finger-Worn Blood Pressure Instrument
Panula, T., Sirkiä, J., & Kaisti, M. (2021) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc46164.2021.9629790 · Cited by 6 · see citing works
Drapkina, O. M., Korsunsky, D. V., Komkov, D. S., & Калинина, А. М. (2022) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2022-3212 · Cited by 6 · see citing works
Toriumi, S., Hoshide, S., Kabutoya, T., & Kario, K. (2023) · Hypertension Research · doi:10.1038/s41440-023-01487-5 · Cited by 6 · see citing works
Self-citationKario, K., Tomitani, N., Haimoto, K., Narita, K., Komi, R., Koba, S., Shimizu, H., Ohbayashi, H., Fujiwara, T., Kabutoya, T., et al. (2024) · Hypertension Research · doi:10.1038/s41440-024-01930-1 · Cited by 6 · see citing works
Self-citation
- Authors
- Kario, K., Kanegae, H., Tomitani, N., Okawara, Y., Fujiwara, T., Yano, Y., Hoshide, S., & on behalf of the J-HOP Study Group
- Affiliations
- Jichi Medical University (JP)
- JMU Center of Global Home and Ambulatory BP Analysis (GAP), Tochigi, Japan (Y.O.).
- JMU Center of Excellence, Community Medicine Cardiovascular Research and Development (JCARD), Tochigi, Japan (K.K., N.T., T.F., Y.Y., S.H.)
- Corresponding author
- Kario, Kazuomi
- ORCID
- Venue
- Hypertension
- Published
- 2019-06
- Volume
- 73
- Issue
- 6
- Pages
- 1240-1248
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC6510323
- OpenAlex
- W2939115855
- Cited by
- 167
- References
- 36
- Citations by year
- 2026: 14 · 2025: 22 · 2024: 19 · 2023: 17 · 2022: 22 · 2021: 31 · 2020: 30 · 2019: 12
- FWCI
- 17.16
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Hypertension (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- nocturnal blood pressure, home blood pressure monitoring, cardiovascular events, cardiovascular risk prediction, systolic blood pressure, coronary disease, stroke, general practice patients, antihypertensive drugs, oscillometric blood pressure devices
- MeSH terms
- Blood Pressure, Cardiovascular Diseases, Circadian Rhythm, Female, Follow-Up Studies, Humans, Japan, Male, Middle Aged, Prognosis, Systole, Time Factors, Incidence, Blood Pressure Monitoring, Ambulatory, General Practice
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