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Cited by 167Blood Pressure and Hypertension StudiesCardiovascular Health and Disease PreventionSodium Intake and Health

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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

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Kario, Kazuomi, Kanegae, Hiroshi, Tomitani, Naoko, Okawara, Yukie, Fujiwara, Takeshi, Yano, Yuichiro, Hoshide, Satoshi, on behalf of the J-HOP Study Group·2019·Hypertension
DOI 10.1161/hypertensionaha.118.12740PMC PMC6510323
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Abstract

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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Figure 1. Hazard ratios for cardiovascular events according to quintiles of nighttime home systolic blood pressure (average of the values at 2:00, 3:00, and 4:00 am; n=2545). Hazard ratios are adjusted by demographic variables (age and sex), clinical characteristics at baseline (body mass index, past history of cardiovascular disease (CVD), diabetes mellitus, total cholesterol, HDL [high-density lipoprotein]-cholesterol, smoking, and the use of antihypertensive drugs, statins, and aspirin), and office and morning home systolic blood pressures. The second quintile (Q2) was taken as the reference. CAD indicates coronary artery disease.
Figure 1. Hazard ratios for cardiovascular events according to quintiles of nighttime home systolic blood pressure (average of the values at 2:00, 3:00, and 4:00 am; n=2545). Hazard ratios are adjusted by demographic variables (age and sex), clinical characteristics at baseline (body mass index, past history of cardiovascular disease (CVD), diabetes mellitus, total cholesterol, HDL [high-density lipoprotein]-cholesterol, smoking, and the use of antihypertensive drugs, statins, and aspirin), and office and morning home systolic blood pressures. The second quintile (Q2) was taken as the reference. CAD indicates coronary artery disease.CC BY-NC-ND · PubMed Central
Figure 2. Kaplan-Meyer curve of cardiovascular events in quintiles (Qs) of nighttime home systolic blood pressure (average of the values at 2:00, 3:00, and 4:00 am).
Figure 2. Kaplan-Meyer curve of cardiovascular events in quintiles (Qs) of nighttime home systolic blood pressure (average of the values at 2:00, 3:00, and 4:00 am).CC BY-NC-ND · PubMed Central

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Metadata

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
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-06
Volume
73
Issue
6
Pages
1240-1248
ISSN
  • 0194-911X (ISSN-L)
  • 1524-4563
DOI
10.1161/hypertensionaha.118.12740
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
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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