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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
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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![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.](/paper-figures/62c7a761130345ac8b2e4733a462a2ba/nighttime-blood-pressure-measured-by-home-blood-pressure-monitoring-as-an-figure-1.jpg)
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“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]
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“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]
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2018 ESC/ESH Guidelines for the management of arterial hypertension
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Self-citationStroke Prognosis and Abnormal Nocturnal Blood Pressure Falls in Older Hypertensives
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Self-citationCall to Action on Use and Reimbursement for Home Blood Pressure Monitoring
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Self-citationNocturnal Hypertension: New Technology and Evidence
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Self-citationImai, Y., Kario, K., Shimada, K., Kawano, Y., Hasebe, N., Matsuura, H., Tsuchihashi, T., Ohkubo, T., Kuwajima, I., & Miyakawa, M. (2012) · Hypertension Research · doi:10.1038/hr.2012.56 · Cited by 204
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Self-citationNighttime Home Blood Pressure and the Risk of Hypertensive Target Organ Damage
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Self-citationNocturnal blood pressure measured by home devices: evidence and perspective for clinical application
Asayama, K., Fujiwara, T., Hoshide, S., Ohkubo, T., Kario, K., Stergiou, G. S., Parati, G., White, W. B., Weber, M. A., & Imai, Y. (2019) · Journal of Hypertension · doi:10.1097/hjh.0000000000001987 · Cited by 120
Self-citationDevice for the self-measurement of blood pressure that can monitor blood pressure during sleep
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Kario, K., Tomitani, N., Kanegae, H., Ishii, H., Uchiyama, K., Yamagiwa, K., Shiraiwa, T., Katsuya, T., Yoshida, T., Kanda, K., et al. (2017) · Circulation Journal · doi:10.1253/circj.cj-17-0109 · Cited by 71
Self-citationReproducibility of Nocturnal Blood Pressure Assessed by Self-Measurement of Blood Pressure at Home
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Isolated Nocturnal Hypertension: What Do We Know and What Can We Do?
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Self-citationNight-time home versus ambulatory blood pressure in determining target organ damage
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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
- 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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