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Assessment of the reductions in night-time blood pressure and dipping induced by antihypertensive medication using a home blood pressure monitor

Ishikawa, Joji; Shimizu, Motohiro; Sugiyama Edison, Eijiro; Yano, Yuichiro; Hoshide, Satoshi; Eguchi, Kauzo; Kario, Kazuomi; J-TOP (Japan Morning Surge-Target Organ Protection) Study Investigators Group

doi: 10.1097/HJH.0b013e328365c8a8
ORIGINAL PAPERS: BP measurement

Background: Night-time blood pressure (BP) is strongly associated with hypertensive target organ damage; however, no previous studies have compared home BP monitor measurements of the reduction in night-time BP induced by antihypertensive medications with those obtained with ambulatory BP monitors.

Methods: As part of the Japan Morning Surge-Target Organ Protection study, in which candesartan (thiazide diuretics were added, if needed) was administered to hypertensive patients in the morning or at bedtime, 50 hypertensive patients had their night-time home and ambulatory BP successfully measured at the baseline and 6 months. In addition, three night-time home BP readings were taken during sleeping hours (at 2, 3, and 4 o’clock) for 6 months.

Results: The mean reduction in night-time BP did not differ significantly between home and ambulatory BP monitoring (10.4 ± 17.9/6.0 ± 12.0 vs. 13.3 ± 14.6/7.6 ± 8.9 mmHg, P = 0.219/0.344), but the differences varied among individual patients. The reduction in night-time BP according to home BP monitoring was significantly correlated with the value obtained with ambulatory BP monitoring (r = 0.51/0.38, P < 0.001/=0.006). The reduction in night-time SBP according to home BP monitoring was significantly correlated with the reductions in left ventricular mass index (r = 0.385, P = 0.013, N = 41) and Sokolow–Lyon voltage (r = 0.335, P = 0.035, N = 40).

Conclusion: Home BP monitoring produces estimates of mean night-time BP reductions comparable to those from ambulatory monitoring, while the differences varied among individual patients. The reduction in night-time home BP according to home BP monitoring is significantly correlated with the reduction in left ventricular hypertrophy.

Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan

Correspondence to Kazuomi Kario, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan. Tel: +81 285587344; fax: +81 285442132; e-mail: kkario@jichi.ac.jp

Abbreviations: BP, blood pressure; IVSTD, diastolic interventricular septal diameter; J-TOP Study, Japan Morning Surge-Target Organ Protection Study; LVIDD, diastolic left ventricular dimension; LVM, left ventricular mass; LVMI, left ventricular mass index; PWTD, diastolic posterior wall diameter; SAMPLE Study, Study on Ambulatory Monitoring of Blood Pressure and Lisinopril Evaluation Study

Received 22 June, 2013

Revised 7 August, 2013

Accepted 13 August, 2013

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