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Characteristics of resistant hypertension determined by self-measured blood pressure at home and office blood pressure measurements: the J-HOME study

Oikawa, Takuyaa; Obara, Takua,c; Ohkubo, Takayoshib,c; Kikuya, Masahirob; Asayama, Keic; Metoki, Hirohitoa,c; Komai, Riea; Murai, Kayob; Hashimoto, Junichirob,c; Totsune, Kazuhitoa,c; Imai, Yutakaa,cthe J-HOME study group

doi: 10.1097/01.hjh.0000242397.53214.27
Original papers: Blood pressure measurement
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Objectives To diagnose resistant hypertension using self-measured blood pressure (BP) at home and office BP, and to evaluate the characteristics of resistant hypertensive patients.

Methods The subjects were 528 hypertensive patients taking at least three or more different antihypertensive drugs. Subjects were classified into four groups (controlled hypertension, isolated office resistant hypertension, isolated home resistant hypertension and sustained resistant hypertension) on the basis of the cut-off values of home BP (135/85 mmHg) and office BP (140/90 mmHg). The relationship between each resistant hypertension group and various factors was analysed using univariate and multivariate analyses.

Results Of the 528 patients, 17.8% were classified with controlled hypertension, 16.1% with isolated office resistant hypertension, 23.5% with isolated home resistant hypertension and 42.6% with sustained resistant hypertension. The presence of hypercholesterolemia was found to have a significant and independent association with isolated office resistant hypertension. Higher office systolic blood pressure (SBP), a past history of ischaemic heart disease, and a lower prescription rate of potassium-sparing diuretics were found to have a significant and independent association with isolated home resistant hypertension. Patients with sustained resistant hypertension had a significantly lower prescription rate of potassium-sparing diuretics than those with controlled hypertension.

Conclusions The present study demonstrated that resistant hypertension is mediated at least partly by the white-coat effect. Home BP measurements and other relevant factors associated with resistant hypertension, such as relatively higher office SBP, type of drugs prescribed, and cardiovascular complications, should be taken into account for the diagnosis and treatment of resistant hypertension.

aDepartments of Clinical Pharmacology and Therapeutics, Japan

bPlanning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Science and Medicine, Japan

cTohoku University 21st Century COE Program ‘Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation’, Sendai, Japan

Received 7 November, 2005

Accepted 26 April, 2006

Correspondence and requests for reprints to Takayoshi Ohkubo, MD, PhD, Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Science, 1-1 Seiryo-cho, Aobaku, Sendai, 980-8574, Japan Tel: +81 22 717 8590; fax: +81 22 717 8591; e-mail: tohkubo@mail.tains.tohoku.ac.jp

Sponsorship: This work was supported by health science research grants on health services (13072101, H12-Medical Care-002) from the Ministry of Health, Labor and Welfare, and by Nouvelle Place Inc., Japan.

© 2006 Lippincott Williams & Wilkins, Inc.