The Importance of Home Blood Pressure Measurement for Preventing Stroke and Cardiovascular Disease in Hypertensive Patients: A Sub-Analysis of the Japan Hypertension Evaluation with Angiotensin II Antagonist Losartan Therapy (J-HEALTH) Study, a Prospective Nationwide Observational Study
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Key result
Masked hypertension was associated with a non-significant increase in cardiovascular events compared to well-controlled hypertension (RR 2.00), though its risk profile was similar to poorly controlled hypertension.
Why the study?
Does masked hypertension increase the risk of cardiovascular events compared to well-controlled hypertension in treated Japanese patients?
Population
4,596 Japanese hypertensive patients receiving treatment, mean age 60.8 years, 43.2% men.
Comparison
Masked hypertension, poorly controlled… vs Well-controlled hypertension
Design
Cohort
Follow-up
mean 3.5 years
Authors
Discussion
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Member takes
Implication
Does not support treatment escalation for masked hypertension; leaves open its independent prognostic role in larger cohorts.
Study Design
Type
Observational (n=4,596)
Multicenter
Yes
Structured PICO
Does masked hypertension increase the risk of cardiovascular events compared to well-controlled hypertension in treated Japanese patients?
P
Population
4,596 Japanese hypertensive patients aged 20 years or older, receiving losartan-based therapy, followed for a mean of 3.5 years to assess the relationship between home blood pressure and cardiovascular events.
E
Exposure
Masked hypertension, poorly controlled hypertension, and white-coat hypertension (identified via home and clinic blood pressure monitoring)
C
Comparator
Well-controlled hypertension
O
Outcome
Occurrence of cardiovascular events and strokehard clinical
Main Result
Relative Risk: 2 (95% CI 0.67–5.98)
Absolute Event Rate: 4.41% vs 2.04%
p-value: p=0.215
Limitations
- Not a randomized controlled trial but a prospective observational study without a set target blood pressure, leading to variable treatment intensity.
- Home blood pressure measurement was not mandatory and was based on physician or patient preference, potentially introducing selection bias.
- The low number of cardiovascular events may have limited the statistical power to detect significant differences among the hypertension subgroups.
- Further investigation is required to fully characterize the cardiovascular risks associated with masked HT among Japanese patients receiving treatment
Cite This Study
Shimada et al. (2008) conducted an observational in Hypertension (n=4,596). Masked hypertension vs. Well-controlled hypertension was evaluated on Cardiovascular events (stroke and myocardial infarction) (RR 2.00, 95% CI 0.67-5.98, p=0.215). Masked hypertension was associated with a non-significant increase in cardiovascular events compared to well-controlled hypertension (RR 2.00), though its risk profile was similar to poorly controlled hypertension.
Topics
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