Why the study?
Does morning home blood pressure measurement provide better predictive ability for asymptomatic organ damage compared to evening home blood pressure in patients with cardiovascular risk factors?
Does morning home blood pressure measurement provide better predictive ability for asymptomatic organ damage compared to evening home blood pressure in patients with cardiovascular risk factors?
Morning home blood pressure provides superior stand-alone predictive ability for subclinical target organ damage compared to evening blood pressure, though both offer useful information.
Morning home SBP may better indicate subclinical damage than evening; leaves open whether timing should alter risk stratification or trials.
BACKGROUND: Several guidelines recommend that home blood pressure (HBP) be measured both in the morning and in the evening. However, there have been fewer reports about the clinical significance of morning HBP than about the clinical significance of evening HBP. METHODS: Our study included 4,310 patients recruited for the Japan Morning Surge Home Blood Pressure Study who had one or more cardiovascular risk factors. We measured morning and evening HBP, urinary albumin-creatinine ratio (UACR), left ventricular mass index (LVMI), brachial-ankle pulse wave velocity (baPWV), maximum carotid intima media thickness (IMT), N-terminal pro-brain-type natriuretic peptide (NT-proBNP), and high-sensitivity cardiac troponin T (Hs-cTnT). RESULTS: The correlation coefficients for the associations between morning systolic BP (SBP) and log-transformed baPWV, NT-proBNP, or Hs-cTnT were significantly greater than the corresponding relationships for evening SBP (all P < 0.01). The goodness-of-fit of the associations between morning home SBP and UACR (P < 0.05) or baPWV (P < 0.01) was improved by adding evening home SBP to the SBP measurement. In contrast, the goodness-of-fit values of the associations between evening SBP and UACR (P < 0.001), LVMI (P < 0.05), baPWV (P < 0.001), NT-proBNP (P < 0.001), and Hs-cTnT (P < 0.001) were improved by adding morning home SBP to the SBP measurement. CONCLUSIONS: Morning BP and evening BP provide equally useful information for subclinical target organ damage, yet multivariate modeling highlighted the stand-alone predictive ability of morning BP.
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Hoshide et al. (2014) studied this question.
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