Determinants of Exaggerated Difference in Morning and Evening Blood Pressure Measured by Self-measured Blood Pressure Monitoring in Medicated Hypertensive Patients: Jichi Morning Hypertension Research (J-MORE) Study

• Published in: American journal of hypertension 2005-07, Vol.18 (7), p.958-965
• Main Authors: Ishikawa, Joji, Kario, Kazuomi, Hoshide, Satoshi, Eguchi, Kazuo, Morinari, Masato, Kaneda, Ruri, Umeda, Yuji, Ishikawa, Shizukiyo, Kuroda, Toshio, Hojo, Yukihiro, Shimada, Kazuyuki
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - adverse effects; Adrenergic beta-Antagonists - therapeutic use; Adult; Age Factors; Aged; Aged, 80 and over; Alcohol Drinking - physiopathology; Antihypertensive Agents - therapeutic use; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - physiology; Blood Pressure Determination; Cardiology. Vascular system; Circadian Rhythm - physiology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Female; Fundamental and applied biological sciences. Psychology; Heart Rate - drug effects; Hemodynamics. Rheology; Humans; hypertension; Hypertension - drug therapy; Hypertension - physiopathology; Japan - epidemiology; Male; Medical sciences; Middle Aged; morning surge; Regression Analysis; Risk Factors; Self-measured blood pressure monitoring; Sex Factors; Smoking - physiopathology; Vertebrates: cardiovascular system
• ISSN: 0895-7061; 1879-1905; 1941-7225
• DOI: 10.1016/j.amjhyper.2005.01.013

Morning blood pressure (BP) surge in ambulatory BP monitoring was a risk factor for stroke in our previous study. We studied the determinants of the morning minus evening systolic BP difference (ME difference) in self-measured BP monitoring, as a possible risk factor for stroke in medicated hypertensive patients. Nine hundred sixty-nine hypertensive outpatients receiving stable antihypertensive drug treatment were studied using self-measured BP monitoring in the morning and evening. The ME difference ranged from −37.3 to 53.3 mm Hg (mean 7.9 mm Hg). The highest quartile (Q4) of the ME difference group (>15.0 mm Hg) had older age (68.0 ± 9.8 years v 66.2 ± 10.3 years, P = .01) and higher prevalence of men (48.3% v 39.9%, P = .02), regular alcohol drinkers (34.7% v 26.0%, P = .01) and β-blocker use (26.9% v 19.9%, P = .03) than the other quartile groups (Q1 to Q3), whereas there was no significant difference in the average of morning and evening (ME average) BP. In logistic regression analysis controlling for ME average and other confounding factors, independent risks for Q4 of ME difference were older age (10 years older: odds ratio [OR] 1.21, P = .01, 95% confidence interval (CI) 1.04–1.42), regular alcohol drinker (OR 1.51, P = .04, 95% CI 1.01–2.26), and β-blocker use (OR 1.50, P = .02, 95% CI 1.06–2.12). Older age, β-blocker use, and regular alcohol drinking were significant determinants of the exaggerated ME difference in medicated hypertensive patients.