Home BP monitoring essential for managing hypertension
Home blood pressure (BP) monitoring is important in the management of hypertension, especially morning and nocturnal hypertension, according to a presentation at APCH 2017.
It is extremely important to control morning BP as it is the strongest independent predictor of stroke, said Dr Kazuomi Kario from the Jichi Medical University Department of Medicine in Tochigi, Japan. “For stroke and coronary artery disease (CAD), morning is the [riskiest] time [as] BP simultaneously increases in the morning.”
Previous evidence has shown a higher prevalence of silent cerebral infarcts and a higher incidence of stroke events among hypertensive elderly patients with morning BP surges. [Circulation 2003;107:1401-1406] Moreover, Asians were found to have a higher risk of stroke and CAD compared with Caucasians, [Hypertension 2007;50:991-997] and Japanese individuals particularly exhibited higher morning BP levels and BP surges vs Caucasians. [Hypertension 2015;66:750-756; Circ J 2017;81:1337-1345]
Kario and his colleagues indicated that controlling morning hypertension (≥135/85 mm Hg) could be clinically relevant in the therapeutic management of hypertension and in the prevention of cardiovascular complications. [J Hypertens 2017;35:1554-1563; Am J Hypertens 2005;18:149-151]
“Uncontrolled morning BP during trough effect hours could be a hallmark of inadequate antihypertensive regimen such as the use of short-acting or intermediate-acting drugs, under-dosing of drugs, or no or low use of combination therapy,” said Kario.
On the other hand, uncontrolled nocturnal hypertension (sleep systolic BP of ≥120 mm Hg), which was found to be associated with a higher UACR# and NTproBNP##, [Hypertension 2012;60:912-928; Hypertension 2015;17:340-348] could be the unrevealed target of antihypertensive treatment, said Kario.
Given the cardiovascular outcomes associated with morning and nocturnal hypertension, having access to a home BP monitoring system would help patients achieve the ideal morning and nocturnal BP levels, said Kario.
An ICT###-based home BP monitoring system is a potential alternative to an ambulatory BP monitoring system as this will enable patients to self-monitor their BP levels as shown in the NOCTURNE* trial. [Circ J 2017;81:948-957; Prog Cardiovasc Dis 2016;59:262-281]
Kario recommended an ICT-based stratified strategy to achieve a ‘zero’ cardiovascular event rate in the future or a ‘perfect 24-hour BP control’ by monitoring the nocturnal BP dipping, BP variability, and the morning surge. [Hypertens 2017;31:231-243; Hypertension 2015;65:1163-1169]
“The [individualized] home BP-guided approach [could] be the best approach to increase the quality of management of hypertension … [I]ts use in clinical care would add considerably to improving hypertension outcomes in Asia,” concluded Kario.