Published online before print April 16, 2007, doi: 10.1161/HYPERTENSIONAHA.107.090993
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(Hypertension. 2007;49:e40.)
© 2007 American Heart Association, Inc.
Letters to the Editor |
Out-of-Office Blood Pressure Control Among Treated Subjects
Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan, and Tohoku University 21st Century Center of Excellence Program Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Sendai, Japan
Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan, and Tohoku University 21st Century Center of Excellence Program Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Sendai, Japan
Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan, and Tohoku University 21st Century Center of Excellence Program Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Sendai, Japan
Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan
Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan, and Tohoku University 21st Century Center of Excellence Program Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Sendai, Japan
We read with great interest the article by Banegas et al1 dealing with the control of office blood pressure (BP) and daytime ambulatory BP in 12 897 treated patients with hypertension in primary care settings in Spain. They found that office BP was adequately controlled (<140/90 mm Hg) in only 23.6% of their patients. In contrast, daytime ambulatory BP was adequately controlled (<135/85 mm Hg) in 51.6% of patients.
We previously conducted a comparable survey in primary care settings in Japan, which included 3400 treated patients with hypertension, that assessed self-measured BP at home (home BP) as the out-of-office BP: the Japan Home Versus Office Blood Pressure Measurement Evaluation Study.2 We found that, compared with office BP, morning home BP was rather poorly controlled: 42.0% of patients had controlled office BP (<140/90 mm Hg), and 34.8% of patients had controlled morning home BP (<135/85 mm Hg).
The discrepancy between the 2 studies could be partly attributed to the difference in the study methods and the time that the BP measurements were taken, that is, average BP obtained during the daytime in 1 day and the average of multiple BP measurements obtained in the early morning for 2 weeks. We reported previously that a high morning home BP was associated with a higher risk of stroke, especially in patients treated with antihypertensive medication.3 A high morning BP is accompanied by sustained elevation of nocturnal BP (nondipper and inverted dipper) and a morning BP surge. This suggests that, in subjects taking antihypertensive medication, an insufficient duration of antihypertensive drug action only partly medicates a nondipping pattern of circadian BP variation.4 It is essential to evaluate patients’ cardiovascular risk based on their nocturnal BP and the presence of a morning BP surge.5
The other possible reason for the discrepancy between the 2 studies in the out-of-office BP control status might be the difference in the proportions of patients who took antihypertensive drugs in the morning alone (80.2% in Spain and 68.0% in Japan).1,2 It has been shown that even the newer, long-acting antihypertensive drugs do not necessarily lower BP throughout the entire day. Because most patients in the Spanish study were given antihypertensive drugs only in the morning, it is possible that the effect did not persist into the night and that the control of nocturnal BP might have been less sufficient than that of daytime BP. Therefore, we would be interested in knowing the degree of nocturnal BP control that was present in their study.
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Acknowledgments |
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Disclosures
None.
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References |
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 Top References |
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1. Banegas JR, Segura J, Sobrino J, Rodriguez-Artalejo F, de la Sierra A, de la Cruz JJ, Gorostidi M, Sarria A, Ruilope LM; Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry Investigators. Evaluation of control condition of out-of-office BP among treated subjects. Hypertension. 2007; 49: 62–68.
2. Obara T, Ohkubo T, Funahashi J, Kikuya M, Asayama K, Metoki H, Oikawa T, Hashimoto J, Totsune K, Imai Y. Isolated uncontrolled hypertension at home and in the office among treated hypertensive patients from the J-HOME study. J Hypertens. 2005; 23: 1653–1660.[Medline] [Order article via Infotrieve]
3. Asayama K, Ohkubo T, Kikuya M, Obara T, Metoki H, Inoue R, Hara A, Hirose T, Hoshi H, Hashimoto J, Totsune K, Satoh H, Imai Y. Prediction of stroke by home "morning" versus "evening" blood pressure values: the Ohasama study. Hypertension. 2006; 48: 737–743.
4. Chonan K, Hashimoto J, Ohkubo T, Tsuji I, Nagai K, Kikuya M, Hozawa A, Matsubara M, Suzuki M, Fujiwara T, Araki T, Satoh H, Hisamichi S, Imai Y. Insufficient duration of action of antihypertensive drugs mediates high blood pressure in the morning in hypertensive population: the Ohasama study. Clin Exp Hypertens. 2002; 24: 261–275.[CrossRef][Medline] [Order article via Infotrieve]
5. Metoki H, Ohkubo T, Kikuya M, Asayama K, Obara T, Hashimoto J, Totsune K, Hoshi H, Satoh H, Imai Y. Prognostic significance for stroke of a morning pressor surge and a nocturnal blood pressure decline: the Ohasama study. Hypertension. 2006; 47: 149–154.
This article has been cited by other articles:
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  J. R. Banegas, A. de la Sierra, J. Segura, J. J. de la Cruz, and L. M. Ruilope Response to Out-of-Office Blood Pressure Control Among Treated Subjects Hypertension, June 1, 2007; 49(6): e42 - e42. [Full Text] [PDF]
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