Published Online
on September 4, 2006

A more recent version of this article appeared on October 1, 2006

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Submitted on April 3, 2006
Revised on April 7, 2006

Prediction of Stroke by Home "Morning" Versus "Evening" Blood Pressure Values. The Ohasama Study

Kei Asayama^*; Takayoshi Ohkubo; Masahiro Kikuya; Taku Obara; Hirohito Metoki; Ryusuke Inoue; Azusa Hara; Takuo Hirose; Haruhisa Hoshi; Junichiro Hashimoto; Kazuhito Totsune; Hiroshi Satoh; and Yutaka Imai

From the Departments of Planning for Drug Development and Clinical Evaluation (K.A., T.O., J.H., Y.I.), Clinical Pharmacology and Therapeutics (M.K., T.O., H.M., A.H., T.H., K.T., Y.I.), and Environmental Health Sciences (H.S.), Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation (K.A., T.O., H.M., R.I., J.H., K.T., H.S., Y.I.), Tohoku University 21st Century Center of Excellence Program, Sendai, Japan; and Ohasama Hospital (H.H.), Hanamaki, Japan.

^* To whom correspondence should be addressed. E-mail: keitish{at}fc5.so-net.ne.jp.

Abstract--Predictive power of self-measured blood pressure at home (home BP) for cardiovascular disease risk has been reported to be higher than casual-screening BP. However, the differential prognostic significance of home BP in the morning (morning BP) and in the evening (evening BP), respectively, has not been elucidated. In the Ohasama study, 1766 subjects (40 years) were followed up for an average of 11 years. The predictive power for stroke incidence of evening BP was compared with that of morning BP as continuous variables. The Cox regression model demonstrated that evening BP and morning BP predicted future stroke risk equally. Subjects were also assigned to 1 of 4 categories based on home BP. In this analysis, stroke risk in morning hypertension ([HT] morning BP 135/85 mm Hg and evening BP <135/85 mm Hg; relative hazard (RH): 2.66; 95% CI:1.64 to 4.33) and that in sustained HT(morning BP and evening BP 135/85 mm Hg; RH: 2.38; 95% CI: 1.65 to 3.45) was significantly higher than that in normotension (morning BP and evening BP <135/85 mm Hg). The risk in morning HT was more remarkable in subjects taking antihypertensive medication (RH: 3.55; 95% CI: 1.70 to 7.38). Although the risk in evening HT (morning BP <135/85 mm Hg and evening BP 135/85 mm Hg) was higher than that in normotension, the differences were not significant. In conclusion, morning BP and evening BP provide equally useful information for stroke risk, whereas morning HT, which indicates HT specifically observed in the morning, might be a good predictor of stroke, particularly among individuals using anti-HT medication.

Key words: self-measurement • home blood pressure • stroke • general population • morning-home blood pressure • evening-home blood pressure • Ohasama study

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