title: Prediction of stroke by home "morning" versus "evening" blood pressure values: the Ohasama study.
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 (>or=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 >or=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 >or=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 >or=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.
authors.affiliation: Department of Planning for Drug Development and Clinical Evaluation, Tohoku University 21st Century Center of Excellence Program, Sendai, Japan. keitish@fc5.so-net.ne.jp
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kikuya
authors.forename: Taku
authors.initials: T
authors.lastname: Obara
authors.forename: Hirohito
authors.initials: H
authors.lastname: Metoki
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Inoue
authors.forename: Azusa
authors.initials: A
authors.lastname: Hara
authors.forename: Takuo
authors.initials: T
authors.lastname: Hirose
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Hoshi
authors.forename: Junichiro
authors.initials: J
authors.lastname: Hashimoto
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Totsune
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Satoh
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination / Q000379:methods*; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012648:Self Care; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*
chemical_list: D000959:Antihypertensive Agents