An alpha-adrenergic blocker titrated by self-measured blood pressure recordings lowered blood pressure and microalbuminuria in patients with morning hypertension: the Japan Morning Surge-1 Study.
BACKGROUND
The impact on microalbuminuria of strict treatment aimed at lowering of self-measured morning blood pressure using an adrenergic blockade is unclear.


METHODS
We conducted an open-label multicenter trial, the Japan Morning Surge-1 Study, that enrolled 611 hypertensive patients, whose self-measured morning systolic blood pressure levels were more than 135 mmHg while taking antihypertensive drugs. These were randomly allocated to an experimental group, whose members received bedtime administration of 1-4 mg doxazosin (doxazosin group) or a control group whose members continued without any add-on medication (control group). The urinary albumin/creatinine ratio was investigated at the baseline and 6 months after the randomization.


RESULTS
Both the morning and evening blood pressures and urinary albumin/creatinine ratio (-3.4 vs. 0.0 mg/gCr for urinary albumin/creatinine ratio; P < 0.001) were more markedly reduced in the doxazosin group than in the control group. This difference in the urinary albumin/creatinine ratio between the two groups was more marked in the patients with microalbuminuria (n = 238, -27.9 vs. -8.1 mg/gCr, P < 0.001). The reduction of urinary albumin/creatinine ratio was significantly associated with the use of doxazosin, and the change in all self-measured blood pressures (morning, evening, the average morning-evening), and these associations were independent of each other (P < 0.001).


CONCLUSIONS
Adding a bedtime dose of an alpha-adrenergic blocker titrated by self-measured morning blood pressure in treated hypertensive patients with uncontrolled morning hypertension significantly reduced blood pressure and urinary albumin excretion rate, particularly in those with microalbuminuria.
Kario
Kazuomi
K
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. kkario@jichi.ac.jp
Matsui
Yoshio
Y
Shibasaki
Seiichi
S
Eguchi
Kazuo
K
Ishikawa
Joji
J
Hoshide
Satoshi
S
Ishikawa
Shizukiyo
S
Kabutoya
Tomoyuki
T
Schwartz
Joseph E
JE
Pickering
Thomas G
TG
Shimada
Kazuyuki
K
D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D001795:Blood Pressure Determination; D002940:Circadian Rhythm / Q000502:physiology; D003404:Creatinine / Q000652:urine; D017292:Doxazosin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D007564:Japan; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D012646:Self Administration
D000317:Adrenergic alpha-Antagonists; D003404:Creatinine; D017292:Doxazosin