title: Morning and Evening Home Blood Pressure and Risks of Incident Stroke and Coronary Artery Disease in the Japanese General Practice Population: The Japan Morning Surge-Home Blood Pressure Study.
abstract: Our aim is to determine the optimal time schedule for home blood pressure (BP) monitoring that best predicts stroke and coronary artery disease in general practice. The Japan Morning Surge-Home Blood Pressure (J-HOP) study is a nationwide practice-based study that included 4310 Japanese with a history of or risk factors for cardiovascular disease, or both (mean age, 65 years; 79% used antihypertensive medication). Home BP measures were taken twice daily (morning and evening) over 14 days at baseline. During a mean follow-up of 4 years (16 929 person-years), 74 stroke and 77 coronary artery disease events occurred. Morning systolic BP (SBP) improved the discrimination of incident stroke (C statistics, 0.802; 95% confidence interval, 0.692-0.911) beyond traditional risk factors including office SBP (0.756; 0.646-0.866), whereas the changes were smaller with evening SBP (0.764; 0.653-0.874). The addition of evening SBP to the model (including traditional risk factors plus morning SBP) significantly reduced the discrimination of incident stroke (C statistics difference, -0.008; 95% confidence interval: -0.015 to -0.008; P=0.03). The category-free net reclassification improvement (0.3606; 95% confidence interval, 0.1317-0.5896), absolute integrated discrimination improvement (0.015; SE, 0.005), and relative integrated discrimination improvement (58.3%; all P<0.01) with the addition of morning SBP to the model (including traditional risk factors) were greater than those with evening SBP and with combined morning and evening SBP. Neither morning nor evening SBP improved coronary artery disease risk prediction. Morning home SBP itself should be evaluated to ensure best stroke prediction in clinical practice, at least in Japan. This should be confirmed in the different ethnic groups.
  
  
  
  URL: http://www.umin.ac.jp/ctr/. Unique identifier: UMIN000000894.
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine (S.H., M.F., K.E., K.K.) and Department of Sleep and Circadian Cardiology (S.H.), Jichi Medical University School of Medicine, Tochigi, Japan; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Haimoto Clinic, Aichi, Japan (H.H.); Yamagiwa Clinic, Aichi, Japan (K.Y.); Oooka Clinic, Nagano, Japan (K.U.); Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan (S.N.); Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (S.N.); Iwakuni City Medical Center Ishikai Hospital, Yamaguchi, Japan (Y.M.); Nagoya Teishin Hospital, Aichi, Japan (A.N.); and Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hoshide
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine (S.H., M.F., K.E., K.K.) and Department of Sleep and Circadian Cardiology (S.H.), Jichi Medical University School of Medicine, Tochigi, Japan; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Haimoto Clinic, Aichi, Japan (H.H.); Yamagiwa Clinic, Aichi, Japan (K.Y.); Oooka Clinic, Nagano, Japan (K.U.); Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan (S.N.); Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (S.N.); Iwakuni City Medical Center Ishikai Hospital, Yamaguchi, Japan (Y.M.); Nagoya Teishin Hospital, Aichi, Japan (A.N.); and Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yano
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine (S.H., M.F., K.E., K.K.) and Department of Sleep and Circadian Cardiology (S.H.), Jichi Medical University School of Medicine, Tochigi, Japan; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Haimoto Clinic, Aichi, Japan (H.H.); Yamagiwa Clinic, Aichi, Japan (K.Y.); Oooka Clinic, Nagano, Japan (K.U.); Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan (S.N.); Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (S.N.); Iwakuni City Medical Center Ishikai Hospital, Yamaguchi, Japan (Y.M.); Nagoya Teishin Hospital, Aichi, Japan (A.N.); and Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
authors.forename: Hajime
authors.initials: H
authors.lastname: Haimoto
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine (S.H., M.F., K.E., K.K.) and Department of Sleep and Circadian Cardiology (S.H.), Jichi Medical University School of Medicine, Tochigi, Japan; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Haimoto Clinic, Aichi, Japan (H.H.); Yamagiwa Clinic, Aichi, Japan (K.Y.); Oooka Clinic, Nagano, Japan (K.U.); Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan (S.N.); Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (S.N.); Iwakuni City Medical Center Ishikai Hospital, Yamaguchi, Japan (Y.M.); Nagoya Teishin Hospital, Aichi, Japan (A.N.); and Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
authors.forename: Kayo
authors.initials: K
authors.lastname: Yamagiwa
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine (S.H., M.F., K.E., K.K.) and Department of Sleep and Circadian Cardiology (S.H.), Jichi Medical University School of Medicine, Tochigi, Japan; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Haimoto Clinic, Aichi, Japan (H.H.); Yamagiwa Clinic, Aichi, Japan (K.Y.); Oooka Clinic, Nagano, Japan (K.U.); Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan (S.N.); Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (S.N.); Iwakuni City Medical Center Ishikai Hospital, Yamaguchi, Japan (Y.M.); Nagoya Teishin Hospital, Aichi, Japan (A.N.); and Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Uchiba
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine (S.H., M.F., K.E., K.K.) and Department of Sleep and Circadian Cardiology (S.H.), Jichi Medical University School of Medicine, Tochigi, Japan; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Haimoto Clinic, Aichi, Japan (H.H.); Yamagiwa Clinic, Aichi, Japan (K.Y.); Oooka Clinic, Nagano, Japan (K.U.); Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan (S.N.); Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (S.N.); Iwakuni City Medical Center Ishikai Hospital, Yamaguchi, Japan (Y.M.); Nagoya Teishin Hospital, Aichi, Japan (A.N.); and Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Nagasaka
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine (S.H., M.F., K.E., K.K.) and Department of Sleep and Circadian Cardiology (S.H.), Jichi Medical University School of Medicine, Tochigi, Japan; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Haimoto Clinic, Aichi, Japan (H.H.); Yamagiwa Clinic, Aichi, Japan (K.Y.); Oooka Clinic, Nagano, Japan (K.U.); Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan (S.N.); Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (S.N.); Iwakuni City Medical Center Ishikai Hospital, Yamaguchi, Japan (Y.M.); Nagoya Teishin Hospital, Aichi, Japan (A.N.); and Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Matsui
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine (S.H., M.F., K.E., K.K.) and Department of Sleep and Circadian Cardiology (S.H.), Jichi Medical University School of Medicine, Tochigi, Japan; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Haimoto Clinic, Aichi, Japan (H.H.); Yamagiwa Clinic, Aichi, Japan (K.Y.); Oooka Clinic, Nagano, Japan (K.U.); Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan (S.N.); Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (S.N.); Iwakuni City Medical Center Ishikai Hospital, Yamaguchi, Japan (Y.M.); Nagoya Teishin Hospital, Aichi, Japan (A.N.); and Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
authors.forename: Akira
authors.initials: A
authors.lastname: Nakamura
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine (S.H., M.F., K.E., K.K.) and Department of Sleep and Circadian Cardiology (S.H.), Jichi Medical University School of Medicine, Tochigi, Japan; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Haimoto Clinic, Aichi, Japan (H.H.); Yamagiwa Clinic, Aichi, Japan (K.Y.); Oooka Clinic, Nagano, Japan (K.U.); Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan (S.N.); Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (S.N.); Iwakuni City Medical Center Ishikai Hospital, Yamaguchi, Japan (Y.M.); Nagoya Teishin Hospital, Aichi, Japan (A.N.); and Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
authors.forename: Motoki
authors.initials: M
authors.lastname: Fukutomi
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine (S.H., M.F., K.E., K.K.) and Department of Sleep and Circadian Cardiology (S.H.), Jichi Medical University School of Medicine, Tochigi, Japan; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Haimoto Clinic, Aichi, Japan (H.H.); Yamagiwa Clinic, Aichi, Japan (K.Y.); Oooka Clinic, Nagano, Japan (K.U.); Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan (S.N.); Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (S.N.); Iwakuni City Medical Center Ishikai Hospital, Yamaguchi, Japan (Y.M.); Nagoya Teishin Hospital, Aichi, Japan (A.N.); and Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
authors.forename: Kazuo
authors.initials: K
authors.lastname: Eguchi
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine (S.H., M.F., K.E., K.K.) and Department of Sleep and Circadian Cardiology (S.H.), Jichi Medical University School of Medicine, Tochigi, Japan; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Haimoto Clinic, Aichi, Japan (H.H.); Yamagiwa Clinic, Aichi, Japan (K.Y.); Oooka Clinic, Nagano, Japan (K.U.); Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan (S.N.); Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (S.N.); Iwakuni City Medical Center Ishikai Hospital, Yamaguchi, Japan (Y.M.); Nagoya Teishin Hospital, Aichi, Japan (A.N.); and Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.).
authors.forename: Joji
authors.initials: J
authors.lastname: Ishikawa
authors.affiliation: From the Division of Cardiovascular Medicine, Department of Medicine (S.H., M.F., K.E., K.K.) and Department of Sleep and Circadian Cardiology (S.H.), Jichi Medical University School of Medicine, Tochigi, Japan; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Haimoto Clinic, Aichi, Japan (H.H.); Yamagiwa Clinic, Aichi, Japan (K.Y.); Oooka Clinic, Nagano, Japan (K.U.); Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan (S.N.); Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (S.N.); Iwakuni City Medical Center Ishikai Hospital, Yamaguchi, Japan (Y.M.); Nagoya Teishin Hospital, Aichi, Japan (A.N.); and Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan (J.I.). kkario@jichi.ac.jp.
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
mesh_terms: D017677:Age Distribution; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage; D001795:Blood Pressure Determination / Q000379:methods; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D002940:Circadian Rhythm; D015331:Cohort Studies; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D016208:Databases, Factual; D005260:Female; D058006:General Practice / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D007564:Japan; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D015996:Survival Rate
chemical_list: D000959:Antihypertensive Agents
keywords: Japan; blood pressure monitoring, home ethnic groups; stroke general practice