Study of Sustained Blood PressureLowering Effect

Authors: Kazuomi Kario Yoko Uehara Masayuki Shirayama Megumi Takahashi Kazuhito Shiosakai Katsutoshi Hiramatsu Masahiro Komiya Kazuyuki Shimada

Publish Date: 2013/03/22

Volume: 13, Issue: 1, Pages: 75-85

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Abstract

Morning hypertension is a risk factor for cardiovascular and cerebrovascular events and consequently diagnosis and control of morning hypertension are considered very important We previously reported the results of the Azelnidipine Treatment for Hypertension Openlabel Monitoring in the Early morning AtHOME Study which indicated that azelnidipine effectively controlled morning hypertensionThe objective of this AtHOME subgroup analysis was to evaluate the sustained blood pressure BPlowering effect of azelnidipine using mean morning and evening systolic BP ME average and morning systolic BP minus evening systolic BP ME differenceWe analyzed the selfmeasured home BP data measured in the morning and at bedtime from this 16week prospective observational study to clarify the effect of morning dosing of azelnidipine mean ± standard deviation maximum dose 143 ± 36 mg/day A subgroup of patients from the AtHOME Study who had an evening home BP measurement within 28 days prior to the baseline date were used for efficacy analysis n = 2546 mean age 651 years female 536 Home systolic BP/diastolic BP levels in the morning and evening were significantly lowered p  00001 by −194 ± 171/−103 ± 106 and −169 ± 170/−94 ± 106 mmHg respectively Home pulse rates in the morning and evening were also significantly lowered p  00001 by −35 ± 78 and −35 ± 73 beats/min respectively At baseline patients whose ME average was ≥135 mmHg and whose ME difference was ≥15 mmHg defined as morningpredominant hypertension accounted for 204  of the study population However at the end of the study the number of such patients was significantly reduced to 79  p  00001 Patients whose ME average was ≥135 mmHg and whose ME difference was 15 mmHg defined as sustained hypertension accounted for 711  of the study population at baseline This was reduced significantly to 428  at the end of the study p  00001 ME average decreased significantly from 1538 ± 155 mmHg to 1356 ± 119 mmHg and ME difference also decreased significantly from 67 ± 131 mmHg to 47 ± 108 mmHg both p  00001Blood pressure BP fluctuates daily in a circadian pattern ie it is elevated from evening to morning and the frequency of myocardial infarction or stroke is also increased during the same period 1 2 Morning BP correlates with cardiovascular events and therefore morning hypertension during the highrisk hours is very important 3 4 5 Organ damage is related more to morning hypertension than to hypertension defined on the basis of measurement of BP at the clinic clinic BP 6 Morning hypertension has been reported to be associated with an increased risk of future stroke 4 7Although there is no consensus definition of morning hypertension one practical definition is BP of 135/85 mmHg or higher measured at home in the morning morning home BP 8 In the Ambulatory Blood Pressure Monitoring ABPM Study 7 subjects were classified using the following thresholds i an average of morning and evening systolic BP ME average of 135 mmHg and ii a difference between morning and evening systolic BP ME difference of 20 mmHg the relative risk of stroke was compared in the resulting four groups of subjects with normal BP normal BP with a morning BP surge pattern sustained hypertension and morningpredominant hypertension The risks of stroke were 21 and 66 times higher in the sustained hypertension and morningpredominant hypertension groups respectively than in the normal BP group The stroke risk increased by 41  with a 10 mmHg increase in ME average and by 24  with a 10 mmHg increase in ME difference Given that other cardiovascular risks also increase in the morning the diagnosis of morning hypertension and control of BP have tremendous significance

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