Essential Manual of 24 Hour Blood Pressure Management

From Morning to Nocturnal Hypertension

Kazuomi Kario

• Publisher: Wiley-Blackwell
• Year: 2015
• Print ISBN:
  9781119087243
• eBook ISBN:
  9781119087267
• Edition: 1
• Topic: Medicine
• Subtopic: Cardiology

It is well known that cardiovascular events occur more frequently in the morning as blood pressure (BP) levels have been shown to increase during the period from night to early morning. In recent years, clinical research using ambulatory blood pressure monitoring (ABPM) or home BP monitoring has clarified that morning BP and BP surge are more closely related to the cardiovascular risk than clinical BP. This practical manual from field leading expert, Dr. Kazuomi Kario, reviews recent evidence on ?morning? and ?nocturnal? hypertension and the IT technologies physicians can use to support patients in home monitoring BP. Guidance on management via antihypertensive drugs is also discussed and with the aim of promoting ?perfect 24 hour BP control?.

CHAPTER 1
First, focusing on “morning hypertension”

The morning is the most important period for cardiovascular diseases [1, 2]. Cardiovascular events occur most frequently in the morning just after awakening, at the time of the peak ambulatory blood pressure (BP) (Figure 1.1) [2]. Exaggerated morning BP surge (MBPS) and morning hypertension are a risk for cardiovascular events (Figure 1.2), and are associated with advanced organ damage (Figure 1.3) [3–7]. Morning BP level is more closely associated with organ damage to brain, heart, and kidney, and the risk of cardiovascular and cerebrovascular events (Figure 1.4) and disability in the elderly than clinic BP both in hypertensive patients and community-based normotensive populations [8, 9]. Finally, recent evidence demonstrates that uncontrolled morning hypertension on medication is a strong predictor of cardiovascular events [10].

Figure 1.1 Onset time of cardiovascular events. Source: Muller et al. 1989 [2].

Figure 1.2 Morning BP surge and stroke risk in hypertension (matching for age and 24-hour systolic BP). Source: Kario et al. 2003 [3].

Figure 1.3 A 69-year-old man with morning hypertension exhibiting advanced organ damage. Cardiac echography demonstrated that concentric hypertrophy (left ventricular mass index = 144.2 g/m2; relative wall thickness = 0.30) with reduced systolic function (ejection fraction = 46%). IMT, intima media thickness.

Figure 1.4 Morning BP is the strongest independent predictor of stroke events. Source: Kario et al. 2006 [5].

What is the “perfect 24-hour blood pressure control”?

The management of “morning hypertension” is the most effective first step to achieve “perfect 24-hour BP control” [1]. The majority of the benefit of antihypertensive treatment is derived from BP control per se. There is robust evidence that indicates BP control throughout 24 hours is essentially important for lowering the risk of organ damage and cardiovascular events. However, not only strict reduction of the 24-hour BP level (amount of 24-hour BP lowering), but also restoring disrupted circadian BP rhythms, and reducing exaggerated BP variability (quality of 24-hour BP lowering), are required to achieve “perfect 24-hour BP control” (Figure 1.5) [11].

Figure 1.5 Triad of perfect 24-hour BP control. Source: Kario 2012 [11].

Recent guidelines such as the Japanese Society of Hypertension (JSH2014) Guidelines [12], European Society of Hypertension/European Society of Cardiology (ESH/ESC2013) Guidelines [13], and NICE 2011 Guidelines (UK) [14] recommend the practical use of the out-of-office BP for the diagnosis and management of hypertension. Clinically, two methods are available to measure our BP in clinical practice. One is ambulatory BP monitoring (ABPM), and the other is home BP monitoring (HBPM) (Figure 1.6). Figure 1.7 demonstrates the different thresholds of clinic, home, and ambulatory BPs for the definition of hypertension [11–13]. Masked hypertension is defined as normotension for office BP and hypertension for out-of-office BP, while white-coat hypertension is defined as normotension for out-of-office BP and hypertension for office BP [15]. There are three subtypes of masked hypertension, namely morning hypertension, daytime (stress-induced) hypertension, and nocturnal hypertension (Figure 1.8). Among these masked hypertension subtypes, only morning hypertension could be definitively detected by the conventional measurement of HBPM.

Figure 1.6 Out-of-clinic BP monitoring.

Figure 1.7 Different thresholds of BP level for diagnosis of hypertension.

Figure 1.8 Three types of masked hypertension. Source: Kario K. Masked hypertension—pathogenesis and treatment. Nihon Naika Gakkai Zasshi. 2007;96:79–85.

Definition of “morning hypertension”

Wide definition of “morning hypertension” is having the average of morning BPs ≥135 mmHg for systolic BP (SBP), or ≥85 mmHg for diastolic BP (DBP), regardless of clinic BPs (Figure 1.9) [1]. In addition, strict definition of “morning hypertension” ...

Table of contents

• Cover
• Dedication
• Title page
• Copyright
• Author biography
• Preface
• Acknowledgments
• 1 First, focusing on “morning hypertension”
• 2 Morning surge in blood pressure
• 3 Nocturnal hypertension
• 4 What is systemic hemodynamic atherothrombotic syndrome?
• 5 Home blood pressure variability
• 6 Development of information-technology-based new home blood pressure variability monitoring system
• 7 Home blood-pressure-monitoring-guided morning hypertension control
• 8 Blood-pressure-lowering characteristics of 
antihypertensive drugs
• 9 Home and ambulatory blood-pressure-profile-based combination strategy
• 10 Management of resistant hypertension
• 11 Era of renal denervation
• 12 Latest evidence of controlling morning hypertension: the HONEST study
• Conclusion and perspectives
• References
• Index
• EULA