Diagnostic agreement of masked uncontrolled hypertension detected by ambulatory blood pressure and home blood pressure measured by an all-in-one BP monitoring device: The HI-JAMP study

Comparison of nocturnal blood pressure dipping status detected by home vs. ambulatory blood pressure monitoring: analysis of J-HOP Nocturnal BP Study data

Nocturnal blood pressure (BP) dipping is a risk factor for cardiovascular disease, independent of nighttime BP levels. We compared nocturnal BP dipping detected by conventional ambulatory BP monitoring (ABPM) with that detected by nocturnal home BP monitoring (HBPM), which can measure BP during sleep with a timer function. We analyzed data of 927 subjects in the nationwide practice-based J-HOP Nocturnal BP Study and observed that the prevalences of nocturnal BP dipping status for HBPM and ABPM respectively were: extreme dipper, 6.9% and 14.8%; dipper, 36.1% and 42.4%; non-dipper, 42.8% and 33.2%; riser pattern, 14.1%, and 9.6%. The agreement between nocturnal dipping classification by HBPM and ABPM was 41.0%, and when we used ≥3 days of HBPM data, the agreement rate increased to 42.8%. Obtaining an increased number of nighttime BP measurements at home for multiple days may increase the reliability of assessments of nocturnal BP dipping status detected by HBPM.

Cardiovascular Events Risk in Office-Masked Nocturnal Hypertension Defined by Home Blood Pressure Monitoring

Background

Nocturnal home blood pressure monitoring (HBPM) may identify people at higher cardiovascular disease (CVD) risk than expected.

Objectives

The aim of this study was to examine the association between office-masked nocturnal hypertension, defined by HBPM, and CVD risk in a clinical practice-based population.

Methods

Prospective observational study including Japanese high cardiovascular-risk participants. Three office blood pressures (OBPs) were taken on two different occasions. Nocturnal home blood pressure (HBP) was measured three times per night for 2 weeks. The association between office-masked nocturnal hypertension and time to first CVD events (fatal and nonfatal stroke or coronary heart disease) was examined using Cox regression.

Results

The cohort included 2,545 participants who were followed for a median of 7.8 years (18,116 person-years), during which 152 CVD events occurred. The proportions of participants with nocturnal normotension (OBP <140/90 mm Hg and nocturnal HBP <120/70 mm Hg), white-coat nocturnal hypertension (OBP ≥140/90 mm Hg and nocturnal HBP <120/70 mm Hg), office-masked nocturnal hypertension (OBP <140/90 mm Hg and nocturnal HBP ≥120/70 mm Hg), and sustained nocturnal hypertension (OBP ≥140/90 mm Hg and nocturnal HBP ≥120/70 mm Hg) were 25.3%, 14.4%, 23.2%, and 37.1%, respectively. Relative to nocturnal normotension, those with both office-masked nocturnal hypertension (adjusted HR: 1.72; 95% CI: 1.01-2.92) and sustained nocturnal hypertension (adjusted HR: 1.75; 95% CI: 1.03-2.96) had similarly increased CVD risk, even after adjustment for daytime HBP values.

Conclusions

Screening for office-masked nocturnal hypertension with HBPM identifies a potentially important group of patients with increased risk for incident CVD events for whom additional preventative measures may be appropriate.

The role of wearable home blood pressure monitoring in detecting out-of-office control status

Ambulatory blood pressure (ABP) and home blood pressure (HBP) monitoring is currently recommended for management of hypertension. Nonetheless, traditional HBP protocols could overlook diurnal fluctuations, which could also be linked with adverse cardiovascular outcomes. In this observational study, we studied among a group of treated hypertensive patients (N = 62, age: 52.4 ± 10.4 years) by using out-of-office ABP and wearable HBP. They received one session of 24-h ABP measurement with an oscillometric upper-arm monitor, and totally three sessions of 7-day/6-time-daily wearable HBP measurement separated in each month with HeartGuide. Controlled hypertension is defined as an average BP <130/80 mmHg for both daytime ABP and HBP. There was substantial reliability (intraclass correlation coefficient, ICC 0.883-0.911) and good reproducibility (Cohen's kappa = 0.600) for wearable HBP measurement, especially before breakfast and after dinner. Among all patients, 27.4% had both uncontrolled HBP and ABP, 30.6% had uncontrolled HBP only, while 6.5% had uncontrolled ABP only. Female gender and increased numbers of anti-hypertensive agents are correlated with controlled hypertension. Patients with uncontrolled hypertension had a significantly higher maximal daytime blood pressure, which was previously signified as an imperial marker for cardiovascular risk. In conclusion, wearable HBP monitoring in accordance with a dedicated daily-living schedule results in good reliability and reproducibility. Patients with an uncontrolled wearable HBP should benefit from repeated HBP or ABP measurement for risk stratification.

2023 update and perspectives

Total 276 manuscripts were published in Hypertension Research in 2022. Here our editorial members picked up the excellent papers, summarized the current topics from the published papers and discussed future perspectives in the sixteen fields. We hope you enjoy our special feature, 2023 update and perspectives in Hypertension Research.

Home blood pressure-centered approach - from digital health to medical practice: HOPE Asia Network consensus statement 2023

Recent innovations in digital technology have enabled the simultaneous accumulation, and the linking and analysis of time-series big data relating to several factors that influence blood pressure (BP), including biological indicators, physical activity, and environmental information. Various approaches can be used to monitor BP: in the office/clinic; at home; 24-h ambulatory recording; or with wearable and cuffless devices. Of these, home BP monitoring is a reliable and convenient method, and is recommended for hypertension management by current national and international guidelines. This recommendation is based on evidence showing that home BP is an important predictor of cardiovascular, cerebrovascular and kidney disease in patients with hypertension. In addition, lifetime personalized health record (PHR)-based home BP with telemonitoring combined with co-interventions has been shown to lower BP more effectively than the traditional approach based on office BP. Thus, home BP represents a key metric for personalized anticipation medicine, from digital healthcare to digital medicine. This paper summarizes the latest evidence on home BP monitoring and proposes a Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network consensus on a home BP-centered approach to the management of hypertension.

Digital hypertension towards to the anticipation medicine

"Digital Hypertension" is a new research field proposed by the Japanese Society of Hypertension that integrates digital technology into hypertension management and proactively promotes research activities. This novel approach includes the development of new technologies for better BP management, such as sensors for detecting environmental factors that affect BP, information processing, and machine learning. To facilitate "Digital Hypertension," a more sophisticated BP monitoring system capable of measuring an individual's BP more frequently in various situations would be required. With the use of these technologies, hypertension management could shift from the current "dots" management based on office BP readings during clinic visits to a "line" management system based on seamless home BP or individual BP data taken by a wearable BP monitoring device. DTx is the innovation to change hypertension management from "dots" to "line", completely achieved by wearable BP.