Essential Manual of 24 Hour Blood Pressure Management (eBook)

From Morning to Nocturnal Hypertension

Kazuomi Kario (Autor)

eBook Download: EPUB

2015
John Wiley & Sons (Verlag)
978-1-119-08726-7 (ISBN)

Infos

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?.

Dr Kazuomi Kario is currently Professor and Chairman of Cardiovascular Medicine, and Professor of the Department of Sleep and Circadian Cardiology, Jichi Medical University School of Medicine, Japan, and Staff Visiting Professor, Institute of Cardiovascular Science, University College London, London, UK.

Dr Kario and his team were the first to demonstrate “morning surge” in blood pressure (BP) as an independent risk factor for cardiovascular disease in 2003 (Kario et al. Circulation 2013).He first used “morning hypertension” with the definition of morning BP >135/85 mmHg regardless of clinic BP and stressed its clinical relevance in his book, Clinician’s Manual on Early Morning Risk Management in Hypertension in 2004 (Science Press, London, UK, 2004).

His research includes the development of new technology-based BP monitoring such as “IT-based home nocturnal BP monitoring” (Hypertension 2013) and “hypoxia-triggered home sleep BP monitoring (TSP)” (Hypertension Research 2013) to clarify the clinical relevance of 24-hour BP control.

He is the principle investigator of several clinical studies, such as the Japan Morning Surge-Home Blood Pressure Study (J-HOP), Japan ambulatory BP monitoring (JAMP) study, Country-based Ambulatory BP Registry in Asia 2010 (CARE Asia), and Sleep BP and disordered breathing in REsistant hypertension And cardiovascular Disease (SPREAD), and The Home BP measurement with Olmesartan Naive patients to Establish Standard Target blood pressure (HONEST) study, the largest prospective observational study involving >20 000 patients receiving angiotensin receptor blocker-based antihypertensive treatment for 2 years.

He has served as Editor-in-Chief of Curr Hypertens Rev and is past Executive Editor of Hypertens Res. He is an editorial board member of more than 15 international journals, including Hypertension, J Hypertens, Circ J, J Clin Hypertens, J Am Soc Hypertens, Am J Hypertens, Blood Press Monit, Curr Hypertens Rep, and Curr Cardiol Rev. Dr Kario has published over 600 academic papers.

Autor

Kazuomi Kario MD, PhD, FACC, FACP, FAHA, FESC Professor and Chairman, Department of Cardiovascular Medicine Professor and Chairman, Department of Sleep and Circadian Cardiology Jichi Medical University School of Medicine, Tochigi, Japan Staff Visiting Professor of Medicine, UCL Institute of Cardiovascular Science University College London, London, UK

Inhalt

Author biography viii

Preface x

Acknowledgments xi

1 First focusing on "morning hypertension" 1

What is the "perfect 24-hour blood pressure control"? 1

Definition of "morning hypertension" 4

How to assess "morning hypertension" 5

Home BP monitoring 7

Ambulatory BP Monitoring 9

Feasibility of controlling morning hypertension 12

Subtypes of morning hypertension 14

2 Morning surge in blood pressure 15

Definition of MBPS 15

Cardiovascular events with MBPS 16

Organ damage with MBPS 19

Hypertensive heart disease 20

Vascular disease and inflammation 21

Silent cerebrovascular disease 22

Chronic kidney disease 24

Determinants of MBPS 25

Mechanism of morning risk 28

Hemostatic abnormality and MBPS 29

Vascular mechanism of exaggerated MBPS 31

3 Nocturnal hypertension 35

Circadian rhythm of BP 35

Non-dipper/risers of nocturnal BP 35

Definition and risk of nocturnal hypertension 38

Mechanism of nocturnal hypertension 43

Associated conditions 44

Diabetes 45

Chronic kidney disease 47

Sleep apnea syndrome 48

Extreme dipper--another type of disrupted circadian BP rhythm 48

4 What is systemic hemodynamic atherothrombotic syndrome? 50

A typical case of SHATS 50

Clinical relevance of SHATS 52

Pathological target of SHATS 54

Mechanism of vicious cycle of SHATS 57

5 Home blood pressure variability 61

Maximum home SBP 61

SD of morning SBP 62

Morning orthostatic hypertension 64

6 Development of information technology-based new home blood pressure variability monitoring system 67

Disaster cardiovascular prevention network 67

Cutting-edge of HBPM 71

Basic nocturnal BP monitoring at home (Medinote) 71

"Thermosensitive hypertension" detecting home BP device 74

Trigger nocturnal BP monitoring 75

IT-based trigger nocturnal pressure monitoring system 81

Detection and management of OSAS using new IHOPE-TNP 82

7 Home blood-pressure-monitoring guided morning hypertension control 88

Non-specific treatment 88

Specific treatment 89

8 Blood-pressure-lowering characteristics of antihypertensive drugs 91

Diuretics 91

Calcium channel blockers 91

Amlodipine 92

Nifedipine 94

Cilnidipine 95

Azelnidipine 96

Angiotensin-converting enzyme inhibitors 96

Angiotensin-receptor blockers 98

Telmisartan 98

Candesartan 98

Olmesartan 99

Azilsartan 103

Alpha-adrenergic blockers and beta-adrenergic blockers 104

RAS inhibitor-based combination 106

9 Home and ambulatory blood-pressure-profile-based combination strategy 109

First-line therapy 109

Second-line therapy 109

Arterial stiffness type 109

Volume retention type 110

Third-line therapy 110

10 Management of resistant hypertension 111

Evaluation of resistant hypertension 111

Fourth-line therapy 111

Circadian medication 114

11 Era of renal denervation 115

Evidence of renal denervation 115

Hypothesis of "perfect 24-hour BP control" by renal denervation 116

12 Latest evidence of controlling morning hypertension: the HONEST study 118

Conclusion and perspectives 122

References 123

Index 135

Textauszug

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” is those with morning–evening difference (ME-dif) (morning SBP – evening SBP) in home BP ≥15 mmHg [1, 5]. Morning hypertension (ambulatory morning hypertension) can also be diagnosed using ABPM [5]. Masked morning hypertension is defined as morning hypertension with clinic BP <140/90 mmHg.

Figure 1.9 Definition of morning hypertension. Source: Kario 2004 [1].

How to assess “morning hypertension”

Morning BP can be measured by HBPM and by ABPM. HBPM is the BP self-measured in sitting conditions at home, while ABPM measures ambulatory BP with 15–30 minutes intervals throughout 24-hour periods. Clinical use of HBPM is superior to ABPM, because it is convenient without discomfort. However, the BP profiles evaluated by these two methods are different. HBPM only measures BPs in a specific time (morning and/or evening) and in a specific condition (resting while sitting), while ABPM measures dynamic ambulatory BP changes during daytime as well as MBPS, and nocturnal BPs during sleep period detecting dynamic nocturnal BP changes as well as detecting masked nocturnal hypertension. Recent advances in the HBPM device could practically measure nocturnal BP during sleep. In clinical practice, these HBPM and ABPM devices should be used not alternatively but complimentarily [12].

The clinical use of HBPM and ABPM increases quality of the management of hypertension. Ideally, HBPM and antihypertensive treatment based on HBPM are recommended for all hypertensive patients, while ABPM is recommended for high-risk hypertensive patients with home BP ≥125/75 mmHg, especially for those with a history of cardiovascular events, evidence of organ damage (ECG-LVH, etc.), and nocturnal hypertension-suspected comorbidities such as sleep apnea syndrome, diabetes, and chronic kidney disease (CKD) (Figure 1.10).

Figure 1.10 Subjects for recommendation of home and ambulatory BP monitoring. LVH, left ventricular hypertrophy. Source: Kario K, Essential Manual of 24-hour Blood Pressure Management from Morning to Nocturnal Hypertension, Wiley-Blackwell, 2015.

Home BP monitoring

Figure 1.11 shows the standard method of self-measured HBPM in the morning. In both medicated and non-medicated hypertensives, the ME difference of self-measured home BP was associated with left ventricular mass index (LVMI) and the risk of concentric hypertrophy, as well as with increased PWV [16–18]. In our previous study, ME-dif was significantly associated with left ventricular hypertrophy (LVH), and increased brachial-ankle pulse wave velocity (baPWV) (Figure 1.12) [16], and morning hypertension defined by the ME-dif and the average of morning and evening BPs (ME-ave) is a determinant of concentric LVH (Figure 1.13) [17]. Even among the home normotensives (white-coat hypertensives), patients with ME-dif ≥15 mmHg had a higher percentage of concentric remodeling than those with ME-dif <15 mmHg (32.5% vs. 14.7%, p = 0.017). Recently, ME-dif assessed both by ABPM or by HBPM are reported to be associated with cardiovascular risk independently of the ME-ave [5, 19]. The ME-dif of ABPM is an independent predictor of future stroke events in elderly hypertensives [5].

Figure 1.11 Home BP measurement in the morning.

Figure 1.12 Morning–evening difference (ME-dif) of home BP and cardiovascular disease in unmedicated hypertensive patients (N = 356). baPWV, brachial-ankle pulse wave velocity. Source: Matsui et al. 2009 [16].

Figure 1.13 Morning hypertension and left ventricular hypertrophy in unmedicated hypertensive patients (N = 356). LVH, left ventricular hypertrophy. Source: Matsui et al. 2010 [17].

If clinic BP is normotensive <140/90 mmHg, those with morning BP ≥135/85 mmHg are defined as having “masked” morning hypertension [1]. In addition, “isolated” morning hypertension, i.e. hypertension only in the morning (≥135/85 mmHg), but normotension in the evening or other BPs measured at different times of the day (<135/85 mmHg) or those with increased ME-dif ≥15 mmHg, could be considered as the predisposing condition (prehypertension) before development of clinic hypertension and/or 24-hour ambulatory hypertension [1, 20].

Evening BP measurement in addition to morning measurement is recommended especially for diabetic hypertensive patients, because the reduction of evening BP as well as morning BP is closely correlated with the reduction of urinary albumin/creatinine ratio (UACR) [21].

Ambulatory BP monitoring

Ambulatory BP monitoring (ABPM) could more extensively assess the 24-hour ambulatory BP profile including BP variability of individual patients. Figures 1.14, 1.15,...

Produkt-Details

• Erscheint lt. Verlag: 2.3.2015
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Kardiologie / Angiologie
• Schlagworte: blood pressure (BP), ambulatory blood pressure monitoring (ABPM), home BP monitoring, cardiovascular risk, Dr. Kazuomi Kario, “morning” and “nocturnal” hypertension, antihypertensive drugs, perfect 24 hour BP control • Cardiovascular Disease • Kardiovaskuläre Erkrankungen • Medical Science • Medizin
• ISBN-10: 1-119-08726-0 / 1119087260
• ISBN-13: 978-1-119-08726-7 / 9781119087267