• Cerebrovascular Disease
• Cardiology Clinical Trials
• Hypertensive Disease

• Cerebrovascular Disease
• Cardiology Clinical Trials
• Hypertensive Disease
• Cardiology

Morning systolic blood pressure (SBP) is associated with increased risk of cerebrovascular events, even if clinic SBP is low. Kazuomi Kario, MD, PhD, Jichi Medical University School of Medicine, Shimotsuke, Japan, presented data from the Home Blood Pressure Measurement With Olmesartan Naive Patients to Establish Standard Target Blood Pressure study [HONEST; UMIN000002567; Saito I et al. Hypertens Res 2013].

Home blood pressure (BP) monitoring is the first step in achieving 24-hour BP control [Shimamoto K et al. Hypertens Res 2014]. Morning hypertension—defined as BP ≥135/85 mm Hg in the morning—is a recommended target in clinical practice, by having patients take their antihypertensive medication in the morning [Kario K. Am J Hypertens 2005]. The purpose of the HONEST study was to determine the effect of home BP, clinic BP, and the occurrence of cardiovascular events.

In the large prospective observational HONEST study, 21,591 olmesartan-naïve patients with essential hypertension who had data for 2 days of morning home and clinic BP were followed for 2 years. At baseline, the mean age was 65 years, the body mass index was 24 kg/m², and 50% of participants had previously used antihypertensive therapy. All patients received olmesartan at baseline (mean dose, 18.2 mg), and 83% continued its use by the end of the study (mean dose, 20 mg). The primary end points included cerebrovascular event, cardiac event, and sudden death.

Morning home SBP and clinic SBP were significantly associated with reaching the primary end point at 18 months (p=0.015 and p=0.0005, respectively) and 24 months (p≤0.0001 for both). According to a spline regression analysis, the minimum risk for morning home SBP and clinic SBP was 124 mm Hg and 131 mm Hg, respectively. Patients with morning home SBP ≥145 mm Hg and clinic SBP ≥150 mm Hg had the greatest risk of reaching the primary end point (HR, 3.92; p<0.0001), with patients having morning home SBP ≥145 mm Hg and clinic SBP <130 mm Hg also having significant risk for reaching the primary end point (HR, 2.47; p=0.014).

There were no significant differences between morning home SBP and clinic SBP and between morning home diastolic BP (DBP) and clinic DBP, over the 2 years of follow-up. In addition, morning home and clinic BPs decreased by 20 and 10 mm Hg, respectively, at 2 years. The incidence of the primary end point was 6.46 (95% CI, 5.75 to 7.27), with a stroke incidence of 2.92 (95% CI, 2.46 to 3.48). In addition, the incidence of cardiac events was 3.85 (95% CI, 3.30 to 4.48), including a myocardial infarction incidence of 1.03 (95% CI, 0.77 to 1.38). The incidence for sudden death was 0.80 (95% CI, 0.58 to 1.12).

Dr. Kario concluded that data from the HONEST study suggest that on-treatment morning home SBP >145 mm Hg is associated with an increase in risk of cardiovascular events at 2 years. In addition, the risk is high for patients who have masked hypertension (ie, those patients who have high home BP but low clinic BP).

• © 2014 MD Conference Express®