Ethnic differences in the degree of morning blood pressure surge and in its determinants between Japanese and European hypertensive subjects: data from the ARTEMIS study

Morning blood pressure (BP) surge has been reported to be a prognostic factor for cardiovascular events. Its determinants are still poorly defined, however. In particular, it is not clear whether ethnic differences play a role in determining morning surge (MS) size. Aim of our study was to explore w...

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Published in:	Hypertension (Dallas, Tex. 1979) Vol. 66; no. 4; p. 750
Main Authors:	Hoshide, Satoshi, Kario, Kazuomi, de la Sierra, Alejandro, Bilo, Grzegorz, Schillaci, Giuseppe, Banegas, José Ramón, Gorostidi, Manuel, Segura, Julian, Lombardi, Carolina, Omboni, Stefano, Ruilope, Luis, Mancia, Giuseppe, Parati, Gianfranco
Format:	Journal Article
Language:	English
Published:	United States 01.10.2015
Subjects:	Aged Antihypertensive Agents - therapeutic use Asian Continental Ancestry Group Blood Pressure - physiology Blood Pressure Determination - methods Circadian Rhythm - physiology Europe - epidemiology European Continental Ancestry Group Female Follow-Up Studies Humans Hypertension - drug therapy Hypertension - ethnology Hypertension - physiopathology Japan - epidemiology Male Middle Aged Morbidity - trends Risk Factors Time Factors Europe Japan ambulatory blood pressure monitoring arterial hypertension blood pressure variability cardiovascular events ethnicity sympathetic nervous system morning blood pressure surge
ISSN:	1524-4563, 1524-4563
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Abstract	Morning blood pressure (BP) surge has been reported to be a prognostic factor for cardiovascular events. Its determinants are still poorly defined, however. In particular, it is not clear whether ethnic differences play a role in determining morning surge (MS) size. Aim of our study was to explore whether differences exist in the size of MS between Japanese and Western European hypertensive patients. We included 2887 untreated hypertensive patients (age 62.3±8.8 years) from a European ambulatory BP monitoring database and 811 hypertensive patients from a Japanese database (Jichi Medical School Ambulatory Blood Pressure Monitoring WAVE1, age 72.3±9.8 years) following the same inclusion criteria. Their 24-hour ambulatory BP monitoring recordings were analyzed focusing on MS. Sleep-trough MS was defined as the difference between mean systolic BP during the 2 hours after awakening and mean systolic BP during the 1-hour night period that included the lowest sleep BP level. The sleep-trough MS was higher in Japanese than in European hypertensive patients after adjusting for age and 24-hour mean BP levels (40.1 [95% confidence interval 39.0-41.2] versus 23.0 [22.4-23.5] mm Hg; P<0.001). This difference remained significant after accounting for differences in night-time BP dipping. Age was independently associated with MS in the Japanese database, but not in the European subjects. Our results for the first time show the occurrence of substantial ethnic differences in the degree of MS. These findings may help in understanding the role of ethnic factors in cardiovascular risk assessment and in identifying possible ethnicity-related differences in the most effective measures to be implemented for prevention of BP-related cardiovascular events.
AbstractList	Morning blood pressure (BP) surge has been reported to be a prognostic factor for cardiovascular events. Its determinants are still poorly defined, however. In particular, it is not clear whether ethnic differences play a role in determining morning surge (MS) size. Aim of our study was to explore whether differences exist in the size of MS between Japanese and Western European hypertensive patients. We included 2887 untreated hypertensive patients (age 62.3±8.8 years) from a European ambulatory BP monitoring database and 811 hypertensive patients from a Japanese database (Jichi Medical School Ambulatory Blood Pressure Monitoring WAVE1, age 72.3±9.8 years) following the same inclusion criteria. Their 24-hour ambulatory BP monitoring recordings were analyzed focusing on MS. Sleep-trough MS was defined as the difference between mean systolic BP during the 2 hours after awakening and mean systolic BP during the 1-hour night period that included the lowest sleep BP level. The sleep-trough MS was higher in Japanese than in European hypertensive patients after adjusting for age and 24-hour mean BP levels (40.1 [95% confidence interval 39.0-41.2] versus 23.0 [22.4-23.5] mm Hg; P<0.001). This difference remained significant after accounting for differences in night-time BP dipping. Age was independently associated with MS in the Japanese database, but not in the European subjects. Our results for the first time show the occurrence of substantial ethnic differences in the degree of MS. These findings may help in understanding the role of ethnic factors in cardiovascular risk assessment and in identifying possible ethnicity-related differences in the most effective measures to be implemented for prevention of BP-related cardiovascular events. Morning blood pressure (BP) surge has been reported to be a prognostic factor for cardiovascular events. Its determinants are still poorly defined, however. In particular, it is not clear whether ethnic differences play a role in determining morning surge (MS) size. Aim of our study was to explore whether differences exist in the size of MS between Japanese and Western European hypertensive patients. We included 2887 untreated hypertensive patients (age 62.3±8.8 years) from a European ambulatory BP monitoring database and 811 hypertensive patients from a Japanese database (Jichi Medical School Ambulatory Blood Pressure Monitoring WAVE1, age 72.3±9.8 years) following the same inclusion criteria. Their 24-hour ambulatory BP monitoring recordings were analyzed focusing on MS. Sleep-trough MS was defined as the difference between mean systolic BP during the 2 hours after awakening and mean systolic BP during the 1-hour night period that included the lowest sleep BP level. The sleep-trough MS was higher in Japanese than in European hypertensive patients after adjusting for age and 24-hour mean BP levels (40.1 [95% confidence interval 39.0-41.2] versus 23.0 [22.4-23.5] mm Hg; P<0.001). This difference remained significant after accounting for differences in night-time BP dipping. Age was independently associated with MS in the Japanese database, but not in the European subjects. Our results for the first time show the occurrence of substantial ethnic differences in the degree of MS. These findings may help in understanding the role of ethnic factors in cardiovascular risk assessment and in identifying possible ethnicity-related differences in the most effective measures to be implemented for prevention of BP-related cardiovascular events.Morning blood pressure (BP) surge has been reported to be a prognostic factor for cardiovascular events. Its determinants are still poorly defined, however. In particular, it is not clear whether ethnic differences play a role in determining morning surge (MS) size. Aim of our study was to explore whether differences exist in the size of MS between Japanese and Western European hypertensive patients. We included 2887 untreated hypertensive patients (age 62.3±8.8 years) from a European ambulatory BP monitoring database and 811 hypertensive patients from a Japanese database (Jichi Medical School Ambulatory Blood Pressure Monitoring WAVE1, age 72.3±9.8 years) following the same inclusion criteria. Their 24-hour ambulatory BP monitoring recordings were analyzed focusing on MS. Sleep-trough MS was defined as the difference between mean systolic BP during the 2 hours after awakening and mean systolic BP during the 1-hour night period that included the lowest sleep BP level. The sleep-trough MS was higher in Japanese than in European hypertensive patients after adjusting for age and 24-hour mean BP levels (40.1 [95% confidence interval 39.0-41.2] versus 23.0 [22.4-23.5] mm Hg; P<0.001). This difference remained significant after accounting for differences in night-time BP dipping. Age was independently associated with MS in the Japanese database, but not in the European subjects. Our results for the first time show the occurrence of substantial ethnic differences in the degree of MS. These findings may help in understanding the role of ethnic factors in cardiovascular risk assessment and in identifying possible ethnicity-related differences in the most effective measures to be implemented for prevention of BP-related cardiovascular events.
Author	Banegas, José Ramón Parati, Gianfranco de la Sierra, Alejandro Schillaci, Giuseppe Mancia, Giuseppe Gorostidi, Manuel Omboni, Stefano Kario, Kazuomi Hoshide, Satoshi Ruilope, Luis Segura, Julian Bilo, Grzegorz Lombardi, Carolina
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Italian Institute of Telemedicine, Varese, Italy (S.O.); and Department of Health Sciences, University of Milano-Bicocca, Milan, Italy (G.M., G.P.) – sequence: 3 givenname: Alejandro surname: de la Sierra fullname: de la Sierra, Alejandro organization: From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ-CIBERESP), Madrid, Spain (J.R.B.); Department of Nephrology, Hospital Universitario Central de Asturias, RedinRen, Oviedo, Spain (M.G.); Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Instituto de investigación Hospital 12 de Octubre (i+12), Madrid, Spain (J.S., L.R.); Italian Institute of Telemedicine, Varese, Italy (S.O.); and Department of Health Sciences, University of Milano-Bicocca, Milan, Italy (G.M., G.P.) – sequence: 4 givenname: Grzegorz surname: Bilo fullname: Bilo, Grzegorz organization: From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ-CIBERESP), Madrid, Spain (J.R.B.); Department of Nephrology, Hospital Universitario Central de Asturias, RedinRen, Oviedo, Spain (M.G.); Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Instituto de investigación Hospital 12 de Octubre (i+12), Madrid, Spain (J.S., L.R.); Italian Institute of Telemedicine, Varese, Italy (S.O.); and Department of Health Sciences, University of Milano-Bicocca, Milan, Italy (G.M., G.P.) – sequence: 5 givenname: Giuseppe surname: Schillaci fullname: Schillaci, Giuseppe organization: From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ-CIBERESP), Madrid, Spain (J.R.B.); Department of Nephrology, Hospital Universitario Central de Asturias, RedinRen, Oviedo, Spain (M.G.); Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Instituto de investigación Hospital 12 de Octubre (i+12), Madrid, Spain (J.S., L.R.); Italian Institute of Telemedicine, Varese, Italy (S.O.); and Department of Health Sciences, University of Milano-Bicocca, Milan, Italy (G.M., G.P.) – sequence: 6 givenname: José Ramón surname: Banegas fullname: Banegas, José Ramón organization: From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ-CIBERESP), Madrid, Spain (J.R.B.); Department of Nephrology, Hospital Universitario Central de Asturias, RedinRen, Oviedo, Spain (M.G.); Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Instituto de investigación Hospital 12 de Octubre (i+12), Madrid, Spain (J.S., L.R.); Italian Institute of Telemedicine, Varese, Italy (S.O.); and Department of Health Sciences, University of Milano-Bicocca, Milan, Italy (G.M., G.P.) – sequence: 7 givenname: Manuel surname: Gorostidi fullname: Gorostidi, Manuel organization: From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ-CIBERESP), Madrid, Spain (J.R.B.); Department of Nephrology, Hospital Universitario Central de Asturias, RedinRen, Oviedo, Spain (M.G.); Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Instituto de investigación Hospital 12 de Octubre (i+12), Madrid, Spain (J.S., L.R.); 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Italian Institute of Telemedicine, Varese, Italy (S.O.); and Department of Health Sciences, University of Milano-Bicocca, Milan, Italy (G.M., G.P.) – sequence: 13 givenname: Gianfranco surname: Parati fullname: Parati, Gianfranco email: gianfranco.parati@unimib.it organization: From the Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (S.H., K.K.); Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Spain (A.d.l.S.); Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy (G.B., C.L., G.M., G.P.); Unit of Internal Medicine, Department of Medicine, University of Perugia at Terni, Terni, Italy (G.S.); Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ-CIBERESP), Madrid, Spain (J.R.B.); Department of Nephrology, Hospital Universitario Central de Asturias, RedinRen, Oviedo, Spain (M.G.); Hypertension Unit, Department of Nephrology, Hospital 12 de Octubre, Instituto de investigación Hospital 12 de Octubre (i+12), Madrid, Spain (J.S., L.R.); Italian Institute of Telemedicine, Varese, Italy (S.O.); and Department of Health Sciences, University of Milano-Bicocca, Milan, Italy (G.M., G.P.). gianfranco.parati@unimib.it
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/26303289$$D View this record in MEDLINE/PubMed
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Copyright	2015 American Heart Association, Inc.
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Keywords	ambulatory blood pressure monitoring arterial hypertension blood pressure variability cardiovascular events ethnicity sympathetic nervous system morning blood pressure surge
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PublicationTitle	Hypertension (Dallas, Tex. 1979)
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Snippet	Morning blood pressure (BP) surge has been reported to be a prognostic factor for cardiovascular events. Its determinants are still poorly defined, however. In...
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SubjectTerms	Aged Antihypertensive Agents - therapeutic use Asian Continental Ancestry Group Blood Pressure - physiology Blood Pressure Determination - methods Circadian Rhythm - physiology Europe - epidemiology European Continental Ancestry Group Female Follow-Up Studies Humans Hypertension - drug therapy Hypertension - ethnology Hypertension - physiopathology Japan - epidemiology Male Middle Aged Morbidity - trends Risk Factors Time Factors
Title	Ethnic differences in the degree of morning blood pressure surge and in its determinants between Japanese and European hypertensive subjects: data from the ARTEMIS study
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