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J.Health Sci., 50(2), 113-119, 2004
-Review-
Epidemiology of Hypertension Based on Ambulatory Blood Pressure Monitoring
and Self-Measurement of Blood
Pressure at Home
Yutaka Imai,*, a Takayoshi
Okubo,b Kei
Asayama,a Hirohito
Metoki,a Masahiro
Kikuya,a Junichiro
Hashimoto,b Takashi
Ugajin,a Kazuhito
Totsune,a and Hiroshi
Satohc
aDepartment of Clinical Pharmacology and Therapeutics,
bDepartment of Planning for Drug Development and Clinical Evaluation,
and cDepartment of Environmental Health Sciences, Tohoku University Graduate School of Pharmaceutical Science and Medicine,
1-1 Seiryomachi, Sendai 980-8574, Japan
Measurements of ambulatory blood pressure (ABP) and of home blood pressure (HBP) as an adjunct to
casual/clinic BP (CBP) measurements are currently widely used for the diagnosis and treatment of hypertension. We have
monitored a rural cohort of people from the population of Ohasama, Japan, with respect to their prognosis and have
previously reported that ABP and HBP are superior to CBP for the prediction of cardiovascular mortality. We
examined the prognostic significance of white-coat hypertension for mortality and found that the relative hazard for the
overall mortality of patients with white-coat hypertension was significantly lower than that for true hypertension
during 5-year observation period but observed that the development of sustained hypertension was more frequent in
patients with white-coat hypertension than those with true normotension during 10-year observation period. Our
results also confirmed that day-by-day variability as well as short-term blood pressure variability (as measured
every 30 min) was independently associated with cardiovascular mortality. In addition, research has recently
focused on isolated systolic hypertension and pulse pressure as independent risk factors for poor cardiovascular
prognosis. The Ohasama study also clearly demonstrated that isolated systolic hypertension and increased pulse
pressure, as assessed by HBP, were associated with an increase in the risk of cardiovascular mortality. Concerning
diurnal blood pressure variation, the relative hazard for cardiovascular mortality increased in non-dippers and
inverted dippers while that in extreme dipper did not. The Ohasama study also clearly demonstrated that nocturnal BP
levels in hypertensive patients with extreme dipper were significantly higher than those in normotensive subjects.
The Ohasama study showed that the level and variability of hypertension as assessed by ABP and HBP are
independent predictors of cardiovascular morbidity and mortality. It also demonstrated an independent association between
the prognosis of hypertension and each component of ABP and HBP, indicating the prognostic significance of these
blood pressure measurements.
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