Essential Manual of 24 Hour Blood Pressure Management: From Morning to Nocturnal Hypertension

Description

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 .

Table of Contents

Author biography
Preface
Acknowledgments

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 infl ammation, 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-specifi c treatment, 88
• Specifi c 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