State of the Art Review
Research and Development of Information and Communication Technology-based Home Blood Pressure Monitoring from Morning to Nocturnal Hypertension
Authors:
Kazuomi Kario ,
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tochigi, Japan
About Kazuomi
MD, PhD
Naoko Tomitani,
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tochigi, Japan
Yuri Matsumoto,
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tochigi, Japan
Haruna Hamasaki,
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tochigi, Japan
Yukie Okawara,
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tochigi, Japan
Maiko Kondo,
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tochigi, Japan
Ryoko Nozue,
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tochigi, Japan
Hiromi Yamagata,
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tochigi, Japan
Ayako Okura,
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tochigi, Japan
Satoshi Hoshide
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tochigi, Japan
About Satoshi
MD, PhD
Abstract
Asians have specific characteristics of
hypertension (HTN) and its relationship with
cardiovascular disease. The morning surge in blood pressure (BP) in Asians is more extended, and the association slope between higher BP and the risk for cardiovascular events is steeper in this population than in whites. Thus, 24-hour BP control including at night and in the morning is especially important for Asian patients with HTN. There are 3 components of “perfect 24-hour BP control”: the 24-hour BP level, adequate dipping of nocturnal BP (dipper type), and adequate BP variability such as the morning BP surge. The morning BP-guided approach using home BP monitoring (HBPM) is the first step toward perfect 24-hour BP control. After controlling morning HTN, nocturnal HTN is the second target. We have been developing HBPM that can measure nocturnal BP. First, we developed a semiautomatic HBPM device with the function of automatic fixed-interval BP measurement during sleep. In the J-HOP (Japan Morning Surge Home Blood Pressure) study, the largest nationwide home BP cohort, we successfully measured nocturnal home BP using this device with data memory, 3 times during sleep (2, 3, and 4 am), and found that nocturnal home BP is significantly correlated with organ damage independently of office and morning BP values. The second advance was the development of trigger nocturnal BP (TNP) monitoring with an added trigger function that initiates BP measurements when oxygen desaturation falls below a variable threshold continuously monitored by
pulse oximetry. TNP can detect the specific nocturnal BP surges triggered by hypoxic episodes in patients with sleep apnea syndrome. We also added the lowest heart rate-trigger function to TNP to detect the “basal nocturnal BP,” which is determined by the circulating volume and structural
cardiovascular system without any increase in sympathetic tonus. This double TNP is a novel concept for evaluating the pathogenic
pressor mechanism of nocturnal BP. These data are now collected using an information and communication technology (ICT)-based monitoring system. The BP variability includes different time-phase variability from the shortest beat-by-beat, positional, diurnal, day-by-day, visit-to-visit, seasonal, and the longest yearly changes. The synergistic resonance of each type of BP variability would produce great dynamic BP surges, which trigger cardiovascular events. Thus, in the future, the management of HTN based on the simultaneous assessment of the resonance of all of the BP variability phenotypes using a wearable “surge” BP monitoring device with an ICT-based data analysis system will contribute to the ultimate individualized medication for cardiovascular disease.
How to Cite:
Kario, K., Tomitani, N., Matsumoto, Y., Hamasaki, H., Okawara, Y., Kondo, M., Nozue, R., Yamagata, H., Okura, A. and Hoshide, S., 2016. Research and Development of Information and Communication Technology-based Home Blood Pressure Monitoring from Morning to Nocturnal Hypertension. Annals of Global Health, 82(2), pp.254–273. DOI: http://doi.org/10.1016/j.aogh.2016.02.004
Published on
29 Jun 2016.
Peer Reviewed
Downloads
