b>Background and objectives; Home blood pressure (BP) measurement has a better prognostic accuracy than office BP measurement, especially in patients with ���masked hypertension��� detected by self-measured home BP. And there was a few report advocating morning BP in self-measured home BP monitoring is more closely related to target-organ damage and cardiovascular event than evening BP, especially in treated hypertensive patients. Scarce data exists for comprehensive analysis of home BP monitoring.
Methods; We evaluated 1087 hypertensive patients on anti-hypertensive medication at least for 6 months under the control of Hypertension Research Network including 9 university grade hospitals in Korea. They measured home BPs for 7 days and were checked baseline characteristics and laboratory data. We defined ���masked hypertension��� as patients demonstrated normal clinic BP and elevated home BP and ���morning hypertension��� as morning-evening systolic or diastolic BP difference is more than 10 mmHg and morning BP is 135/85 mmHg or higher.
Results; 1087 patients were evaluated and there were 173 patients (15.9%) with morning hypertension and 114 patients (10.5%) with masked hypertension by definition. The patients with morning hypertension showed higher clinic BP and home BP irrespective of systolic or diastolic period with comparable pulse rate. Patients achieving BP-goals are less in the morning hypertension group at office (29.5% vs. 56.6%, p<0.0001) and at home (33.0% vs. 67.2%, p<0.0001) and it is similar in DM patients having lower BP-goal (clinic BP: 6.5% vs. 24.5%, p=0.026, home BP: 12.9% vs. 40.1%, p=0.004). They have more reverse-white-coat effect. (32.37% vs. 21.88%, p=0.003 in systolic BP, 33.53% vs. 22.32%, p=0.002 in mean BP).
Conclusion; The patients with morning hypertension showed higher BPs than the patients without it. They had higher prevalence of masked hypertension and uncontrolled hypertension. So, we can suggest that home BP monitoring is essential for detection and treatment of hypertension and the patients with morning hypertension should be treated more vigorously because they showed higher BP in every times and everywhere.