Sleep Blood Pressure Self-Measured at Home as a Novel Determinant of Organ Damage: Japan Morning Surge Home Blood Pressure (J-HOP) Study

To study whether sleep blood pressure (BP) self-measured at home is associated with organ damage, the authors analyzed the data of 2562 participants in the J-HOP study who self-measured sleep BP using a home BP monitoring (HBPM) device, three times during sleep (2am, 3am, 4am), as well as the home morning and evening BPs. The mean sleep home systolic BPs (SBPs) were all correlated with urinary albumin/creatinine ratio (UACR), left ventricular mass index (LVMI), brachial-ankle pulse wave velocity (baPWV), maximum carotid intima-media thickness, and plasma N-terminal pro-hormone pro-brain-type natriuretic peptide (NTproBNP) (all P<.001). After controlling for clinic SBP and home morning and evening SBPs, associations of home sleep SBP with UACR, LVMI, and baPWV remained significant (all P<.008). Even in patients with home morning BP <135/85mmHg, 27% exhibited masked nocturnal hypertension with home sleep SBP 120mmHg and had higher UACR and NTproBNP. Masked nocturnal hypertension, which is associated with advanced organ damage, remains unrecognized by conventional HBPM.