Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
5619542 | Progress in Cardiovascular Diseases | 2016 | 65 Pages |
Abstract
There are notable differences between Asians and Westerners regarding hypertension (HTN) and the relationship between HTN and cardiovascular disease (CVD). Asians show greater morning surges in blood pressure (BP) and a steeper slope illustrating the link between higher BP and the risk of CVD events. It is thus particularly important for Asian hypertensives to achieve 24-h BP control, including morning and night-time control. There are three components of 'perfect 24-h BP control:' the 24-h BP level, nocturnal BP dipping, and BP variability (BPV), such as the morning BP surge that can be assessed by ambulatory BP monitoring. The morning BP-guided approach using home BP monitoring (HBPM) is the first step toward perfect 24-h BP control, followed by the control of nocturnal HTN. We have been developing new HBPM devices that can measure nocturnal BP. BPV includes different time-phase variability from the shortest beat-by-beat, positional, diurnal, day-by-day, visit-to-visit, seasonal, and yearly changes. The synergistic resonance of each type of BPV would produce a great dynamic BP surge (resonance hypothesis), which triggers a CVD event, especially in the high-risk patients with systemic hemodynamic atherothrombotic syndrome (SHATS). In the future, the innovative management of HTN based on the simultaneous assessment of the resonance of all of the BPV phenotypes using a beat by beat wearable 'surge' BP monitoring device (WSP) and an information and communication technology (ICT)-based data analysis system will produce a paradigm shift from 'dots' BP management to 'seamless' ultimate individualized 'anticipation medication' for reaching a zero CVD event rate.
Keywords
HBPMUrine albumin-to-creatinine ratioUACRHTNSBPLVHRASCHDABPMT2DCPAPbpVobstructive sleep apneaOsacoronary heart diseasecardiovascular diseasechronic kidney diseaseType 2 diabetesCVDRenin–angiotensin systemContinuous positive airway pressurehypertension or hypertensivesystolic blood pressureNocturnal hypertensionBlood pressureInformation and Communication TechnologyICTcardiovascularblood pressure variabilityheart failureCKDhome blood pressure monitoringambulatory blood pressure monitoringLeft ventricular hypertrophy
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Authors
Kazuomi Kario,