Prediction of stroke by home "morning" versus "evening" blood pressure values: The Ohasama study

Kei Asayama, Takayoshi Ohkubo, Masahiro Kikuya, Taku Obara, Hirohito Metoki, Ryusuke Inoue, Azusa Hara, Takuo Hirose, Haruhisa Hoshi, Junichiro Hashimoto, Kazuhito Totsune, Hiroshi Satoh, Yutaka Imai

Research output: Contribution to journalArticlepeer-review

140 Citations (Scopus)


Predictive power of self-measured blood pressure at home (home BP) for cardiovascular disease risk has been reported to be higher than casual-screening BP. However, the differential prognostic significance of home BP in the morning (morning BP) and in the evening (evening BP), respectively, has not been elucidated. In the Ohasama study, 1766 subjects (≥40 years) were followed up for an average of 11 years. The predictive power for stroke incidence of evening BP was compared with that of morning BP as continuous variables. The Cox regression model demonstrated that evening BP and morning BP predicted future stroke risk equally. Subjects were also assigned to 1 of 4 categories based on home BP. In this analysis, stroke risk in morning hypertension ([HT] morning BP ≥135/85 mm Hg and evening BP <135/85 mm Hg; relative hazard (RH): 2.66; 95% CI:1.64 to 4.33) and that in sustained HT(morning BP and evening BP ≥135/85 mm Hg; RH: 2.38; 95% CI: 1.65 to 3.45) was significantly higher than that in normotension (morning BP and evening BP <135/85 mm Hg). The risk in morning HT was more remarkable in subjects taking antihypertensive medication (RH: 3.55; 95% CI: 1.70 to 7.38). Although the risk in evening HT (morning BP <135/85 mm Hg and evening BP ≥135/85 mm Hg) was higher than that in normotension, the differences were not significant. In conclusion, morning BP and evening BP provide equally useful information for stroke risk, whereas morning HT, which indicates HT specifically observed in the morning, might be a good predictor of stroke, particularly among individuals using anti-HT medication.

Original languageEnglish
Pages (from-to)737-743
Number of pages7
Issue number4
Publication statusPublished - 2006 Oct
Externally publishedYes


  • Evening-home blood pressure
  • General population
  • Home blood pressure
  • Morning-home blood pressure
  • Ohasama study
  • Self-measurement
  • Stroke

ASJC Scopus subject areas

  • Internal Medicine


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