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Predictive power of home blood pressure measurement for cardiovascular outcomes in patients with type 2 diabetes: KAMOGAWA-HBP study

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Abstract

Our previous study showed that the morning systolic blood pressure target should be <120 mmHg to prevent the onset or progression of diabetic nephropathy in patients with type 2 diabetes. In this study, we examined the prognostic values of home and clinical blood pressure for first cardiovascular events in the same cohort. Morning and evening home blood pressure measurements were obtained in triplicate for 14 consecutive days from the beginning of the study in a retrospective cohort of 1081 type 2 diabetes patients (44.5% women; median age 66.0 years) with no history of macrovascular complications. The first major cardiovascular event was the primary endpoint; the risk was examined by the Cox proportional hazards model. After a mean follow-up of 6.63 years, first-time cardiovascular events occurred in 119 patients (incidence, 16.6/1000 patient-years). Baseline morning systolic blood pressure (hazard ratio: 1.14, 95% CI 1.01–1.28) significantly predicted cardiovascular events, whereas clinical blood pressure did not. The adjusted hazard ratio (95% CI) for the incidence of cardiovascular events in patients with morning systolic blood pressure ≥135 mmHg tended to be higher than that in those with morning systolic blood pressure <125 mmHg [1.67 (0.94–2.97)]. Elevated home blood pressure measurement is a predictor of future cardiovascular events in type 2 diabetes patients and may be superior to clinical blood pressure measurement in this regard.

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Acknowledgements

We acknowledge Dr. Atsushi Omoto and Dr. Wataru Fukuda of Kyoto First Red Cross Hospital, Dr. Shin-ichi Mogami and Dr. Yoshihiro Kitagawa of Osaka General Hospital of West Japan Railway Company for their assistance in collecting data. We would like to thank Naoko Higo, Machiko Hasegawa and Terumi Kaneko at the Kyoto Prefectural University of Medicine for teaching the patients how to measure their BP and Sayoko Tanaka, also at the Kyoto Prefectural University of Medicine, for her secretarial assistance. We would like to thank Editage (www.editage.com) for English language editing.

Funding

EU received grant support from the Japanese Study Group for Physiology and Management of Blood Pressure and the Astellas Foundation for Research on Metabolic Disorders (Grant number: 4024).

Author information

Authors and Affiliations

  1. Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan

    Emi Ushigome, Nobuko Kitagawa, Noriyuki Kitagawa, Mai Asano, Masahide Hamaguchi, Masahiro Yamazaki & Michiaki Fukui

  2. Department of Endocrinology and Metabolism, Kyoto First Red Cross Hospital, Kyoto, Japan

    Toru Tanaka

  3. Department of Endocrinology and Metabolism, Kyoto Second Red Cross Hospital, Kyoto, Japan

    Goji Hasegawa

  4. Department of Endocrinology and Metabolism, Osaka General Hospital of West Japan Railway Company, Osaka, Japan

    Masayoshi Ohnishi

  5. Department of Cardiology, Nishijin Hospital, Kyoto, Japan

    Sei Tsunoda

  6. Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan

    Hidetaka Ushigome

  7. Department of Biostatistics, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan

    Isao Yokota

  8. Saiseikai Kyoto Hospital, Kyoto, Japan

    Naoto Nakamura

Authors
  1. Emi Ushigome
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  2. Nobuko Kitagawa
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  3. Noriyuki Kitagawa
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  4. Toru Tanaka
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  5. Goji Hasegawa
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  6. Masayoshi Ohnishi
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  7. Sei Tsunoda
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  8. Hidetaka Ushigome
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  9. Isao Yokota
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  10. Naoto Nakamura
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  11. Mai Asano
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  12. Masahide Hamaguchi
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  13. Masahiro Yamazaki
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  14. Michiaki Fukui
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Corresponding author

Correspondence to Emi Ushigome.

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Conflict of interest

EU received grants from the Japan Society for the Promotion of Science and ONO PHARMACEUTICAL CO., LTD. and received personal fees from AstraZeneca plc; Astellas Pharma Inc.; DAIICHI SANKYO COMPANY, LIMITED; Kyowa Hakko Kirin Company Ltd.; KOWA PHARMACEUTICAL COMPANY LTD.; MSD K.K.; Mitsubishi Tanabe Pharma Corp.; Novo Nordisk Pharma Ltd.; Taisho Toyama Pharmaceutical Co., Ltd.; Takeda Pharmaceutical Co., Ltd.; Nippon Boehringer Ingelheim Co., Ltd.; Sumitomo Dainippon Pharma Co., Ltd.; and Johnson & Johnson K.K. outside the submitted work. Masahide Hamaguchi received grants from Asahi Kasei Pharma; Nippon Boehringer Ingelheim Co., Ltd.; Mitsubishi Tanabe Pharma Corporation; DAIICHI SANKYO COMPANY, LIMITED; Sanofi K.K.; Takeda Pharmaceutical Company Limited; Astellas Pharma Inc.; Kyowa Kirin Co., Ltd.; Sumitomo Dainippon Pharma Co., Ltd.; Novo Nordisk Pharma Ltd.; and Eli Lilly Japan K.K. Masahide Hamaguchi also received personal fees from ONO PHARMACEUTICAL CO., LTD.; AstraZeneca plc; KOWA PHARMACEUTICAL COMPANY LTD.; MSD K.K.; Mitsubishi Tanabe Pharma Corp.; and Sumitomo Dainippon Pharma Co., Ltd. outside the submitted work. Masahiro Yamazaki received personal fees from MSD K.K.; Sumitomo Dainippon Pharma Co., Ltd.; Kowa Company, Ltd.; AstraZeneca PLC; Takeda Pharmaceutical Company Ltd.; Kyowa Hakko Kirin Co., Ltd.; DAIICHI SANKYO COMPANY, LIMITED; KOWA PHARMACEUTICAL COMPANY LTD.; and ONO PHARMACEUTICAL CO., LTD. outside the submitted work. Michiaki Fukui received grants from the Japan Society for the Promotion of Science; Nippon Boehringer Ingelheim Co., Ltd.; KISSEI PHARMACEUTICAL CO., LTD.; Mitsubishi Tanabe Pharma Corporation; DAIICHI SANKYO COMPANY, LIMITED; Sanofi K.K.; Takeda Pharmaceutical Company Limited; Astellas Pharma Inc.; MSD K.K.; Kyowa Hakko Kirin Co., Ltd.; Sumitomo Dainippon Pharma Co., Ltd.; KOWA PHARMACEUTICAL COMPANY LTD.; Novo Nordisk Pharma Ltd.; ONO PHARMACEUTICAL CO., LTD.; SANWA KAGAKU KENKYUSHO CO., LTD.; Eli Lilly Japan K.K.; Taisho Pharmaceutical Co., Ltd.; TERUMO CORPORATION; TEIJIN PHARMA LIMITED; Nippon Chemiphar Co., Ltd.; and Johnson & Johnson k.k. Medical Company. Michiaki Fukui also received honoraria from Nippon Boehringer Ingelheim Co., Ltd.; KISSEI PHARMACEUTICAL CO., LTD.; Mitsubishi Tanabe Pharma Corporation; DAIICHI SANKYO COMPANY, LIMITED; Sanofi K.K.; Takeda Pharmaceutical Company Limited; Astellas Pharma Inc.; MSD K.K.; Kyowa Kirin Co., Ltd.; Sumitomo Dainippon Pharma Co., Ltd.; KOWA PHARMACEUTICAL COMPANY LTD.; Novo Nordisk Pharma Ltd.; ONO PHARMACEUTICAL CO., LTD.; SANWA KAGAKU KENKYUSHO CO., LTD.; Eli Lilly Japan K.K.; Taisho Pharmaceutical Co., Ltd.; Bayer Yakuhin, Ltd.; AstraZeneca K.K.; MOCHIDA PHARMACEUTICAL CO., LTD.; and Combi Corporation outside the submitted work. IY received speaking fees from Chugai Pharmaceutical Co., Ltd. and Japan Tobacco Inc. Pharmaceutical Division outside the submitted work. The sponsors were not involved in the study design; in the collection, analysis, or interpretation of the data; in the writing of this manuscript; or in the decision to submit the article for publication. The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. The authors declare that although they are affiliated with a department that is supported financially by a pharmaceutical company, the authors received no current funding for this study, and their department affiliation does not alter their adherence to all the full journal policies on sharing data and materials.

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Ushigome, E., Kitagawa, N., Kitagawa, N. et al. Predictive power of home blood pressure measurement for cardiovascular outcomes in patients with type 2 diabetes: KAMOGAWA-HBP study. Hypertens Res 44, 348–354 (2021). https://doi.org/10.1038/s41440-020-00584-z

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