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Differences in Dynamic Diurnal Blood Pressure Variability Between Japanese and American Treatment-Resistant
Kazuomi Kario1, Deepak L Bhatt2, Sandeep Brar3
1Department of Cardiovascular Medicine, Jichi Medical University School of Medicine.
Summary
Japanese patients with resistant hypertension exhibit greater dynamic systolic blood pressure surges compared to Black and White Americans. These findings suggest ethnic differences in blood pressure regulation, impacting treatment strategies.
Area of Science:
- Cardiology
- Hypertension Research
- Ethnic Health Disparities
Background:
- Dynamic diurnal changes in 24-hour ambulatory systolic blood pressure (SBP) are linked to heightened cardiovascular risk.
- Treatment-resistant hypertension (TRH) presents unique challenges in blood pressure management.
Purpose of the Study:
- To compare ambulatory blood pressure (BP) dynamics in Japanese, Black, and White populations with TRH.
- To investigate potential ethnic differences in BP circadian variation and surges.
Main Methods:
- Retrospective comparison of ambulatory BP indices in the HTN-Japan cohort and the SYMPLICITY HTN-3 trial (White and Black patients).
- Inclusion criteria: office SBP ≥160 mmHg, 24-h ambulatory SBP ≥135 mmHg on ≥3 antihypertensives.
- Analysis focused on circadian variation, morning/nighttime dynamic surges, and peak morning SBP.
Main Results:
- All cohorts had similar baseline office SBP.
- Japanese cohort had lower BMI, less sleep apnea, and less hypercholesterolemia.
- Japanese patients showed significantly higher morning SBP, peak morning SBP, morning dynamic surge, and nighttime dynamic surge compared to Black and White patients, even after adjustment.
Conclusions:
- Greater diurnal BP variability and dynamic surges in Japanese patients suggest ethnic variations in BP regulation mechanisms in TRH.
- These ethnic differences may necessitate tailored drug and device-based therapeutic strategies.
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