[Show abstract][Hide abstract] ABSTRACT: To determine the role of home blood pressure (BP) monitoring for a reproducible assessment of orthostatic hypertension (OHT) and the effectiveness of hypertension control by doxazosin. In this study, 605 medicated hypertensive outpatients were enrolled. Home BP in the sitting and standing positions was monitored in all patients in the morning and evening for 6 months. According to an open-label multicenter trial design, the patients were randomly allocated to either an intervention group that took doxazosin (1-4 mg) at bedtime or to a control group that did not receive any add-on medication. The patients were divided into deciles of orthostatic BP change as evaluated by home BP monitoring at baseline. Those in the top decile, in the lowest decile and in deciles two through eight were then assigned to the OHT group, the orthostatic hypotension group and the orthostatic normotension group, respectively.Orthostatic BP in the OHYPO group did not change, whereas that of the OHT group was markedly reduced by doxazosin (P<0.01). In the control group, classification into orthostatic BP categories using home BP monitoring was more reproducible (κ coefficient: 0.42-0.50) than when using clinical BP (κ coefficient: 0.13-0.24). In all groups, a reduction in the urinary albumin/creatinine ratio was significantly associated with a reduction in orthostatic BP doxazosin (P<0.001).The identification of OHT based on home BP monitoring was highly reproducible. The administration of doxazosin might control OHT and consequently prevent target organ damage.
Hypertension Research 09/2011; 35(1):100-6. DOI:10.1038/hr.2011.156 · 2.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We here present the study protocol of The Japan Morning Surge -1 (JMS-1) Study, which is a multicenter trial to clarify the hypothesis that predominant reduction in morning BP using add-on bedtime administration of alpha-adrenergic blocker, doxazosin (Dox), restore hypertensive target organ damage (TOD). We enrolled hypertensives, whose morning systolic BP (SBP) levels measured by home BP monitoring ≥135mmHg under antihypertensives at least for 3 months. An independent study control center randomly allocated these patients into the strict morning BP control group who receive bedtime administration of Dox (Dox group), and control group who followed without any add-on medication (CT group). In the Dox group, Dox was initiated from 1 mg and be titrated to 4 mg for 3 months to achieve morning SBP135mmHg at 3 month after Dox initiation, β-blocker was further added. The primary outcomes were 1) self-measured morning and evening BPs at sitting and standing positions, 2) urinary albumin/creatinine ratio (UAR), 3) brain-type natriuretic peptide (BNP), 4) hypotension-associated symptom, at the baseline and 6 months after the randomization. We successfully recruited 605 hypertensives (>600, predefined target number) from July 1, 2003 to December 31, 2004. Morning SBP were significantly correlated with plasma BNP levels (r=0.20, P
American Journal of Hypertension 05/2005; 18(5). DOI:10.1016/j.amjhyper.2005.03.689 · 3.40 Impact Factor