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PP.31.20: SEASONAL VARIATION IN HOME BLOOD PRESSURE AMONG PATIENTS UNDER ANTIHYPERTENSIVE MEDICATION HOMED-BP STUDY

Objective: The purpose of the present study was to investigate the multi-year seasonal variation in home blood pressure (HBP) among hypertensive patients who were taking antihypertensive medication by applying model-based mathematical approach. Design and method: Hypertension Objective Treatment Based on Measurement by Electrical Devices of Blood Pressure (HOMED-BP) study was a randomized controlled trial to establish the long-term benefit in clinical practice based on self-measured HBP. In the present analysis, hypertensive patients with 52 or more points of weekly-averaged HBP after 1 year from randomization were chosen from the HOMED-BP database. Morning and the evening HBP were separately evaluated. Weekly-averaged systolic and diastolic HBPs were fitted into the following cosine function using nonlinear mixed effect model: HBP = HBP Variation + Other Effects + Intercept HBP Variation = (BPvar/2)•cos {(2&pgr;/Tfreq•(W − Tmax)} where BPvar is the maximum-minimum difference in HBP in one cycle of the cosine curve (mmHg), Tfreq is the time requiring one cycle of HBP variation (week), and Tmax is the time when HBP reached for the maximum point at the first time (week) as constants. W denotes the time (week) and W 1–52 means Jan 1st to Dec 31st in the year when each patient was randomized. Other effects included the 2 terms proportional to the defined daily doses (DDD) and the elapsed time from randomization in the HOMED-BP study. Intercept was a constant showing the reference point of HBP variation. Results: From 3518 patients randomized in the HOMED-BP study, 1647 and 1284 eligible patients were selected for the morning and the evening HBP analysis, respectively, and the all cosine function models converged (p < 0.0001). The systolic/diastolic maximum-minimum differences, BPvar, in the morning HBP were 6.6/2.9 mmHg, and those in the evening were 5.5/2.7 mmHg. The time when HBP reached for the maximum point, Tmax, were within 2.6–3.4 weeks. Conclusions: The cosine-curve models appropriately demonstrated the seasonal variation in HBP with 1-year cycle. The highest HBP can be observed in mid-to-late January.