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Hypertension Objective treatment based on Measurement by Electrical Devices of Blood Pressure Study (HOMED BP Study) is the first large-scale intervention trial in Japan using a Prospective Randomized Open Blinded Endpoint (PROBE) design to determine an optimal target blood pressure (BP) level on the basis of self-measured BP at home, and an optimal initial course of antihypertensive medication. The registered patients are randomized to either a more intensive BP-lowering group (home systolic BP < 125 mmHg and diastolic < 80 mmHg) or a less intensive group (home systolic/diastolic BP within the range 134-125/84-80 mmHg) by host computer via the Internet. The differential effect of three classes of initial antihypertensive regimens on the prognosis, i.e., calcium antagonist (Ca-A), angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor antagonist (ARB), which are used most frequently in Japan, are examined. Three regimens are also randomly assigned to the host computer via the Internet. A pilot study was started in May 2001. In March 2002, the number of participating doctors was 461. At the end of March 2002, 546 patients were recruited. Of these, 412 (202 men and 210 women, aged 58.4 +/- 10.2 y) were randomized. Patients will be recruited until February, 2006 and followed for 7 years.

Objective: To clarify the effects of bedtime administration of the centrally acting alpha(2)-agonists, guanabenz and clonidine, on morning hypertension., Methods: Patients with morning hypertension were assigned to receive once-daily evening administration of guanabenz (2 mg/day, n = 81; 4 mg/day, n = 2) or clonidine (75 microg/day, n = 40; 150 microg/day, n = 10) for 4 weeks, and the blood pressure (BP)-lowering effects of these drugs in the morning and evening were evaluated by assessing self-monitored BP in the home environment. The subjects were then subdivided into different groups according to their evening BP, and the effects of guanabenz and clonidine on evening BP were evaluated further for each group. In addition, as a substitute for the trough/peak ratio, the evening/morning (E/M) ratio was calculated to assess the duration of action of the two alpha(2)-agonists., Results: Evening dosing with guanabenz or clonidine lowered morning BP significantly. Both drugs decreased evening BP in the subgroup of subjects with a high evening BP, but not in those with a normal evening BP. The individual E/M ratios for guanabenz, but not for clonidine, were significantly greater in those with a high evening BP than in those with a normal evening BP. In the early treatment period, treatment with guanabenz resulted in a higher diastolic E/M ratio in those subjects with a high evening diastolic BP than did treatment with clonidine., Conclusion: The results suggest that evening administration of the central alpha(2)-agonists guanabenz and clonidine effectively suppresses the morning BP elevation in treated hypertensive patients.