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Lifestyle modifications are important in the prevention and treatment of hypertension. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH2014) recommend salt reduction (< 6 g/day), increased intake of vegetables/fruit and fish (fish oil), reduced intake of cholesterol and saturated fatty acids, weight loss (body mass index < 25kg/m2), exercise (≥ 30 min/day), reduction of alcohol intake (≤ 20-30 mL/day in men, ≤ 10-20 mL/day in women as ethanol), and quitting smoking. These lifestyle modifications are capable of reducing blood pressure and ameliorating other cardiovascular risk factors. However, the reduction in blood pressure is mild to moderate and the adherence to lifestyle modifications has been still suboptimal.

It has been increasingly recognized that, for the reliable assessment of blood pressure (BP) and the accurate diagnosis of hypertension, not only office-BP but out-of-office BP measurement with ambulatory BP monitoring (ABPM) or self BP measurement at home is useful and important. Although office-BP should be used as reference, ABPM and home BP monitoring improves the prediction of cardiovascular risk in untreated and treated hypertensive patients. In this article, we reviewed the methodology for measuring BP by these procedures, its diagnostic and therapeutic thresholds, and its clinical applications in the management of hypertension. We also mentioned the abnormal circadian rhythm of BP and related conditions diagnosed by the implementation of these procedures.

Systolic blood pressure (SBP) increases by aging. In contrast, diastolic blood pressure (DBP) decreases after age 60 because of lowering aortic compliance. Therefore, isolated systolic hypertension (ISH) is common in the elderly. ISH is a risk for cardiovascular complications, and induces a left ventricular hypertrophy combined with diastolic dysfunction. Diastolic heart failure followed by diastolic dysfunction is more common than systolic heart failure in the elderly. Furthermore, changes in neuroendocrine systems by aging may lead orthostatic hypotension, non-dipping status, large blood pressure variability, and reduced heart rate variability. In the management of elderly hypertension, the understanding for these age-related hemodynamic changes is very important.

Objective: To study the effect of once-daily administration of a nitrendipine tablet 10 mg on 24-hour ambulatory blood pressure in inpatients with renal parenchymal hypertension., Methods: Sixteen patients participated in the present study, and one patient was withdrawn because the baseline office blood pressure was less than 140/90 mmHg. In the baseline period, ambulatory blood pressure was monitored every 30 minutes for 30 hours. After the baseline measurement, nitrendipine 10 mg was orally administered once daily every morning for 7 days. The 30-hour ambulatory blood pressure monitoring was repeated after Day 6., Results: Fifteen patients (aged 64.9 +/- 15.0 years) completed the study protocol. Baseline office blood pressure was 157.9 +/- 17.5/84.7 +/- 12.5 mmHg (mean +/- SD). Nitrendipine 10 mg tablets significantly reduced both systolic blood pressure (SBP) and diastolic blood pressure (DBP) at least for 11 hours after administration compared with those at baseline. The rate of "Decrease" (reduction in blood pressure > or = 20/10 mmHg and/or achieved blood pressure < 140/90 mmHg at trough point) was 60.0% (9/15). Eleven patients were considered as effective cases at peak point (maximal reduction in blood pressure > or = 20/10 mmHg). The rate of "Decrease" in effective cases at peak point was 72.7% (8/11)., Conclusion: These results suggest that a once-daily administration of nitrendipine 10 mg tablets is effective for the 24-hour control of blood pressure in patients with renal parenchymal hypertension.