Clinical Significance and Therapeutic Implication of Nocturnal Hypertension: Relationship between Nighttime Blood Pressure and Quality of Sleep

Abstract

Recent global hypertension guidelines recommend an early, strict and 24-hour blood pressure (BP) control for the prevention of target organ damage and cardiovascular events. Out-of-office BP measurement such as ambulatory BP monitoring and home BP monitoring is now widely utilized to rule out white-coat hypertension, to detect masked hypertension, to evaluate the effects of antihypertensive medication, to analyze diurnal BP variation, and to increase drug adherence. Nocturnal hypertension has been neglected in the management of hypertension despite of its clinical significance. Nighttime BP and non-dipping patterns of BP are stronger risk predictors for the future cardiovascular mortality and morbidity than clinic or daytime BP. In addition to ambulatory or home daytime BP and 24-hour mean BP, nocturnal BP should be a new therapeutic target for the optimal treatment of hypertension to improve prognosis in hypertensive patients. This review will provide an overview of epidemiology, characteristics, and pathophysiology of nocturnal hypertension and clinical significance, therapeutic implication and future perspectives of nocturnal hypertension will be discussed.

Impact of oscillometric measurement artefacts in ambulatory blood pressure monitoring on estimates of average blood pressure and of its variability: a pilot study

“…Further, almost one quarter of patients changed dipping classifications when considering only analyzing artefact-free measurements for analysis. Most of them changed from 'dipping' to 'nondipping' status, which could have significant therapeutic consequences [24,25].…”

Total Atherosclerosis Burden of Baroreceptor-Resident Arteries Independently Predicts Blood Pressure Dipping in Patients With Ischemic Stroke

“…In addition, the neurological deficit of all patients was relatively minor (mean National Institutes of Health Stroke Scale at admission was 3 points). Third, considering that sleep quality could exert significant influence on the BP dipping pattern, 25 a relatively long ABPM recording interval was used in this study to avoid much disturbance to the patients. The frequency of BP measurement was half lower in this study than the guidelines recommended, 14 though it had been successfully applied in several previous studies.…”

Variabilidad De La Presión Arterial, Hipertensión Arterial Nocturna Y Su Asociación Con Tabaquismo

“…La prevalencia de HTA nocturna fue de 57,7%, similar a otros datos publicados (28) . En el Jackson Heart Study se observó una prevalencia de HTA nocturna del 57%, mientras que en el Spanish ABPM Registry Study la prevalencia fue de 41% en los pacientes no tratados y de 50% en los pacientes tratados (29) .…”

“…Existen trabajos que hallaron una relación inversa entre HTA nocturna y tabaquismo, observando una menor PA nocturna en los pacientes fumadores (30,31). Por el contrario, en el Spanish ABPM Registry Study (n= 99884), se encontró una asociación positiva entre HTA nocturna y tabaquismo, observándose además un mayor riesgo cardiovascular y un incremento de la mortalidad en los pacientes con HTA nocturna (29) . Finalmente, en otros estudios, no se encontró asociación entre estas dos variables.…”