Night-time blood pressure and target organ damage

O’Flynn, Anne Marie; Curtin, Ronan J.; O’Brien, Eoin; Perry, Ivan J.; Kearney, Patricia M.

doi:10.1097/hjh.0000000000000690

Cited by 25 publications

(5 citation statements)

References 51 publications

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“…The CRIC study, which enrolled 1492 CKD participants, explained the relationship between ambulatory BP and TOD [25]. The superiority of night-time BP levels, as captured by ABPM, rather than daytime, nondipping BP or clinic BP for predicting TOD or the development of cardiovascular disease in hypertensive patients has been reported [5,7,9,26,27]. In addition, night-time BP avoids mood and movement interference, which may affect BP.…”

Section: Discussionmentioning

confidence: 99%

Lower ambulatory nocturnal SBP is associated with less cardiovascular and renal damage in normotensive hospitalized patients with chronic kidney disease

Zhang

Song²,

Zhou³

et al. 2021

Journal of Hypertension

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Objective: The impact of nocturnal blood pressure (BP) on target organ damage (TOD) in chronic kidney disease (CKD) patients with normotension has not been established. In this study, we determined whether nocturnal BP is correlated with cardiovascular and renal damage independent of the 24-h BP in CKD patients with normotension or hypertension. Methods: A total of 1166 hospitalized patients with CKD not requiring dialysis were enrolled in this cross-sectional study, 421 and 745 of whom had normotension and hypertension, respectively. TOD was assessed by the left ventricular mass index (LVMI), estimated glomerular filtration rate (eGFR) and presence of proteinuria. Univariate and multivariable regression analyses were used to evaluate the relationships between nocturnal BP and TOD. Results: In the multivariable-adjusted models, including the 24-h BP, nocturnal SBP was independently associated with the LVMI, eGFR and proteinuria in patients with normotension (P < 0.05), while the nocturnal DBP was not correlated with proteinuria. The nocturnal SBP was associated with LVMI and proteinuria, but not the eGFR in patients with hypertension. We did not demonstrate an association between nocturnal DBP and TOD in these patients. When nocturnal SBP in patients with normotension was further divided into tertiles [tertile 1 (<104 mmHg), tertile 2 (104–114 mmHg) and tertile 3 (≥114 mmHg)], multivariate analysis showed that tertile 3 was independently associated with TOD. Conclusion: Nocturnal SBP was shown to be an independent risk factor for TOD in patients with normotension. Targeting a nocturnal ambulatory SBP to less than 114 mmHg or even less than 104 mmHg may help prevent TOD in patients with CKD.

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Section: Discussionmentioning

confidence: 99%

Lower ambulatory nocturnal SBP is associated with less cardiovascular and renal damage in normotensive hospitalized patients with chronic kidney disease

Zhang

Song²,

Zhou³

et al. 2021

Journal of Hypertension

View full text Add to dashboard Cite

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“…30,34 A nondipping BP pattern and nighttime hypertension (nighttime BP ≥120/70 mm Hg) are common with a prevalence of 32% to 64% for nondipping BP pattern and 27% to 40% for nighttime hypertension. [35][36][37][38][39] Non-Hispanic Black adults experience the highest rates of hypertension and CVD among all racial/ethnic groups, and there are known health disparities in treatment and CVD outcomes. 40 There is evidence to suggest that African American women and men have a high prevalence of nondipping BP.…”

Section: Altered Bp Rhythm and Hypertension-related Health Risksmentioning

confidence: 99%

Toward Precision Medicine: Circadian Rhythm of Blood Pressure and Chronotherapy for Hypertension - 2021 NHLBI Workshop Report

et al. 2023

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Healthy individuals exhibit blood pressure variation over a 24-hour period with higher blood pressure during wakefulness and lower blood pressure during sleep. Loss or disruption of the blood pressure circadian rhythm has been linked to adverse health outcomes, for example, cardiovascular disease, dementia, and chronic kidney disease. However, the current diagnostic and therapeutic approaches lack sufficient attention to the circadian rhythmicity of blood pressure. Sleep patterns, hormone release, eating habits, digestion, body temperature, renal and cardiovascular function, and other important host functions as well as gut microbiota exhibit circadian rhythms, and influence circadian rhythms of blood pressure. Potential benefits of nonpharmacologic interventions such as meal timing, and pharmacologic chronotherapeutic interventions, such as the bedtime administration of antihypertensive medications, have recently been suggested in some studies. However, the mechanisms underlying circadian rhythm-mediated blood pressure regulation and the efficacy of chronotherapy in hypertension remain unclear. This review summarizes the results of the National Heart, Lung, and Blood Institute workshop convened on October 27 to 29, 2021 to assess knowledge gaps and research opportunities in the study of circadian rhythm of blood pressure and chronotherapy for hypertension.

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“…Results supported that frequent treatment reduces cardiovascular morbidity and death by restoring the natural dipping pattern [ 74 ]. However, recent studies in untreated hypertensive individuals indicate that most surrogate markers of CVD, such as left ventricular hypertrophy, carotid media layer thickness, arterial stiffness, and endothelial dysfunction, are comparable between dippers and non-dippers [ 83 - 86 ]. Several clinical and methodological factors may nullify the predictive usefulness of nondipping in untreated HTN.…”

Section: Reviewmentioning

confidence: 99%

Effects of Nondipping Blood Pressure Changes: A Nephrologist Prospect

Habas,

Akbar,

Alfitori

et al. 2023

Cureus

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Blood pressure (BP) variations depend on various internal, environmental, and behavioral factors. BP fluctuations occur both in normotensive and hypertensive people. Although it fluctuates over the 24-hr day and night, the morning BP increases after waking up and declines throughout sleep. It is typical for BP to decrease by 10% to 20%, while sleeping, known as dipping BP. However, if there is no decrease in nighttime mean systolic BP or a drop of less than 10 mmHg, it is called nondipping BP. Conversely, reverse dipping BP means an increase in mean systolic BP instead of a drop during the night. Reverse dipping is observed in hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD), and obstructive sleep apnea (OSA) syndrome. The introduction of ambulatory BP monitoring (ABPM) led to the emergence of identifying normal and elevated BP patterns. Non-dipping BP increases the risk of cardiovascular system (CVS) complications such as left ventricular hypertrophy, proteinuria, glomerular filtration rate (GFR) reduction, and CKD progression. A loss or blunting of the normal BP profile is recognized as a deleterious variant, and restoring abnormal BP patterns has been reported to significantly impact end-organ damage, morbidity, and mortality. In this non-systematic clinically-oriented, comprehensive review, we aim to update the BP variables and the pathophysiology of nondipping BP and point out the areas which need more investigation from a nephrology perspective because the nondipping BP increases the risk of proteinuria, GFR reduction, and CKD progression. A literature search of PubMed, Google, EMBASE, and Google Scholar was conducted. Checks of selected papers and relevant reviews complemented the electronic search. With improved BP measurement methods, the physiology of BP profile variations is readily detectable during the day and night. A nondipping BP profile is a distinct BP pattern that may have significant end-organ damage effects and therapeutic importance for nephrologists. The pathophysiology of the nondipping BP variant must be clarified to prevent complications, and further investigations are required. Furthermore, there is debate about the best BP index to utilize: systolic BP, diastolic BP, mean arterial pressure, or a mixture of all. All these areas are important and need new research projects.

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Night-time blood pressure and target organ damage

Abstract: Absolute BP level rather than dipping status may be a superior early marker of risk associated with night-time BP. Interventional studies are required to determine whether there is a benefit in specifically targeting absolute night-time BP levels to prevent clinically important outcomes.

Cited by 25 publications

References 51 publications

Lower ambulatory nocturnal SBP is associated with less cardiovascular and renal damage in normotensive hospitalized patients with chronic kidney disease

Lower ambulatory nocturnal SBP is associated with less cardiovascular and renal damage in normotensive hospitalized patients with chronic kidney disease

Toward Precision Medicine: Circadian Rhythm of Blood Pressure and Chronotherapy for Hypertension - 2021 NHLBI Workshop Report

Effects of Nondipping Blood Pressure Changes: A Nephrologist Prospect

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