Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations

Fan, Hong; Li, Yan; Thijs, Lutgarde; Hansen, Tine W.; Boggia, José; Kikuya, Masahiro; Björklund-Bodegård, Kristina; Richart, Tom; Ohkubo, Takayoshi; Jeppesen, Jørgen; Torp‐Pedersen, Christian; Dolan, Eamon; Kuznetsova, Tatiana; Stolarz‐Skrzypek, Katarzyna; Tikhonoff, Valérie; Malyutina, Sofia; Casíglia, Edoardo; Nikitin, Yu. P.; Lind, Lars; Sandoya, Edgardo; Kawecka‐Jaszcz, Kalina; Imai, Yutaka; Ibsen, Hans; O’Brien, Eoin; Wang, Ji‐Guang; Staessen, Jan A.

doi:10.1097/hjh.0b013e32833b49fe

Cited by 329 publications

(181 citation statements)

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“…A previous meta‐analysis based on individual participant data demonstrated that individuals with isolated nocturnal hypertension were associated with a significantly higher risk of total mortality and all cardiovascular events than normotensive individuals 11. In comparison with MS parameters, morning hypertension may be an easier target to manage because both ABPM and home BP monitoring can provide morning BP measurements 20.…”

Section: Discussionmentioning

confidence: 99%

“…We hypothesized that the rate of a BP increase carries valuable prognostic information in association with cardiovascular outcomes beyond the amplitude of STMS. Moreover, subjects with morning and nocturnal hypertension are known to have increased risks for cardiovascular events and total mortality 10, 11. Whether the presence of morning or nocturnal hypertension could modify the prognostic value of MS is largely unknown 10.…”

mentioning

confidence: 99%

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Prognostic Utility of Morning Blood Pressure Surge for 20‐Year All‐Cause and Cardiovascular Mortalities: Results of a Community‐Based Study

Cheng

Sung

et al. 2017

JAHA

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BackgroundMorning blood pressure (BP) surge (MS), defined by the MS amplitude, is an independent prognostic factor of cardiovascular outcomes in some, but not all, populations.Method and ResultsWe enrolled 2020 participants (1029 men; aged 30–79 years) with 24‐hour ambulatory BP data. During a median 19.7‐year follow‐up, 607 deaths (182 by cardiovascular causes) were confirmed from the National Death Registry. The amplitude of sleep‐trough MS (STMS) was derived from the difference between morning systolic BP (SBP) and lowest nighttime SBP. The rate of STMS was derived as the slope of linear regression of sequential SBP measures on time intervals within the STMS period. Thresholds for high STMS amplitude and rate were determined by the 95th percentiles (43.7 mm Hg and 11.3 mm Hg/h, respectively). Multivariable Cox models, adjusting for age, sex, body mass index, smoking, alcohol, low‐density lipoprotein cholesterol, 24‐hour SBP, night:day SBP ratio, and antihypertensive treatment, revealed that a high STMS rate (hazard ratio, 1.666; 95% confidence interval, 1.185–2.341), but not STMS amplitude (hazard ratio, 1.245; 95% confidence interval, 0.984–1.843), was significantly associated with a greater mortality risk. Similarly, STMS rate (hazard ratio, 2.608; 95% confidence interval, 1.554–4.375), but not STMS amplitude, was significantly associated with the risk of cardiovascular mortality (hazard ratio, 0.966; 95% confidence interval, 0.535–1.747). Moreover, the prognostic values of STMS rate were comparable in subjects with or without morning and nocturnal hypertension (P>0.05 for interaction for all). In simulation studies, STMS rate was less susceptible to measurement errors of the sleep‐trough SBP than STMS amplitude.Conclusions STMS rate could independently help identify subjects with an increased cardiovascular risk.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Prognostic Utility of Morning Blood Pressure Surge for 20‐Year All‐Cause and Cardiovascular Mortalities: Results of a Community‐Based Study

Cheng

Sung

et al. 2017

JAHA

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“…[21][22][23] The prevalence of isolated nocturnal hypertension was 6-10% in the general population, and a relatively higher prevalence was found in South Americans and Japanese than in Europeans. The following characteristics of patients with isolated nocturnal hypertension were observed, when the patients were compared with normotensives: older, male, obese, higher pulse rate at night, and glucose and lipid abnormalities.…”

Section: How To Evaluate Nocturnal Bpmentioning

confidence: 99%

“…Despite the fact that it cannot be detected by office and home BP measurements, this novel clinical entity was associated with targetorgan damage and increased total mortality, as well as with all cardiovascular events, when patients were compared with normotensive cases. [21][22][23] Further studies are needed to address the benefits of specifically lowering nocturnal BP in patients with isolated nocturnal hypertension.…”

Section: How To Evaluate Nocturnal Bpmentioning

confidence: 99%

“…[17][18][19][20]30 The clinical implications of nondipping in the absence of nocturnal hypertension may vary with age, smoking status, presence of antihypertensive drugs and co-morbidities such as diabetes, chronic kidney disease and preexisting CVD. Nevertheless, the association of nondipping with excess mortality rather than cardiovascular morbidity [17][18][19][20][21] raises the possibility that nondipping is a marker of pre-existing or concurrent diseases ( Figure 2). In particular, reverse dipping (or a 'riser' pattern), that is, a night-to-day BP ratio of 1 or more, consistently shows the poorest outcomes among different types of dipping.…”

Section: Nocturnal Bp Dipping and Cardiovascular Riskmentioning

confidence: 99%

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Nocturnal blood pressure and cardiovascular disease: a review of recent advances

2012

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The accurate measurement, prediction and treatment of high blood pressure (BP) are essential issues in the management of hypertension. Ambulatory blood pressure monitoring (ABPM) has been shown to be superior to clinic BP measurements as ABPM can provide the following important information: (i) the mean BP levels, (ii) the diurnal variation in BP and (iii) the short-term BP variability. Among these parameters, there is increasing evidence that the mean nocturnal BP level is the most sensitive predictor of cardiovascular morbidity and mortality. Furthermore, several studies have shown that less nocturnal BP dipping, defined as less nocturnal BP decline relative to daytime BP, or a high night-day BP ratio was associated with poor prognosis irrespective of the 24-hour BP levels. These findings can be interpreted in at least two ways: namely, high nocturnal BP or less nocturnal BP dipping might be not only a potent risk factor for cardiovascular disease (CVD), but also a marker of pre-existing or concurrent diseases that can lead to nocturnal BP elevation. In this review, we consider the clinical utility of ABPM and in particular focus on the nocturnal BP levels or nocturnal BP dipping as a potent risk factor for CVD. In addition, the clinical management of high nocturnal BP and blunted nocturnal BP dipping with antihypertensive medications is discussed.

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Effects of Low Blood Pressure in Cognitively Impaired Elderly Patients Treated With Antihypertensive Drugs

et al. 2015

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The prognostic role of high blood pressure and the aggressiveness of blood pressure lowering in dementia are not well characterized. OBJECTIVE To assess whether office blood pressure, ambulatory blood pressure monitoring, or the use of antihypertensive drugs (AHDs) predict the progression of cognitive decline in patients with overt dementia and mild cognitive impairment (MCI). DESIGN, SETTING, AND PARTICIPANTS Cohort study between June 1, 2009, and December 31, 2012, with a median 9-month follow-up of patients with dementia and MCI in 2 outpatient memory clinics. MAIN OUTCOMES AND MEASURES Cognitive decline, defined as a Mini-Mental State Examination (MMSE) score change between baseline and follow-up. RESULTS We analyzed 172 patients, with a mean (SD) age of 79 (5) years and a mean (SD) MMSE score of 22.1 (4.4). Among them, 68.0% had dementia, 32.0% had MCI, and 69.8% were being treated with AHDs. Patients in the lowest tertile of daytime systolic blood pressure (SBP) (Յ128 mm Hg) showed a greater MMSE score change (mean [SD], −2.8 [3.8]) compared with patients in the intermediate tertile (129-144 mm Hg) (mean [SD], −0.7 [2.5]; P = .002) and patients in the highest tertile (Ն145 mm Hg) (mean [SD], −0.7 [3.7]; P = .003). The association was significant in the dementia and MCI subgroups only among patients treated with AHDs. In a multivariable model that included age, baseline MMSE score, and vascular comorbidity score, the interaction term between low daytime SBP tertile and AHD treatment was independently associated with a greater cognitive decline in both subgroups. The association between office SBP and MMSE score change was weaker. Other ambulatory blood pressure monitoring variables were not associated with MMSE score change. CONCLUSIONS AND RELEVANCE Low daytime SBP was independently associated with a greater progression of cognitive decline in older patients with dementia and MCI among those treated with AHDs. Excessive SBP lowering may be harmful for older patients with cognitive impairment. Ambulatory blood pressure monitoring can be useful to help avoid high blood pressure overtreatment in this population.

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Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations

Abstract: INH predicts cardiovascular outcome in patients who are normotensive on office or on ambulatory daytime BP measurement.

Cited by 329 publications

References 42 publications

Prognostic Utility of Morning Blood Pressure Surge for 20‐Year All‐Cause and Cardiovascular Mortalities: Results of a Community‐Based Study

Prognostic Utility of Morning Blood Pressure Surge for 20‐Year All‐Cause and Cardiovascular Mortalities: Results of a Community‐Based Study

Nocturnal blood pressure and cardiovascular disease: a review of recent advances

Effects of Low Blood Pressure in Cognitively Impaired Elderly Patients Treated With Antihypertensive Drugs

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