Abstract
Introduction: The new 2017 American College of Cardiology/American Heart Association guidelines propose that blood pressure (BP) measured during the awake period (clinic BP and ambulatory BP) should be controlled to <130/80 mm Hg as a universal BP goal. However, even after controlling daytime BPs, there is still a residual risk in hypertension, i.e., nocturnal hypertension. It has been well-established that night-time BP during sleep is closely associated with cardiovascular events in both community-dwelling subjects and hypertensive patients. Hypothesis: We hypothesized that nocturnal hypertension is associated is associated with hypertension-mediated organ damage (HMOD) in hypertensive patients. Methods: All subjects underwent the following procedures: 2-D and Doppler echocardiography, spot urine microalbuminuria (MA), arterial stiffness using pulse wave velocity (PWV) and ambulatory BP monitoring over 24-h periods. Nocturnal hypertension was defined according to current guidelines (i.e., nighttime systolic BP (SBP) ≥110 and/or diastolic BP ≥70 mm Hg). Results: Among 2375 subjects, (mean age 55±12 years, 45% female), nocturnal hypertension was evident in more than half of the study population with some 43% being masked uncontrolled nocturnal hypertension. Compared to the patients without nocturnal hypertension, the prevalence of left ventricular hypertrophy, increased relative wall thickness, MA and PWV>12m/s in patients with nocturnal hypertension was significantly higher at 25%, 64%, 56%, and 55%, respectively. In multivariate logistic regression analyses, after adjusting for other risk factors, nocturnal BP was associated with HMOD, independent of daytime BP. Conclusions: Nocturnal hypertension is a strong independent risk factor for HMOD, highlighting the importance of early detection and control of this particular BP phenotype in hypertensive patients.
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