OP.6B.08] ASSOCIATION OF NIGHTTIME HOME BLOOD PRESSURE WITH AMBULATORY BLOOD PRESSURE AND TARGET-ORGAN DAMAGE

Abstract

Objective: Accumulating evidence suggests that nighttime blood pressure (BP) evaluated by ambulatory BP (ABP) monitoring carries superior prognostic value in terms of cardiovascular risk. Novel home BP (HBP) monitors allow automated BP monitoring during nighttime sleep. This is a review of published evidence regarding nighttime HBP monitoring in terms of association with ABP and preclinical target-organ damage. Design and method: A systematic search was performed at PubMed. From the initially 299 identified articles, 4 provided comparative data between nighttime HBP and ABP regarding one or more of the following criteria: (i) BP differences, (ii) correlations between BPs, and (iii) association with indices of preclinical target-organ damage. Results: Four studies (n = 1,106, 87% hypertensives, 48% men, weighted mean age [SD]: 59.9 [7.7]) reported nighttime HBP-ABP differences with pooled values for systolic/diastolic BP at 1.7 (95% CI 0.2, 3.3)/−0.2 (−1.2, 0.9) mmHg respectively. Three of the studies (n = 1,066, 90% hypertensives, 47% men, weighted age [SD]: 61.3 [3.7]) reported the correlation between systolic/diastolic nighttime HBP and nighttime ABP with pooled coefficients r 0.72 (95% CI 0.56, 0.88)/0.74 (0.66, 0.82) respectively. Two of the studies (n = 985, 90% hypertensives, 47% men, weighted age [SD]: 61.6 [3.7]) reported similar correlation coefficients for nighttime systolic HBP vs. ABP in terms of association with left ventricular mass index (pooled r 0.29 [95% CI 0.21, 0.38] vs. 0.24 [0.03, 0.45] respectively, p = NS for difference) and urinary albumin excretion (r = 0.39 [0.21, 0.58] vs. 0.31 [0.07, 0.54] respectively, p = 0.05 for difference). Conclusions: Nighttime HBP provides similar values with nighttime ABP. Most importantly it appears to be at least as reliable as nighttime ABP in determining preclinical target-organ damage. Outcome studies are needed to verify these cross-sectional data and confirm the value of nighttime HBP in predicting cardiovascular morbidity and mortality.