Asleep Systolic Blood Pressure Research Articles

New perspective on exploring the predictive factors of blood pressure reduction during CPAP treatment in people with severe OSA and hypertension: a prospective observational study

BackgroundThe predictive factors of blood pressure (BP) response to continuous positive airway pressure (CPAP) in obstructive sleep apnoea (OSA) are still being explored. We aimed to assess the antihypertensive effect...

Effect of intermittent fasting and chronotherapy on blood pressure control in hypertensive patients during Ramadan

Background: During Ramadan, repeated cycles of fasting, associated with alterations in the daily patterns of sleep, activities and medication timing might contribute to changes in blood pressure (BP) and heart rate among hypertensive patients. Studies on the effects of fasting on the blood pressure of hypertensive patients are rare, and have provided inconclusive results. The aim of this study was to examine the effect of medication timing during Ramadan on blood pressure and heart rate in hypertensive individuals taking their treatment once daily. Material and methods: The study prospectively recruited 44 hypertensive patients between April and June 2019, followed up at the cardiology department of Habib Thameur Hospital in Tunis. A 24-hour blood pressure monitoring was carried out during two periods: prior to Ramadan and during the last ten days of Ramadan. We compared the average values of 24-hour awake and asleep systolic and diastolic blood pressure and 24-hour awake and asleep heart rate. Results: We studied 29 women and 15 men, mean age was 58.7 years. Fifteen patients were diabetics, 20 had dyslipidemia and 7 patients had coronaropathy. Twenty patients were on monotherapy, 19 on dual therapy and 5 on a triple antihypertensive therapy. During Ramadan, 25 patients took their treatment during the dinner (group1), whereas 19 took their treatment during the S’hour (group 2). Average 24-hour blood pressure in the whole group was 129 ± 18/74 ± 10 mm Hg before Ramadan and 129 ± 19/74 ± 10 mm Hg during Ramadan (p > 0.05). Daytime and night-time mean values of systolic and diastolic blood pressure as well as mean values of heart rate were not different between both periods regardless of age and gender. However, during Ramadan, those who took their treatment after dinner had significantly higher values of 24-hour systolic BP, awake systolic and diastolic BP, asleep systolic and diastolic BP than those who took their treatment with the S’hour (p < 0.05). Conclusions: In this study, there were no significant changes in systolic and diastolic blood pressures or in heart rate during the 2 periods. However, during Ramadan, a slight superiority of taking the treatment with the S’hour is observed.

Morning blood pressure surge in renal transplant recipients: Its relation to graft function and arterial stiffness.

When the blood pressure rises before awakening in the morning, it is called as morning blood pressure pulse (MBPS). MBPS is considered to be an independent risk factor for cardiovascular disease. The aim of this study was to investigate the associations between MBPS, graft function, arterial stiffness and echocardiographic indices in renal transplant recipients. Among 600 renal transplant recipients, 122 patients who had a history of hypertension and were taking at least one antihypertensive medication were enrolled in the study. Arterial stiffness was measured by carotid-femoral pulse wave velocity (PWv), and echocardiographic indices were assessed. 24h ambulatory blood pressure was monitored for all patients. MBPS was calculated by subtracting morning systolic blood pressure from minimal asleep systolic blood pressure. Mean morning, day time and asleep systolic blood pressure values were 171.2± 23.9, 137.9 ± 18.1, and 131.7± 18.9, respectively. Nondipper hypertension status was observed in 93 patients. Mean MBPS was 35.6± 19.5mm Hg, means PWv was 6.5± 2.0m/s. Patients with MBPS ≥ 35mm Hg, had significantly lower eGFR and higher proteinuria, PWv. higher left atrium volume and LVMI. In regression analysis, day time systolic blood pressure, asleep systolic blood pressure, morning blood pressure surge, nondipper status and left ventricular mass index were detected as the predictors of graft function. Increased morning blood pressure surge is associated with graft dysfunction, increased arterial stiffness and LVMI that contribute to cardiovascular mortality and morbidity in renal transplant recipients.

Abstract P117: Association Of Ambulatory Blood Pressure Monitoring Parameters With Left Ventricular Hypertrophy: Analysis Of Pooled Population- And Community-based Studies

Objectives: Ambulatory blood pressure (BP) monitoring (ABPM) parameters beyond mean BP may be useful for identifying individuals at high risk for cardiovascular end-organ damage. We examined the association between ABPM parameters, including 24-hour BP load, peak BP, peak increase in BP, and mean BP with left ventricular hypertrophy (LVH). Methods: Data were pooled from five US-based studies in which participants underwent ABPM for 24 hours (n=2,892). We defined systolic BP (SBP) load as the weighted average of the percent awake SBP readings ≥ 130 mm Hg and asleep SBP readings ≥ 110 mm Hg; peak SBP as the weighted average of awake and asleep 90 th percentile of SBP; peak increase as the difference between the peak SBP and mean SBP. These parameters were then categorized into quartiles. LVH was assessed by 2D-echocardiography. Analyses were stratified by mean 24-hour BP < 130/80 and ≥ 130/80 mm Hg. Results: Among participants with mean 24-hour BP < 130/80 mm Hg, the prevalence of LVH increased from the lowest to the highest quartile for SBP load, peak SBP, peak increase in SBP, and mean SBP ( Table ). The adjusted prevalence ratio (PR) for the association of the highest versus the lowest quartile with LVH was 1.82 (95%CI: 1.08-3.05) for SBP load, 2.00 (95%CI: 1.18-3.38) for peak SBP, 1.38 (95%CI: 0.85-2.23) for peak increase in SBP, and 1.51 (95%CI: 0.98-2.32) for mean SBP. Among participants with mean 24-hour BP ≥ 130/80 mm Hg, the prevalence of LVH increased for all ABPM parameters from the lowest to the highest quartile. The multivariable-adjusted PR for the association of the highest versus the lowest quartile with LVH was 1.39 (95%CI: 0.98-1.97) for SBP load, 1.66 (95%CI: 1.09-2.53) for peak SBP, 1.08 (95%CI: 0.76-1.53) for peak increase in SBP, and 1.88 (95%CI: 1.24-2.83) for mean SBP. Conclusion: The 24-hour SBP load and peak SBP were associated with a higher prevalence of LVH when mean 24-hour BP was < 130/80 mm Hg. The 24-hour peak SBP and mean SBP were associated with a higher prevalence of LVH when mean 24-hour BP was ≥ 130/80 mm Hg.

The effect of frailty on the 24-hour blood pressure pattern in the very elderly.

Frailty plays a crucial role in the management of hypertension in the very elderly and has a strong association with cardiovascular diseases. Nevertheless, its influence on the 24‐hour blood pressure pattern, including elevated asleep systolic blood pressure (BP) and the lack of BP fall during sleep (non‐dipping) has not been explored in a population above 80 years.Patients older than 80 years were classified into frail or robust subtypes by the five item frailty phenotype criteria. All participants were submitted to office blood pressure measurements and ambulatory BP monitoring over a 24‐hour period. Nocturnal dipping was defined as nighttime BP fall ≥10%.Thirty‐eight frail and 36 non‐frail individuals (mean age 85.3 ± 3.7 years; 67% females) were analyzed. Awake systolic and diastolic BP were similar for frail and robust individuals. Frail patients had higher systolic BP during sleep (128 ± 15 mm Hg vs. 122 ±13 mm Hg p = .04) and reduced systolic BP fall [1 (‐4.5 – 5)% vs. 6.8 (2.1 – 12.8)% p < .01]. Frailty was independently associated with higher risk of non‐dipping (OR 12.4; CI 1.79 – 85.9) and reduced nighttime systolic BP fall (‐6.1%; CI ‐9.6 – ‐2.6%). In conclusions, frailty has a substantial influence on nighttime BP values and pattern in patients older than 80 years.

Number and timing of ambulatory blood pressure monitoring measurements.

Ambulatory blood pressure (BP) monitoring (ABPM) may cause sleep disturbances. Some home BP monitoring (HBPM) devices obtain a limited number of BP readings during sleep and may be preferred to ABPM. It is unclear how closely a few BP readings approximate a full night of ABPM. We used data from the Jackson Heart (N = 621) and Coronary Artery Risk Development in Young Adults (N = 458) studies to evaluate 74 sampling approaches to estimate BP during sleep. We sampled two to four BP measurements at specific times from a full night of ABPM and computed chance-corrected agreement (i.e., kappa) of nocturnal hypertension (i.e., mean asleep systolic BP ≥ 120 mmHg or diastolic BP ≥ 70 mmHg) defined using the full night of ABPM and subsets of BP readings. Measuring BP at 2, 3, and 4 h after falling asleep, an approach applied by some HBPM devices obtained a kappa of 0.81 (95% confidence interval [CI]: 0.78, 0.85). The highest kappa was obtained by measuring BP at 1, 2, 4, and 5 h after falling asleep: 0.84 (95% CI: 0.81, 0.87). In conclusion, measuring BP three or four times during sleep may have high agreement with nocturnal hypertension status based on a full night of ABPM.

Ramadan and blood pressure: importance of chronotherapy

Abstract Funding Acknowledgements Type of funding sources: None. Background During Ramadan, alterations in the daily patterns of sleep, activities and medication timing might contribute to changes in blood pressure (BP) and heart rate among hypertensive patients. The aim of this study was to examine the effect of medication timing during Ramadan on blood pressure and heart rate in hypertensive subjects taking their treatment once daily. Methods The study prospectively recruited 44 hypertensive patients between April and June 2019, followed up at the cardiology department of our Hospital. A 24-hour pressure monitoring was carried out during two periods: prior to Ramadan and during the last ten days of Ramadan. Results We studied 29 women and 15 men, mean age was 58.7 years. 34% of the patients were diabetics and 16% had coronaropathy. 46% of the patients were on monotherapy, 43% on dual therapy and 11% on a triple antihypertensive therapy. During Ramadan, 57% of the patients took their treatment during the dinner (group1), whereas 43% took their treatment during the Shour (group 2). Average 24hour blood pressure in the whole group was 129 ± 18/74 ± 10 mmHg before Ramadan and 129 ± 19/74 ± 10 mmHg during Ramadan (p &amp;gt; 0.05). Daytime and nighttime mean values of systolic and diastolic blood pressure as well as mean values of heart rate were not different between both periods regardless of age and gender. However, during Ramadan, those who took their treatment after dinner had significant higher values of 24 hour systolic BP, awake systolic and diastolic BP, asleep systolic and diastolic BP than those who took their treatment with the shour (p &amp;lt; 0.05). Conclusion In this study, there were no significant changes in systolic and diastolic blood pressures as well as heart rate during the 2 periods. However, during Ramadan, a slight superiority of taking the treatment with the shour is observed. Average values of BP and heart rate Group 1 Group 2 p 24 hour SBP (mmHg) 134 ± 23 122 ± 6 0.017 24 hour DBP (mmHg) 76 ± 12 70 ± 5 0.052 Awake SBP (mmHg) 138 ± 23 125 ± 6 0.012 Awake DBP (mmHg) 79 ± 12 73 ± 5 0.044 Asleep SBP (mmHg) 127 ± 26 114 ± 12 0.030 Asleep DBP (mmHg) 71 ± 13 65 ± 7 0.045 24 hour average heart rate (bpm) 71 ± 7 70 ± 6 0.524 Awake average heart rate (bpm) 76 ± 7 74 ± 7 0.322 Asleep average heart rate (bpm) 65 ± 7 65 ± 7 0.931 Average values of blood pressure and heart rate in both groups Abstract Figure. 24hour course of blood pressure

Association Between Ambulatory Blood Pressure and Coronary Artery Calcification: The JHS.

[Figure: see text].

Association of Serum Aldosterone and Plasma Renin Activity With Ambulatory Blood Pressure in African Americans: The Jackson Heart Study.

The renin-angiotensin-aldosterone system (RAAS) is an important driver of blood pressure (BP), but the association of the RAAS with ambulatory BP (ABP) and ABP monitoring phenotypes among African Americans has not been assessed. ABP and ABP monitoring phenotypes were assessed in 912 Jackson Heart Study participants with aldosterone and plasma renin activity (PRA). Multivariable linear and logistic regression analyses were used to analyze the association of aldosterone and PRA with clinic, awake, and asleep systolic BP and diastolic BP (DBP) and ABP monitoring phenotypes, adjusting for important confounders. The mean age of participants was 59±11 years and 69% were female. In fully adjusted models, lower log-PRA was associated with higher clinic, awake, and asleep systolic BP and DBP (all P<0.05). A higher log-aldosterone was associated with higher clinic, awake, and asleep DBP (all P<0.05). A 1-unit higher log-PRA was associated with lower odds of daytime hypertension (odds ratio [OR] 0.59 [95% CI, 0.49-0.71]), nocturnal hypertension (OR, 0.68 [95% CI, 0.58-0.79]), daytime and nocturnal hypertension (OR, 0.59 [95% CI, 0.48-0.71]), sustained hypertension (OR, 0.52 [95% CI, 0.39-0.70]), and masked hypertension (OR 0.75 [95% CI, 0.62-0.90]). A 1-unit higher log-aldosterone was associated with higher odds of nocturnal hypertension (OR, 1.38 [95% CI, 1.05-1.81]). Neither PRA nor aldosterone was associated with percent dipping, nondipping BP pattern, or white-coat hypertension. Patterns for aldosterone:renin ratio were similar to patterns for PRA. Suppressed renin activity and higher aldosterone:renin ratios were associated with higher systolic BP and DBP in the office and during the awake and asleep periods as evidenced by ABP monitoring. Higher aldosterone levels were associated with higher DBP, but not systolic BP, in the clinic and during the awake and asleep periods. Further clinical investigation of novel and approved medications that target low renin physiology such as epithelial sodium channel inhibitors and mineralocorticoid receptor antagonists may be paramount in improving hypertension control in African Americans.

Objective short sleep duration and 24-hour blood pressure

BackgroundShort sleep duration is a contributor to cardiovascular disease (CVD) events and mortality. Short sleep duration is associated with an increased risk of high clinic blood pressure (BP). BP measured outside the clinic using 24-h ambulatory blood pressure monitoring (ABPM) is a better predictor of an individual's CVD risk. We examined the association between objectively-assessed sleep duration and 24-h ambulatory blood pressure (ABP). MethodsA total of 893 working adults underwent sleep and ABPM. Participants were fitted with an ABPM device, and measures were taken at 28–30 min intervals. Objective sleep duration, and times of wakefulness and sleep during the 24-h ABPM period were derived from wrist-worn actigraphy. Linear regression, adjusted for age, sex, race/ethnicity, body mass index, smoking status, and diabetes were conducted on the relationship between sleep duration and the ABP measures. ResultsMean age of participants (final n = 729, 59.5% female, 11.9% Hispanic) was 45.2 ± 10.4 y. Mean actigraphy-derived sleep duration was 6.8 ± 1.2 h. Sleep duration <6 h was associated with a 1.73 mmHg higher 24-h systolic BP (p = 0.031) and 2.17 mmHg higher 24-h diastolic BP (p < 0.001). Shorter sleep duration was not associated with mean awake or asleep systolic BP (p = 0.89 and p = 0.92) or mean awake or asleep diastolic BP (p = 0.30 and p = 0.74). ConclusionsTo our knowledge, this is the largest study conducted which assessed sleep duration objectively while measuring 24-h ABP. Shorter sleep duration is associated with higher 24-h BP and potentially cardiovascular risk.

La presión arterial ambulatoria, en comparación con la medida clínica, mejora notablemente la estratificación del riesgo cardiovascular de Framingham

Introduction and objectivesAmbulatory blood pressure (BP) better predicts cardiovascular disease (CVD) outcomes than office BP measurements (OBPM). Nonetheless, current CVD risk stratification models continue to rely on exclusively daytime OBPM along with traditional factors, eg, age, sex, smoking, dyslipidemia, and/or diabetes. MethodsData from 19 949 participants of the primary care-based Hygia Project assessed by 48-hour ambulatory BP monitoring (ABPM) and without prior CVD events were used to compare the diagnostic accuracy, discrimination, and performance of the original Framingham risk score (RSOFG) and its adjusted version to the Hygia Project study population (RSAFG) with that of a novel CVD risk stratification model constructed by replacing OBPM with ABPM-derived prognostic parameters (RSABPM). ResultsDuring the follow−up, lasting up to 12.7 years, 1854 participants experienced a primary CVD outcome of CVD death, myocardial infarction, coronary revascularization, heart failure, stroke, transient ischemic attack, angina pectoris, or peripheral artery disease. Asleep systolic BP (SBP) mean and sleep−time relative SBP decline were the only joint significant ABPM−derived predictive factors of CVD risk and were therefore used to substitute for in−clinic SBP in the RSABPM model. The RSABPM model, in comparison with the RSOFG and RSAFG models, showed significantly improved calibration, diagnostic accuracy, discrimination, and performance (always P<.001). The RSAFG−derived event−probabilities of 57.3% of the participants were outside the 95% confidence limits of the event probability determined by the RSABPM model. ConclusionsThese collective findings reveal important limitations of CVD risk stratification when based upon OBPM, as in the Framingham score, and corroborate the clinical value of around−the−clock ABPM to properly diagnose true hypertension and reliably stratify CVD vulnerability.

Cardiovascular disease risk stratification by the Framigham score is markedly improved by ambulatory compared with office blood pressure

Introduction and objectivesAmbulatory blood pressure (BP) better predicts cardiovascular disease (CVD) outcomes than office BP measurements (OBPM). Nonetheless, current CVD risk stratification models continue to rely on exclusively daytime OBPM along with traditional factors, eg, age, sex, smoking, dyslipidemia, and/or diabetes. MethodsData from 19 949 participants of the primary care-based Hygia Project assessed by 48-hour ambulatory BP monitoring (ABPM) and without prior CVD events were used to compare the diagnostic accuracy, discrimination, and performance of the original Framingham risk score (RSOFG) and its adjusted version to the Hygia Project study population (RSAFG) with that of a novel CVD risk stratification model constructed by replacing OBPM with ABPM-derived prognostic parameters (RSABPM). ResultsDuring the follow−up, lasting up to 12.7 years, 1854 participants experienced a primary CVD outcome of CVD death, myocardial infarction, coronary revascularization, heart failure, stroke, transient ischemic attack, angina pectoris, or peripheral artery disease. Asleep systolic BP (SBP) mean and sleep−time relative SBP decline were the only joint significant ABPM−derived predictive factors of CVD risk and were therefore used to substitute for in−clinic SBP in the RSABPM model. The RSABPM model, in comparison with the RSOFG and RSAFG models, showed significantly improved calibration, diagnostic accuracy, discrimination, and performance (always P<.001). The RSAFG−derived event−probabilities of 57.3% of the participants were outside the 95% confidence limits of the event probability determined by the RSABPM model. ConclusionsThese collective findings reveal important limitations of CVD risk stratification when based upon OBPM, as in the Framingham score, and corroborate the clinical value of around−the−clock ABPM to properly diagnose true hypertension and reliably stratify CVD vulnerability.

Circadian rhythms of blood pressure and rate pressure product in children with postural tachycardia syndrome.

To investigate circadian rhythms of blood pressure (BP) and rate pressure product (RPP) in children with postural tachycardia syndrome (POTS) by performing 24-hour ambulatory blood pressure monitoring (24-h ABPM). 103 POTS children and 84 age- and gender-matched healthy children were enrolled and they got 24-h ABPM under usual routine of diurnal activity and nocturnal sleep. Although the mean awake systolic BP (SBP), 24-h diastolic BP (DBP), awake DBP, asleep heart rate (HR) did not differ between two groups (P>0.05), the mean 24-h and asleep SBP, asleep DBP, 24-h and awake HR, 24-h, awake and asleep RPP were significantly higher in POTS children (P<0.01). Non-dipping BP was more prevalent in POTS children (67.0% vs. 46%, P<0.001). The RPP of POTS and control children showed 24-h circadian variations with peak roughly occurring approximately 2h after waking from nocturnal sleep. Compared with controls, the RPP values of POTS children were significantly higher during 2h before and 3h after waking (P<0.05). For the RPP value of 1h after waking, a cutoff value of 8995.6bpm·mmHg yielded a sensitivity of 75.8% and a specificity of 65.4% for predicting POTS. Abnormal circadian BP regulation is prevalent in POTS children. POTS children present with daily sympathetic hyperactivity, especially during nocturnal sleep and within 3h after waking. And the excessive morning surge in RPP parallels with the morning surge of orthostatic HR increments and OI symptoms.

Comparison of 3 Devices for 24-Hour Ambulatory Blood Pressure Monitoring in a Nonclinical Environment Through a Randomized Trial.

The U.S. Preventive Services Task Force recommends the use of 24-hour ambulatory blood pressure monitoring (ABPM) as part of screening and diagnosis of hypertension. The optimal ABPM device for population-based surveys is unknown. We compared the proportion of valid blood pressure (BP) readings, mean awake and asleep BP readings, differences between awake ABPM readings and initial standardized BP readings, and sleep experience among three ABPM devices. We randomized a convenience sample of 365 adults to 1 of 3 ABPM devices: Welch Allyn Mobil-O-Graph (WA), Sun Tech Classic Oscar2 (STO) and Spacelabs 90227 (SL). Participants completed sleep quality questionnaires on the nights before and during ABPM testing. The proportions of valid BP readings were not different among the 3 devices (P > 0.45). Mean awake and asleep systolic BP were significantly higher for STO device (WA vs. STO vs. SL: 126.65, 138.09, 127.44 mm Hg; 114.34, 120.34, 113.13 mm Hg; P < 0.0001 for both). The difference between the initial average standardized mercury systolic BP readings and the ABPM mean awake systolic BP was larger for STO device (WA vs. STO. vs. SL: -5.26, -16.24, -5.36 mm Hg; P < 0.0001); diastolic BP mean differences were ~ -6 mm Hg for all 3 devices (P = 0.6). Approximately 55% of participants reported that the devices interfered with sleep; however, there were no sleep differences across the devices (P > 0.4 for all). Most of the participants met the threshold of 70% valid readings over 24 hours. Sleep disturbance was common but did not interfere with completion of measurement in most of the participants.

Ambulatory blood pressure monitoring-based definition of true arterial hypertension.

Daytime office blood pressure measurements (OBPM), still recommended and utilized today for diagnosis and management of hypertension and categorization of cardiovascular disease (CVD) risk, fail to reveal clinically important features of the mostly predictable BP 24 h pattern and leads to a large proportion of individuals being misclassified. Most clinical guidelines now recommend ambulatory BP monitoring (ABPM) be applied to adult patients to confirm the OBPM-based diagnosis of hypertension, based on the high prevalence of masked hypertension and masked normotension plus demonstrated significantly better CVD prognostic value of around-the-clock ABPM than daytime OBPM. Nonetheless, there is yet no consensus of which parameter(s) and ABPM thresholds to utilize to diagnose hypertension. Findings of large prospective ABPM-based CVD outcome trials permit prospective evaluation of treatment and other induced changes in OBPM and ABPM during follow-up on CVD risk by incorporating multiple periodic (at least annual) patient ABPM assessments. They indicate: 1) asleep systolic BP (SBP) mean and sleep-time relative SBP decline (dipping) together are the most significant and only BP-derived prognostic markers of CVD risk; accordingly, around-the-clock ABPM should be the recommended method to diagnose true arterial hypertension and accurately assess CVD risk; and (2) treatment-induced lowering of the asleep SBP mean and rise of the sleep-time relative SBP decline towards the normal dipper BP pattern are both significantly protective against CVD events, thus constituting novel therapeutic targets to substantially better reduce CVD risk compared to the traditional approach that targets control of daytime OBPM or awake BP mean.

Using Predicted Atherosclerotic Cardiovascular Disease Risk for Discrimination of Awake or Nocturnal Hypertension.

Several atherosclerotic cardiovascular disease (ASCVD) risk factors are associated with awake and nocturnal hypertension. We assessed the association between a composite ASCVD risk score and awake or nocturnal hypertension using data from participants aged 40-79 years who completed ambulatory blood pressure monitoring at the Year 30 Coronary Artery Risk Development in Young Adults study exam in 2015-2016 (n = 716) and the baseline Jackson Heart Study exam in 2000-2004 (n = 770). Ten-year predicted ASCVD risk was calculated using the Pooled Cohort risk equations. Awake hypertension was defined as mean awake systolic blood pressure (SBP) ≥135 mm Hg or diastolic blood pressure (DBP) ≥85 mm Hg and nocturnal hypertension was defined as mean asleep SBP ≥120 mm Hg or DBP ≥70 mm Hg. Among participants with a 10-year predicted ASCVD risk <5%, 5% to <7.5%, 7.5% to <10%, and ≥10%, the prevalence of awake or nocturnal hypertension as a composite outcome was 29.5%, 47.8%, 62.2%, and 69.7%, respectively. After multivariable adjustment, higher ASCVD risk was associated with higher prevalence ratios for awake or nocturnal hypertension among participants with clinic-measured SBP/DBP <130/85 mm Hg but not ≥130/85 mm Hg. The C-statistic for discriminating between participants with vs. without awake or nocturnal hypertension was 0.012 (95% confidence interval 0.003, 0.016) higher when comparing a model with ASCVD risk and clinic-measured blood pressure (BP) together vs. clinic-measured BP without ASCVD risk. Using 10-year predicted ASCVD risk in conjunction with clinic BP improves discrimination between individuals with and without awake or nocturnal hypertension.

Association of Obstructive Sleep Apnea With Nighttime Blood Pressure in African Americans: The Jackson Heart Study.

Obstructive sleep apnea (OSA), nocturnal hypertension, and nondipping systolic blood pressure (BP) are each highly prevalent among African Americans. However, few data are available on the association between OSA and nighttime BP in this population. We examined the association of OSA with nighttime BP among African Americans who completed 24-hour ambulatory BP monitoring (ABPM) at Exam 1 (2000-2004) of the Jackson Heart Study (JHS) and subsequently participated in the JHS Sleep Study (2012-2016). Type 3 home sleep apnea testing was used to assess OSA measures, including respiratory event index (REI4%) and percent sleep time <90% oxygen saturation (nocturnal hypoxemia). Nocturnal hypertension was defined as mean asleep systolic BP (SBP) ≥120 mm Hg or diastolic BP (DBP) ≥70 mm Hg. Multivariable linear regression models were fit to estimate the association between each OSA measure and nighttime SBP and DBP. Among 206 participants who completed ABPM and participated in the Jackson Heart Sleep Study, 50.5% had nocturnal hypertension and 26.2% had moderate to severe OSA (REI4% ≥15 events/hour). After multivariable adjustment, each SD (13.3 events/hour) increase in REI4% was associated with 1.75 mm Hg higher nighttime DBP (95% confidence interval (CI): 0.38, 3.11) and a prevalence ratio of 1.11 (95% CI: 1.00, 1.24) for nocturnal hypertension. Each SD (10.4%) increase in nocturnal hypoxemia was associated with a 1.91 mm Hg higher nighttime SBP (95% CI: 0.15, 3.66). Severity of OSA and nocturnal hypoxemia were associated with high nighttime BP in African American participants in the JHS.

Development of Predictive Equations for Nocturnal Hypertension and Nondipping Systolic Blood Pressure.

BackgroundNocturnal hypertension, defined by a mean asleep systolic blood pressure (SBP)/diastolic blood pressure (BP) ≥120/70 mm Hg, and nondipping SBP, defined by an awake‐to‐asleep decline in SBP <10%, are each associated with increased risk for cardiovascular disease.Methods and ResultsWe developed predictive equations to identify adults with a high probability of having nocturnal hypertension or nondipping SBP using data from the CARDIA (Coronary Artery Risk Development in Young Adults) study (n=787), JHS (Jackson Heart Study) (n=1063), IDH (Improving the Detection of Hypertension) study (n=395), and MHT (Masked Hypertension) study (n=772) who underwent 24‐hour ambulatory BP monitoring. Participants were randomized to derivation (n=2511) or validation (n=506) data sets. The prevalence rates of nocturnal hypertension and nondipping SBP were 39.7% and 44.9% in the derivation data set, respectively, and 36.6% and 44.5% in the validation data set, respectively. The predictive equation for nocturnal hypertension included age, race/ethnicity, smoking status, neck circumference, height, high‐density lipoprotein cholesterol, albumin/creatinine ratio, and clinic SBP and diastolic BP. The predictive equation for nondipping SBP included age, sex, race/ethnicity, waist circumference, height, alcohol use, high‐density lipoprotein cholesterol, and albumin/creatinine ratio. Concordance statistics (95% CI) for nocturnal hypertension and nondipping SBP predictive equations in the validation data set were 0.84 (0.80–0.87) and 0.73 (0.69–0.78), respectively. Compared with reference models including antihypertensive medication use and clinic SBP and diastolic BP as predictors, the continuous net reclassification improvement (95% CI) values for the nocturnal hypertension and nondipping SBP predictive equations were 0.52 (0.35–0.69) and 0.51 (0.34–0.69), respectively.ConclusionsThese predictive equations can direct ambulatory BP monitoring toward adults with high probability of having nocturnal hypertension and nondipping SBP.

Diurnal rhythm of blood pressure among Nigerians with hypertension using 24-hour ambulatory blood pressure monitoring.

Introductionhypertension is the most common cardiac disease in Nigeria. There are very limited studies in Nigeria on the use of 24-hour ambulatory blood pressure monitoring (24-h ABPM) for evaluation of hypertensive patients. Twenty four-hour ABPM, unlike office blood pressure (OBP), can assess diurnal variation using parameters like awake blood pressure (BP), asleep (nocturnal) BP, mean 24-hour BP and dipping pattern. This can help in assessment of increased cardiovascular risk and management of hypertensive patients. We purposed to assess the diurnal rhythm of BP among Nigerians with hypertension.Methodsthis was a prospective cross-sectional study. Consecutive 77 hypertensive subjects were studied using Schiller MT-300 for 24-h ABPM.Resultsout of the 77 patients reviewed, 39 (50.6%) were females. The mean age was 50.9 years (SD 13.5). The mean awake systolic and diastolic BP were 135.6mmHg (SD 15.0) and 83.2mmHg (SD 10.0) respectively; mean asleep systolic and diastolic BP were 127.6mmHg (SD 17.9) and 76.2mmHg (SD 12.2) respectively; and mean 24-h systolic and diastolic BP were 133.6mmHg (SD 15.3) and 81.4mmHg (SD 10.2) respectively. Awake BP was elevated in 59.7% of study subjects. Elevated awake systolic BP and awake diastolic BP were present in 50.6% and 41.6% of the study population. Nocturnal (asleep) BP was elevated in 79.2%. Non-dipping pattern was the most prevalent pattern at 55.8%, followed by dipping (24.7%), reverse dipping (15.6%) and extreme dipping (3.9%).Conclusiona high proportion had nocturnal hypertension (79.2%) and non-dipping pattern was the most prevalent pattern (55.8%). Mean awake systolic BP, mean asleep systolic and diastolic BP and mean 24-h systolic and diastolic BP were elevated. The use of 24-h ABPM will enhance assessment of increased cardiovascular risk and management of Nigerians with hypertension.

Health Behaviors, Nocturnal Hypertension, and Non-dipping Blood Pressure: The Coronary Artery Risk Development in Young Adults and Jackson Heart Study.

Several health behaviors have been associated with hypertension based on clinic blood pressure (BP). Data on the association of health behaviors with nocturnal hypertension and non-dipping systolic BP (SBP) are limited. We analyzed data for participants with ambulatory BP monitoring at the Year 30 Coronary Artery Risk Development in Young Adults (CARDIA) study exam in 2015-2016 (n = 781) and the baseline Jackson Heart Study (JHS) exam in 2000-2004 (n = 1,046). Health behaviors (i.e., body mass index, physical activity, smoking, and alcohol intake) were categorized as good, fair, and poor and assigned scores of 2, 1, and 0, respectively. A composite health behavior score was calculated as their sum and categorized as very good (score range = 6-8), good (5), fair (4), and poor (0-3). Nocturnal hypertension was defined as mean asleep SBP ≥ 120 mm Hg or mean asleep diastolic BP ≥ 70 mm Hg and non-dipping SBP as < 10% awake-to-asleep decline in SBP. Among CARDIA study and JHS participants, 41.1% and 56.9% had nocturnal hypertension, respectively, and 32.4% and 72.8% had non-dipping SBP, respectively. The multivariable-adjusted prevalence ratios (95% confidence interval) for nocturnal hypertension associated with good, fair, and poor vs. very good health behavior scores were 1.03 (0.82-1.29), 0.98 (0.79-1.22), and 0.96 (0.77-1.20), respectively in CARDIA study and 0.98 (0.87-1.10), 0.96 (0.86-1.09), and 0.86 (0.74-1.00), respectively in JHS. The health behavior score was not associated non-dipping SBP in CARDIA study or JHS after multivariable adjustment. A health behavior score was not associated with nocturnal hypertension or non-dipping SBP.