Isolated Daytime Hypertension Research Articles

Epidemiology of Hypertension among Patients on Peritoneal Dialysis Using Standardized Office and Ambulatory Blood Pressure Recordings

Introduction: Prior studies conducted in peritoneal dialysis (PD) patients in the late 1990s provided considerably variable estimates of the prevalence and control of hypertension. The present study aimed to investigate the current state of hypertension management in this high-risk population. Methods: In 140 stable PD patients, we performed standardized automated office blood pressure (BP) measurements and 24-h ambulatory BP monitoring (ABPM) using the Mobil-O-Graph device (IEM, Germany). Office and ambulatory hypertension was diagnosed in patients with office BP ≥140/90 mm Hg and 24-h BP ≥130/80 mm Hg, respectively. Patients treated with ≥1 BP-lowering medications were also classified as hypertensives. Results: The prevalence of office and ambulatory hypertension was 92.9% and 95%, respectively. In all, 92.1% of patients were being treated with an average of 2.4 BP-lowering medications daily. Adequate BP control was achieved in 52.3% and 38.3% of hypertensives by office BP and ABPM, respectively. The agreement between these 2 techniques in the identification of patients with BP levels above the diagnostic thresholds of hypertension was moderate (k-statistic: 0.524). In all, 5% of patients were normotensives with both techniques, 31.4% had controlled hypertension, 5% had white-coat hypertension, 19.3% had masked hypertension, and 39.3% had sustained hypertension. Isolated nocturnal hypertension was detected in 23.6% of patients, whereas no patient had isolated daytime hypertension. Conclusion: Among PD patients, hypertension is highly prevalent and remains often inadequately controlled. The use of ABPM enables the better classification of severity of hypertension and identification of isolated nocturnal hypertension, which is a common BP phenotype in the PD population.

Hypertensive Phenotypes and Pattern of Ambulatory Blood Pressure in Patients of Diabetes Mellitus of Kashmir Valley.

Background:Patients of diabetes mellitus (DM) with hypertension (HTN) have a fourfold increased risk of cardiovascular disease (CVD) as compared to normotensive nondiabetic controls. However, many patients of DM who are normotensive or have controlled blood pressure on office BP measurement (OBPM) may assume that they do not have increased risk of CVD but may be having HTN or uncontrolled blood pressure on ambulatory blood pressure monitoring (ABPM).Study Design Objective:A cross-sectional observational study to compare OBPM with ABPM and thus predict various hypertensive phenotypes like masked hypertension (MH) and white coat hypertension and pattern of blood pressure in diabetic patients of our population.Materials and Methods:Two hundred patients of DM with or without HTN were included in this study. The cases were subjected to detailed history, clinical examination, OBPM, and ABPM.Results:Out of 200 patients of DM, 32 were normotensives, 46 were hypertensives controlled on antihypertensive treatment, 22 were hypertensives not on anti-hypertensive treatment, and 100 were hypertensives uncontrolled on anti-hypertensive treatment. Among 32 normotensive diabetics, 17 (53%) patients had MH on ABPM. Out of these 32 normotensive patients, 7 (21.8%) had isolated nocturnal hypertension, 3 (9.3%) had isolated day-time HTN (IDH) and 7 (21.8%) had day-time and nocturnal HTN (DNH). Patients with MH had higher BMI, an observation that was statistically significant. Non-dipping pattern was found in 53% of patients of masked HTN. Out of 46 hypertensive diabetics with controlled OBPM on antihypertensive treatment, 26 (56.5%) had masked effect or masked uncontrolled hypertension on ABPM. Out of 22 diabetics with treatment naïve HTN, 7 (32%) were found to have white coat hypertension on ABPM. Fifteen (15%) patients out of 100 hypertensive diabetics with uncontrolled OBPM despite on anti-hypertensive were found to have white coat effect on ABPM. Patients with white coat effect had higher body mass index an observation that was statistically significant (p = 0.039). Non-dipping pattern was significantly associated with longer duration of diabetes (≥ 120 months), retinopathy and neuropathy.Conclusion:To rely exclusively on OBPM to diagnose HTN and monitor blood pressure may underestimate the CVD risk especially in diabetics. ABPM is a tool that may not only help clinicians in starting anti-HTN treatment perspicuously, but also may help in avoiding unnecessary anti-hypertensive treatment and/or withdrawing anti-hypertensive treatment as indicated and thus avoiding credulity.

Isolated nocturnal hypertension is associated with increased left ventricular mass index in children.

Isolated nocturnal hypertension (INH) is associated with increased prevalence of left ventricular hypertrophy (LVH) and cardiovascular morbidity and mortality in adult patients. Unlike in adults, data illustrating the possible association between INH and cardiac target organ damage is lacking in children. This study aimed to investigate whether INH is associated with increased left ventricular mass index (LVMI) and LVH in children. Retrospective data from all untreated children with confirmed ambulatory hypertension (HT) in our center was reviewed. Ambulatory blood pressure monitoring (ABPM) and echocardiography were performed concurrently. Ambulatory normotensive children served as controls. LVH was defined as LVMI ≥ 95th percentile. There were 102 ABPM studies; of these, 79 children had renal HT, and 23 had primary HT. Median age of children was 13.2 years (3.8-18.9). Nineteen children had INH, 9 children had isolated daytime HT, 54 had daytime and nighttime HT, and 20 were normotensive. The LVMI adjusted for age (patient's LVMI/95th percentile of the LVMI) was significantly higher in children with INH than in normotensive children (0.83 ± 0.03 vs. 0.74 ± 0.03, p = 0.03). Left ventricular hypertrophy was present in 11% of children with INH; this was not significantly higher than in normotensive children (0%, p = 0.23). This study investigated the association between INH and cardiac structure in children with primary and renal HT and showed children with INH had higher LVMI adjusted for age than normotensive children and children with INH had similar LVMI adjusted for age to children with isolated daytime HT.

Nocturnal blood pressure: the dark side of white-coat hypertension.

The impact of defining white-coat hypertension (WCH) and white-coat uncontrolled hypertension (WCUH) based on daytime and night-time thresholds of ambulatory blood pressure (ABP), instead of 24-h mean value, is unclear. We aimed to reclassify BP status according to both diurnal and nocturnal thresholds in a large sample of hypertensive patients seen in a specialist center and previously classified as WCH and WCUH based on 24-h BP values. A data-base of 7353 individual 24-h ABP monitoring (ABPM) from untreated and treated hypertensive individuals with office BP at least 140 mmHg and/or 90 mmHg was analysed and a subset of 3223 patients characterized by mean 24-h BP less than 130/80 mmHg (i.e. WCH and WCUH) was included in the present analysis. As many as 1281 patients were classified as WCH and 1942 as WCUH. Among them, elevated out-of-office BP according to night-time threshold (i.e. ≥120/70 mmHg) was found in about 30% of cases. In particular, prevalence rates of nocturnal hypertension were 26.9% in WCH and 31.8% in WCUH. Isolated daytime hypertension (i.e. ≥135/85 mmHg) was detected in an additional 4% of individuals. Classification of WCH and WCUH based on mean 24-h BP thresholds does not allow to detect an adverse BP phenotype, such as nocturnal hypertension in a large fraction of untreated and treated patients.

Isolated nocturnal and isolated daytime hypertension associate with altered cardiovascular morphology and function in children with chronic kidney disease: findings from the Cardiovascular Comorbidity in Children with Chronic Kidney Disease study.

Prevalence of isolated nocturnal hypertension (INH) and isolated daytime hypertension (IDH) is around 10% in adults. Data in children, especially in chronic kidney disease (CKD), are lacking. The aim of this cross-sectional multicenter cohort study was to define the prevalence of INH and IDH and its association with cardiovascular morphology and function, that is, pulse wave velocity (PWV), carotid intima-media thickness (cIMT), or left ventricular mass index (LVMI) in children with CKD. Ambulatory blood pressure (BP) monitoring profiles were analyzed in 456 children with CKD stages III-V participating in the Cardiovascular Comorbidity in Children with Chronic Kidney Disease Study (64.3% males, 71.3% congenital anomaly of the kidney and urinary tract, age 12.5 ± 3.2 years, estimated glomerular filtration rate 29 ± 12 ml/min per 1.73 m). Baseline PWV, cIMT, and LVMI were compared in normotension, INH, IDH, or sustained 24-h hypertension. Prevalence of sustained hypertension was 18.4%, of INH 13.4%, and of IDH 3.7%. PWV SDS (SD score) and cIMT SDS were significantly higher in sustained hypertension and INH, and PWV SDS was significantly higher in IDH, compared with normotension. LVMI was significantly increased in sustained hypertension, but not in INH or IDH. Determinants of INH were smallness for gestational age, older age, higher height SDS and parathyroid hormone, and shorter duration of CKD. In logistic regression analysis, day/night-time hypertension or ambulatory BP monitoring pattern (normal, INH, IDH, sustained hypertension) were independently associated with cardiovascular outcome measures: elevated night-time BP was associated with increased cIMT, PWV, and left ventricular hypertrophy; INH was associated with cIMT. INH is present in almost one out of seven children with predialysis CKD; INH and nocturnal hypertension in general are associated with alterations of arterial morphology and function.

Telemonitoring of 24-Hour Blood Pressure in Local Pharmacies and Blood Pressure Control in the Community: The Templar Project.

The analysis of ambulatory blood pressure monitorings (ABPMs) performed in 639 Italian pharmacies in the context of a telehealth-based service allowed to evaluate the level of blood pressure (BP) control in the community. Twenty-four-hour ABPMs were performed by a clinically validated, automated, upper-arm BP monitor. Recordings were uploaded on a certified web-based telemedicine platform (www.tholomeus.net) and remote medical reporting provided. In each subject, an automatic BP measurement was obtained in the pharmacy and clinical information collected before starting the ABPM. A total of 20,773 subjects (mean age 57 ± 15 years; 54% females; 28% receiving antihypertensive medications, 31% with any cardiovascular [CV] risk factor) provided valid ABPMs. BP control was poor, but better in ambulatory conditions (24-hour BP <130/80 mm Hg 54% vs. pharmacy BP < 140/90 mm Hg 43%; P < 0.0001) and in drug-treated subjects. Sustained normotension was reported in only 28% subjects. Isolated nocturnal hypertension (16%; nighttime BP ≥120/70 mm Hg with normal daytime BP) was more common (P < 0.0001) than isolated daytime hypertension (9%; daytime BP ≥ 135/85 mm Hg with normal nighttime BP). Sustained hypertension (43%) was more common in younger males at the lowest CV risk, with daytime hypertension. White-coat hypertension (14%) was more common in females. Masked hypertension was not uncommon (15%) and more often observed in older males with an elevated nocturnal BP. A telemedicine-based service provided to community pharmacies may facilitate access to ABPM, thus favoring a more accurate hypertension screening and detection. It may also help describe the occurrence of different 24-hour BP phenotypes and personalize the physician's intervention.

Relationship between home blood pressure and vascular function in patients receiving antihypertensive drug treatment.

Hypertension is associated with vascular failure, such as increased arterial stiffness, endothelial dysfunction, and vascular smooth muscle dysfunction. The purpose of this study was to investigate the relationship between out-of-office blood pressure and vascular function in patients receiving antihypertensive drugs. We assessed out-of-office blood pressure, including daytime and night-time blood pressure, by home blood pressure monitoring and performed vascular function tests, including brachial-ankle pulse wave velocity (baPWV), flow-mediated vasodilation (FMD), and nitroglycerine-induced vasodilation (NID), in 169 patients receiving antihypertensive drugs, of whom 86 (50.9%) had normotension, 23 (13.6%) had isolated nocturnal hypertension (night-time systolic blood pressure ≥120 mm Hg), 26 (15.4%) had isolated daytime hypertension (daytime systolic blood pressure ≥135 mm Hg), and 34 (20.1%) had sustained hypertension (daytime and nocturnal hypertension). baPWV was significantly higher in patients with sustained hypertension than in those without sustained hypertension (1585 ± 257 cm/s in normotension; 1687 ± 267 cm/s in isolated nocturnal hypertension; 1688 ± 313 cm/s in isolated daytime hypertension; and 1923 ± 399 cm/s in sustained hypertension; P < 0.001). baPWV above the cutoff value of 1858 cm/s, derived from receiver operating characteristic curve analysis to diagnose patients with sustained hypertension, was significantly associated with sustained hypertension after adjustment of other confounding factors (odds ratio, 5.01; 95% confidence interval, 1.94-13.41; P < 0.001). In contrast, there was no significant association of home blood pressure status with FMD or NID in these patients. In patients receiving antihypertensive drugs, baPWV was significantly associated with sustained hypertension, whereas FMD and NID were impaired regardless of the home blood pressure status.

A8629 Isolated Nocturnal Hypertension and Its Association with Subclinical Target Organ Damage in Untreated Chinese Patients

Objectives: Isolated nocturnal hypertension (HT) was termed as a condition of an elevated nighttime blood pressure in the presence of a daytime normotension. The clinical relevance of isolated nocturnal HT has not been comprehensively clarified regarding subclinical target organ damage. Methods: Consecutive untreated patients referred for ambulatory blood pressure (BP) monitoring to our Hypertension Clinic were recruited. The cutoff values for daytime and nocturnal hypertension were a BP of ≥135/85 mmHg and ≥120/70 mmHg, respectively. We measured subclinical target organ damage, including left ventricular mass index (LVMI), E/e’ ratio by echocardiography, carotid-femoral pulse wave velocity (cfPWV), urinary albumin-to-creatinine ratio (ACR) and brachial artery flow-mediated dilation (FMD). Results: The 1808 participants (mean age, 51 years; women, 52%) included 428 (23.7%) ambulatory normotensives, 252 (13.9%) with isolated daytime HT, 209 (11.6%) isolated nocturnal HT and 919 (50.8%) day-night HT. Patients with isolated nocturnal HT were younger (53.4 versus 55.0 years), more often reported as male (42.8% vs 30.2%), drinker (15.4% versus 10.5%) and smoker (15.4% versus 6.5%) compared with ambulatory normotensives. Compared with patients with ambulatory normotension, patients with isolated nocturnal HT had higher cfPWV (7.7 vs 7.5 m/s, P = 0.024), urinary ACR (0.71 vs 0.58 mg/mmol, P = 0.006) and higher E/e’ ratio (10.0 vs 9.6, P = 0.04) after multivariate adjustment. As for FMD and LVMI, no difference (P ≥ 0.23) between isolated nocturnal HT and ambulatory normotension was observed. Conclusion: Isolated nocturnal HT was associated with target organ damage. Ambulatory BP measurement may help clinicians to identify these patients with increased cardiovascular risk.

SUBTYPES OF MASKED HYPERTENSION AND THEIR ASSOCIATIONS WITH TARGET ORGAN DAMAGE IN UNTREATED CHINESE PATIENTS

Objective: Masked hypertension is office normotension in the presence of ambulatory hypertension, which can be subdivided into isolated daytime, isolated nighttime or day-night hypertension. However,no previous studies contrasted the subtypes of masked hypertension in their associations with target organ damage. Design and method: Consecutive untreated patients referred for ambulatory blood pressure (BP) monitoring to our Hypertension Clinic were recruited. The cutoff values for daytime and nighttime hypertension were a BP of 135/85 mmHg and 120/70 mmHg, respectively. Measures of target organ damage, including left ventricular mass index (LVMI), carotid-femoral pulse wave velocity (cfPWV) and urinary albumin-to-creatinine ratio (ACR), were determined. Results: The 1808 participants (mean age, 51 years; women, 52%) included 30.4% normotensive subjects, and 37.2% with masked hypertension, among whom 18% had isolated daytime hypertension, 12% isolated nighttime hypertension, and 70% day-night hypertension. After multivariate adjustment, patients with isolated daytime hypertension (7.9 vs 7.5 m/s, P = 0.003) had higher cfPWV than normotensive subjects. While patients with isolated nocturnal hypertension (0.79 vs 0.58 mg/mmol, P = 0.002) had higher urinary ACR than normotensive subjects. Patients with masked day-night hypertension had consistently higher cfPWV (7.8 vs 7.5 m/s, P < 0.001) and urinary ACR (0.74 vs. 0.58 mg/mmol, P < 0.001) than normotensives. For LVMI, no difference (P > 0.11) between any subtypes of masked hypertension and normotension was observed. Conclusions: Masked hypertension was prevalent in this untreated outpatient cohort. Masked daytime hypertension was associated with arterial stiffness while nighttime hypertension was associated with kidney damage and day-night hypertension with both target organ measures.

ISOLATED NOCTURNAL HYPERTENSION HAD HIGHER 24-HOUR URINE SODIUM/POTASSIUM RATIO THAN NORMOTENSION

Objective: Only few studies showed the association of salt intake with nocturnal blood pressure (BP). However, little is known about salt intake in patients with isolated nocturnal hypertension. Design and method: Among the 1128 participants, 740 participants who had complete 24-hour urine collection and valid 24-h ambulatory BP monitoring were analyzed. Participants were grouped in 4 groups: normotension (NT, n = 371), isolated daytime hypertension (IDHT, n = 26), isolated nocturnal hypertension (INHT, n = 177), and both-hypertension having both daytime and nocturnal hypertension (both-HT, n = 166). Results: The 24-hour urine sodium (24HUNa) was 155.4 ± 62.9, 164.1 ± 65.5, 169.8 ± 65.8 and 180.0 ± 72.2 mmol/24 hour, respectively. The 24-hour urine potassium (24HUK) was 56.6 ± 19.7, 51.3 ± 14.7, 60.1 ± 25.4 and 60.1 ± 21.4 mmol/24-hour and the 24-hour urine sodium/potassium ratio (24HUNa/24HUK) were 2.9 ± 1.2, 3.3 ± 1.0, 3.3 ± 3.2 and 3.2 ± 1.3, respectively. Compared to NT group, INHT had higher 24HUNa (p = 0.014), and both-HT had higher 24HUNa and 24HUNa/24HUK (p < 0.001 and 0.016, respectively). There was no difference in 24HUNa, 24HUNK and 24HUNa/24HUK between INHT and both-HT. In multivariate analysis controlled with age, gender, body mass index, estimated glomerular filtration rate, and use of diuretics, INHT showed significantly higher 24HUNa/24HUK than NT (p = 0.038). The difference of 24HUNa and 24HUNa/24HUK between NT and both-HT was not persistent in multivariate analysis. Conclusions: The result of present study suggests that high ratio of sodium/potassium intake may be a risk of isolated nocturnal hypertension.

Masked Isolated Nocturnal Hypertension in Children and Young Adults.

Isolated nocturnal hypertension (INH) is characterized by normal daytime blood pressure (BP) and elevated nighttime BP diagnosed by ambulatory BP monitoring. Masked isolated nocturnal hypertension (MINH) is a subtype of INH in which office BP is normal. We studied the frequency and characteristics of INH and MINH in children and young adults. One hundred and ninety-eight subjects seen by the pediatric nephrology service were studied retrospectively. Isolated nocturnal hypertension (INH) and MINH were diagnosed according to daytime and nighttime ABP and office BP in the case of the latter. One hundred and eighteen subjects (60%) had normotension, 6 (3%) had isolated daytime hypertension, 32 (16%) had INH, and 42 (21%) had day-night hypertension. Sixteen subjects had MINH (8.1%). The underlying diseases of MINH were as follows: no underlying disease 9 (56%), renal disease 6 (38%), and endocrine disease 1 (6%). There was no significant difference in the underlying disease, gender, age, and BMI between MINH and INH with elevated office BP. In conclusion, MINH is present in children and young adults. Since there were no specific features for MINH, screening with ambulatory or home BP monitoring during sleep may be appropriate.

BP.05.06] DOES NIGHTTIME HYPERTENSION IMPACT LEFT VENTRICULAR MECHANICS?

Objective: The aim of this study was to evaluate left ventricular (LV) mechanics in individuals with daytime, nighttime and day-nighttime hypertension (HT). Design and method: This cross-sectional study included 236 untreated subjects who underwent 24-hour ambulatory blood pressure (BP) monitoring and complete two-dimensional echocardiographic examination (2DE) including strain analysis. According to current guidelines, night-time hypertension was defined as nocturnal systolic BP > = 120 mm Hg or diastolic BP > = 70 mm Hg and day-time hypertension as systolic BP > 135 mm Hg and diastolic BP >85 mm Hg. Results: Using aforementioned criteria, the study sample included 68 normotensive subjects (29%), 51 isolated daytime HT (22%), 45 isolated nighttime HT (19%) and 72 day-nighttime HT (30%). 2DE LV longitudinal strain gradually and significantly decreased from normotensive subjects across daytime and nighttime HT patients to day-nighttime HT individuals (−21.8 ± 2.6 vs. −19.4 ± 2.3 vs. −18.8 ± 2.4 vs. −17.8 ± 2.1%, p < 0.001, respectively). The same direction of changes was also obtained for 2DE LV circumferential strain (−22.6 ± 3.1 vs. −20.9 ± 2.7 vs. −19.7 ± 2.6 vs. −18.2 ± 2.7%, p < 0.001, respectively). 2DE radial strain was significantly lower in nighttime HT and day-nighttime HT patients than in controls (39.4 ± 8.8 vs. 37.7 ± 9.1 vs. 35.1 ± 7.8 vs. 34.0 ± 8.0, p = 0.001, respectively). LV twist increased from normotensive subjects across daytime and nighttime HT patients to day-nighttime HT individuals (18.0 ± 6.3 vs. 19.7 ± 6.6 vs. 21.4 ± 7.1 vs. 22.2 ± 7.5 < degree>, p = 0.005, respectively). 24 h systolic BP fall was associated with peak LV longitudinal (β=−0.477, p < 0.001), LV circumferential strain (β=−0.405, p < 0.001), and LV twist (β=0.389, p < 0.001) in the whole study population independent of LV mass index and E/e’ ratio. Conclusions: Nighttime HT significantly impacts LV mechanics, which gradually deteriorated from normotensive controls, across isolated day- and nighttime HT, to day-nighttime HT. 24-hour systolic BP is associated with LV longitudinal and circumferential strains, as well as LV twist, independently of LV structure and diastolic function.

The influence of night-time hypertension on left ventricular mechanics

ObjectiveThe aim of this study was to evaluate left ventricular (LV) mechanics in individuals with daytime, night-time and day-nighttime hypertension. MethodsThis cross-sectional study included 272 untreated subjects who underwent 24-hour ambulatory blood pressure monitoring and complete two-dimensional echocardiographic examination including strain analysis. According to current guidelines, night-time hypertension was defined as nocturnal systolic blood pressure≥120mmHg and/or diastolic blood pressure≥70mmHg and day-time hypertension as systolic blood pressure≥135mmHg and/or diastolic blood pressure≥85mmHg. ResultsThe study sample included 61 normotensive subjects (22%), 77 isolated daytime hypertension (28%), 40 isolated night-time hypertension (15%) and 94day-nighttime hypertension (35%). LV longitudinal and circumferential strain gradually and significantly decreased from normotensive subjects across patients with isolated daytime and night-time hypertension to hypertensive individuals with persistent hypertension. Radial strain was similar between the observed groups. LV twist increased from normotensive subjects across isolated daytime and night-time hypertensive patients to day-nighttime hypertensive individuals. Hypertensive patients with day-nighttime and night-time hypertension are significantly more associated with decreased longitudinal and circumferential strain than hypertensive patients with isolated day-time hypertension and normotension. ConclusionLV mechanics gradually deteriorated from normotensive controls, across isolated day- and night-time hypertension, to day-nighttime hypertension. Patients with night-time and day-nighttime hypertension are associated with higher risk of LV mechanical dysfunction than normotensives and day-time hypertensives.

Is night-time hypertension worse than daytime hypertension? A study on cardiac damage in a general population: the PAMELA study.

Scanty information is available about the association of isolated daytime hypertension (IDH) and isolated night-time hypertension (INH) with subclinical cardiac damage in the general population. We examined this issue in patients enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni study. The analysis included 2021 participants with valid ambulatory blood pressure (BP) monitoring at baseline evaluation. IDH and INH were defined according to current guidelines. Subclinical organ damage was assessed by validated electrocardiographic and echocardiographic criteria. A total of 1258 patients (62.3%) had daytime/night-time normotension, 376 (18.6%) daytime/night-time hypertension, 231 (11.4%) INH and 156 (7.7%) IDH, respectively. Participants with hypertension, compared with their normotensive counterparts were older, included a higher fraction of men, had higher BMI, LDL cholesterol, triglyceride and glucose levels and exhibited a greater subclinical cardiac involvement. Furthermore, INH and IDH patients showed a similar degree of cardiac damage (i.e. left ventricular mass index: 89 ± 18 vs 90 ± 20 g/m), intermediate between normotensive (82 ± 19 g/m) and day-night hypertensive patients (99 ± 24 g/m). The present study shows that IDH and INH exert similar detrimental effects on cardiac structure. In a practical perspective, appropriate antihypertensive chrono-therapeutic approaches in these opposite ambulatory hypertensive subtypes may have important implications in cardiovascular prevention.

OS 07-01 SUBTYPES OF MASKED HYPERTENSION AND THEIR ASSOCIATIONS WITH TARGET ORGAN DAMAGE IN UNTREATED CHINESE PATIENTS

Objective: Masked hypertension is office normotension in the presence of ambulatory hypertension, which can be subdivided into isolated daytime, isolated nighttime or day-night hypertension. Up to now, no previous studies contrasted the subtypes of masked hypertension in their associations with target organ damage. Design and Method: Consecutive untreated patients referred for ambulatory blood pressure (BP) monitoring to our Hypertension Clinic were recruited. Office and ambulatory BP were measured using the Omron 7051 and SpaceLabs 90217 monitors, respectively. The cutoff values for daytime and nighttime hypertension were a BP of ≥ 135/85 mmHg and ≥ 120/70 mmHg, respectively. Measures of target organ damage, including left ventricular mass index (LVMI) by echocardiography, carotid-femoral pulse wave velocity (cfPWV) and urinary albumin-to-creatinine ratio (ACR), were determined. Results: The 1808 participants (mean age, 51 years; women, 52%) included 580 (30.4%) normotensive subjects, and 672 (37.2%) with masked hypertension, among whom 123 (18%) had isolated daytime hypertension, 78 (12%) isolated nighttime hypertension, and 471 (70%) day-night hypertension. After multivariate adjustment, patients with isolated daytime hypertension (7.9 vs 7.5 m/s, P = 0.003), but not those with isolated nighttime hypertension (7.6 vs 7.5 m/s, P = 0.62), had higher cfPWV than normotensive subjects. While on the contrary, patients with isolated nocturnal hypertension (0.79 vs 0.58 mg/mmol, P = 0.002), but not those with isolated daytime hypertension (0.65 vs 0.58 mg/mmol, P = 0.15), had higher urinary ACR than normotensive subjects. Patients with masked day-night hypertension had consistently higher cfPWV (7.8 vs 7.5 m/s, P < 0.001) and urinary ACR (0.74 vs. 0.58 mg/mmol, P < 0.001) than normotensives. For LVMI, no difference (P = 0.11) between any subtypes of masked hypertension and normotension was observed. Conclusions: Masked hypertension was prevalent in this untreated outpatient cohort, 70% of which was day-night hypertension. Masked daytime hypertension was associated with arterial stiffness while nighttime hypertension was associated with kidney damage and day-night hypertension with both target organ measures.

Hypertension in children after renal transplantation.

Hypertension (HT) is a common and serious complication following renal transplantation in children, and an important risk factor for cardiovascular morbidity and mortality. This study evaluated the clinical characteristics of HT in children after renal transplantation. Twenty-four children who were followed up at least 6 months after renal transplantation were enrolled in the study. From the clinical records, demographic and laboratory data, casual blood pressure (BP) measurement, ambulatory BP monitoring (ABPM), medication, and left ventricular mass index (LVMI) at echocardiogram were documented. Mean age at time of transplantation was 12.6 ± 3.0 years and mean follow-up period was 19.6 ± 15.8 months. HT was detected in 21 children (87.5%) after renal transplantation. Twelve patients (50%) had HT both before and after transplantation and nine (38%) had HT only after transplantation. HT developed in 67% within the first week and in 95% within the first month. All hypertensive children had night-time HT and no child had isolated daytime HT. The efficacy of HT control was 42%. Median LVMI in patients with HT after renal transplantation was 42.3 g/m(2.7). Severe HT, an important complication, was frequently seen in the early period after renal transplantation. Predominance of nocturnal HT and the lack of isolated daytime HT after transplantation underline the importance of ABPM. ABPM should be performed regularly in the first year after transplantation, not only for diagnosis but also for evaluation of HT control.

High Prevalence of Isolated Nocturnal Hypertension in Chinese Patients With Chronic Kidney Disease

BackgroundIsolated nocturnal hypertension (INH) has been studied among the general population and hypertensive patients. However, little insight is available on the prevalence of INH and its role in target-organ damage among patients with chronic kidney disease (CKD).Methods and ResultsWe recruited 1282 CKD patients admitted to our hospital division. Patients were divided into 4 groups: INH; isolated daytime hypertension; day–night sustained; and ambulatory normotension. Multiple linear regression analyses were used to evaluate the correlation between INH and renal/cardiovascular parameters. A total of 262 (20.44%) CKD patients had isolated nocturnal hypertension and 651 (50.78%) had day–night sustained hypertension, whereas only 350 (27.30%) patients showed normotension and 19 (1.48%) had isolated daytime hypertension. Multivariate logistic regression analysis showed that INH was associated mainly with age, estimated glomerular filtration rate, clinic diastolic blood pressure, and that INH was determined only by age, estimated glomerular filtration rate, and clinic diastolic blood pressure. The prevalence of impaired renal function, left ventricular hypertrophy, and carotid intima-media thickness in patients with INH were higher than in normotensive patients (P<0.05), whereas impaired renal function and left ventricular hypertrophy in these patients were lower than patients in the day–night sustained hypertension group (P<0.05). INH was correlated with estimated glomerular filtration rate, left ventricular mass index, and carotid intima-media thickness according to multiple linear regression analyses.ConclusionsThe prevalence of INH in CKD patients was high, and INH was correlated with target-organ damage in CKD patients.

Is Isolated Nocturnal Hypertension A Reproducible Phenotype?

Isolated nocturnal hypertension (INH), defined as nocturnal without daytime hypertension on ambulatory blood pressure (BP) monitoring (ABPM), has been observed to be associated with an increased risk of cardiovascular disease (CVD) events and mortality. The aim of this study was to determine the short-term reproducibility of INH. The Improving the Detection of Hypertension Study enrolled a community-based sample of adults (N = 282) in upper Manhattan without CVD, renal failure, or treated hypertension. Each participant completed two 24-hour ABPM recordings (ABPM1: first recording and ABPM2: second recording) with a mean ± SD time interval of 33 ± 17 days between recordings. Daytime hypertension was defined as mean awake systolic/diastolic BP ≥ 135/85 mm Hg; nocturnal hypertension as mean sleep systolic/diastolic BP ≥ 120/70 mm Hg; INH as nocturnal without daytime hypertension; isolated daytime hypertension (IDH) as daytime without nocturnal hypertension; day and night hypertension (DNH) as daytime and nocturnal hypertension, and any ambulatory hypertension as having daytime and/or nocturnal hypertension. On ABPM1, 26 (9.2%), 21 (7.4%), and 50 (17.7%) participants had INH, IDH, and DNH, respectively. On ABPM2, 24 (8.5%), 19 (6.7%), and 54 (19.1%) had INH, IDH, and DNH, respectively. The kappa statistics were 0.21 (95% confidence interval (CI) 0.04-0.38), 0.25 (95% CI 0.06-0.44), and 0.65 (95% CI 0.53-0.77) for INH, IDH, and DNH respectively; and 0.72 (95% CI 0.63-0.81) for having any ambulatory hypertension. Our results suggest that INH and IDH are poorly reproducible phenotypes, and that ABPM should be primarily used to identify individuals with daytime hypertension and/or nocturnal hypertension.

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

We and other investigators previously reported that isolated nocturnal hypertension on ambulatory measurement (INH) clustered with cardiovascular risk factors and was associated with intermediate target organ damage. We investigated whether INH might also predict hard cardiovascular endpoints. We monitored blood pressure (BP) throughout the day and followed health outcomes in 8711 individuals randomly recruited from 10 populations (mean age 54.8 years, 47.0% women). Of these, 577 untreated individuals had INH (daytime BP <135/85 mmHg and night-time BP ≥120/70 mmHg) and 994 untreated individuals had isolated daytime hypertension on ambulatory measurement (IDH; daytime BP ≥135/85 mmHg and night-time BP <120/70 mmHg). During follow-up (median 10.7 years), 1284 deaths (501 cardiovascular) occurred and 1109 participants experienced a fatal or nonfatal cardiovascular event. In multivariable-adjusted analyses, compared with normotension (n = 3837), INH was associated with a higher risk of total mortality (hazard ratio 1.29, P = 0.045) and all cardiovascular events (hazard ratio 1.38, P = 0.037). IDH was associated with increases in all cardiovascular events (hazard ratio 1.46, P = 0.0019) and cardiac endpoints (hazard ratio 1.53, P = 0.0061). Of 577 patients with INH, 457 were normotensive (<140/90 mmHg) on office BP measurement. Hazard ratios associated with INH with additional adjustment for office BP were 1.31 (P = 0.039) and 1.38 (P = 0.044) for total mortality and all cardiovascular events, respectively. After exclusion of patients with office hypertension, these hazard ratios were 1.17 (P = 0.31) and 1.48 (P = 0.034). INH predicts cardiovascular outcome in patients who are normotensive on office or on ambulatory daytime BP measurement.

Is Isolated Nocturnal Hypertension a Novel Clinical Entity?

We reported previously that normotensive Chinese had higher nighttime diastolic blood pressure compared with non-Chinese. We, therefore, studied the prevalence and characteristics of isolated nocturnal hypertension (HT) and its association with arterial stiffness, an intermediate sign of target organ damage. We recorded ambulatory blood pressure, the central and peripheral systolic augmentation indexes, the ambulatory arterial stiffness index, and brachial-ankle pulse wave velocity in 677 Chinese enrolled in the JingNing population study (53.6% women; mean age: 47.6 years). Prevalence was 10.9% for isolated nocturnal HT (>or=120/70 mm Hg from 10:00 pm to 4:00 am), 4.9% for isolated daytime HT (>or=135/85 mm Hg from 8:00 am to 6:00 pm), and 38.4% for day-night HT. Patients with isolated nocturnal HT, compared with subjects with ambulatory normotension (45.8%), were older (53.7 versus 40.7 years), more often reported alcohol intake (68.9% versus 51.0%), had faster nighttime pulse rate (62.8 versus 60.7 bpm), had higher serum cholesterol (5.12 versus 4.77 mmol/L), and had higher blood glucose (4.84 versus 4.38 mmol/L). Similar to patients with isolated daytime HT or day-night HT, patients with isolated nocturnal HT had higher indexes of arterial stiffness (P<0.05) than subjects with ambulatory normotension (central augmentation index: 140% versus 134%; peripheral augmentation index: 82.6% versus 76.5%; ambulatory arterial stiffness index: 0.40 versus 0.35 U; brachial-ankle pulse wave velocity: 16.2 versus 14.7 m/s). Of 74 patients with isolated nocturnal HT, only 4 (5.4%) had hypertension on conventional office blood pressure measurement (>or=140/90 mm Hg). In conclusion, isolated nocturnal HT can only be diagnosed by ambulatory blood pressure monitoring, is prevalent among Chinese, and is associated with increased arterial stiffness.