Nocturnal Blood Pressure Assessment, an Entity of High Prognostic Value, Not Utilized to Its Potential in Clinical Practice (original) (raw)
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The Role of Nocturnal Blood Pressure and Sleep Quality in Hypertension Management
European Cardiology Review, 2020
The accurate measurement, prediction and treatment of high blood pressure (BP) are essential to the management of hypertension and the prevention of its associated cardiovascular (CV) risks. However, even if BP is optimally controlled during the day, nocturnal high blood pressure may still increase the risk of CV events. The pattern of circadian rhythm of BP can be evaluated by ambulatory BP monitoring (ABPM). Night-time ABPM is more closely associated with fatal and nonfatal CV events than daytime ambulatory BP. However, the use of ABPM is limited by low availability and the fact that it can cause sleep disturbance, therefore may not provide realistic nocturnal measurements. Home blood pressure monitoring (HBPM) offers an inexpensive alternative to ABPM, is preferred by patients and provides a more realistic assessment of BP during an individual’s daily life. However, until recently, HBPM did not offer the possibility to measure nocturnal (sleep time) BP. The development and valida...
Predicting Isolated Nocturnal Hypertension Using Dawn and Dusk Home Blood Pressure Monitoring
2022 44th Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC)
Hypertension is a major global cause of morbidity and mortality. Home Blood Pressure Monitoring (HBPM) has the potential to help diagnose patients experiencing isolated nocturnal hypertension who may otherwise be missed. This paper investigates potential diagnostic thresholds for diagnosing isolated nocturnal hypertension using dawn and dusk HBPM measurements in the BP-Eth ambulatory blood pressure monitoring (ABPM) database. Depending on whether European or American diagnostic guidelines for hypertension were used, incidence of isolated nocturnal hypertension in the BP-Eth database was 17.1% or 16.8%, respectively. Using averaged dawn and dusk HBPM measurements to diagnose isolated nocturnal hypertension yielded an AUROC of 0.79 (European guidelines) or 0.84 (American guidelines). The SBP and DBP diagnostic thresholds required to detect 80% of cases of isolated nocturnal hypertension were found to be 125.4 mmHg and 75.7 mmHg, respectively (European guidelines) or 117.6 mmHg and 74.3 mmHg, respectively (American guidelines). These thresholds corresponded to a sensitivity of 80% and specificity of 63% (European guidelines) or sensitivity of 83% and specificity of 65% (American guidelines). These results demonstrate the potential for HBPM to function as an intermediate step in screening patients, determining which patients require more intensive ABPM monitoring for detection of isolated nocturnal hypertension. Clinical relevance This study investigates the incidence of isolated nocturnal hypertension, and the possibility of using home blood pressure monitoring (HBPM) to screen for it. Isolated nocturnal hypertension is otherwise only detectable using more expensive and burdensome ambulatory blood pressure monitoring (ABPM).
Clinical Significance of the Blood Pressure Changes from Day to Night
Blood pressure (BP) decreases by 10% to 20% from day to night. However, in 25% to 35% of hypertensive subjects there is some reduction in the day-night BP decline. In 3% to 5% of uncomplicated hypertensive subjects there is actually an increase, not a decrease, in BP from day to night. Many studies from independent centers showed that not only left ventricular hypertrophy, but also ventricular arrhythmias, silent cerebrovascular disease, microalbuminuria and progression of renal damage are more advanced in subjects with blunted or abolished fall in BP from day to night than in those with normal day-night BP difference. There is also evidence from longitudinal studies that a blunted, abolished or even reversed BP drop from day to night is associated with an increase in the risk of serious cardiovascular complications. However, if the quantity or quality of sleep is poor during overnight BP monitoring, night-time BP rises and its prognostic significance is no longer reliable. Studies which compared the prognostic value of daytime BP with that of night-time BP inevitably found the superiority of the latter for predicting prognosis. The exciting potential therapeutic implication that the control of night-time BP could be more rewarding, in terms of prevention of cardiovascular disease, than that of daytime BP has yet to be addressed in appropriately designed intervention trials. Of note, 24-hour ABP monitoring is the only practical way to assess the day-night rhythm of BP.
Reproducibility of Nocturnal Blood Pressure Assessed by Self-Measurement of Blood Pressure at Home
Hypertension Research, 2007
To assess the reproducibility of nocturnal blood pressure (BP) during sleep as measured using a self-measurement device at home, we obtained repeated nocturnal home BP at 0200 h and quality of sleep assessment from a diary in 556 subjects (71% women, 62.4 ± 11.1 years) in the general population. We used an Omron device (HEM-747IC-N, Omron Healthcare Co., Ltd., Kyoto, Japan), with which the time and frequency of monitoring can be preset and the readings stored. The mean ± SD of the difference between test-retest BP measurements was 0.7 ± 15.1 mmHg systolic and 0.2 ± 9.7 mmHg diastolic with a mean interval of 5.9 days. The absolute differences were greater than 10 mmHg in 261 (46.9%) subjects for systolic and 145 (26.0%) subjects for diastolic. There was no evidence of regression to the mean in nocturnal measurements over at least three nights (n =390, p >0.22). The differences (the first minus the second measurement) were large in subjects who experienced sleep disturbance only in the first (n =64, 2.3 ± 13.6 mmHg and 1.6 ± 9.6 mmHg for systolic and diastolic, respectively) or second sessions (n =56, -4.1 ± 16.4 mmHg and -2.5 ± 11.4 mmHg) compared with the subjects without sleep disturbance (n =66, 1.5 ± 17.8 mmHg and 0.8 ± 10.3 mmHg) and those with sleep disturbance (n =370, 0.9 ± 14.5 mmHg and 0.2 ± 9.3 mmHg) in both sessions. In conclusion, the reproducibility of single nocturnal BP as assessed using a self-measurement device at home was not good, especially for subjects who experienced different quality of sleep in each session. To evaluate nocturnal BP using a self-measurement device, estimation of quality of sleep is indispensable. (Hypertens
Nocturnal Hypertension: Neglected Issue in Comprehensive Hypertension Management
Acta medica Indonesiana, 2016
The body circardian rhythm affects blood pressure variability at day and night, therefore blood pressure at day and night might be different. Nocturnal hypertension is defined as increase of blood pressure >120/70mmHg at night, which is caused by disturbed circadian rhythm, and associated with higher cardiovascular and cerebrovascular events also mortality in hypertensive patients. Nocturnal hypertension and declining blood pressure pattern, can only be detected by continuous examination for 24 hours, also known as ambulatory blood pressure measurement (ABPM). Chronotherapy, has become a strategy for managing the hypertensive nocturnal patients, by taking hypertensive medication at night to obtain normal blood pressure decrease in accordance with the normal circadian rhythm and, improving blood pressure control.
Nocturnal blood pressure patterns in essential hypertensives: an over-looked cardiovascular burden
Ceylon Medical Journal, 2018
Introduction Understanding the diurnal variation of blood pressure (BP) is important in the management of hypertension. Objectives Primary objectives of the study were to analyse the pattern of nocturnal BP in patients with essential hypertension who are already on treatment. Methodology Cross-sectional descriptive study was conducted at cardiology unit Teaching Hospital Kandy, in 2015, in patients referred from the hypertensive clinic at Teaching Hospital Peradeniya. A consecutive sample of 100 essential hypertensives aged >18 years with stage I to III hypertension were included. Patients with a history of previous ischemic heart disease or cerebro-vascular events were excluded. Twenty-four-hour ambulatory blood pressure monitoring was performed in all patients after complete clinical evaluation. Results Sample size was 100. Mean age was 60.86 ± 8.73 years. Twenty eight were male. In the sample 32 had normal dipping patterns. Out of the 68 with abnormal dipping, 45 had sub-optimal dipping, 19 had reverse dipping and 4 had extreme dipping. There were 72 patients with nocturnal hypertension, of them 29 (39.7%) had isolated nocturnal hypertension. Conclusion A high prevalence of abnormal dipping, nocturnal hypertension and isolated nocturnal hypertension among our sample of patients with essential hypertension. Therefore, it is important to increase awareness and to consider ambulatory blood pressure monitoring to detect these abnormal nocturnal blood pressure variations.
The Journal of Clinical Hypertension
Nocturnal blood pressure (BP) measured by ambulatory BP monitoring (ABPM) is a better predictor of future cardiovascular events than daytime BP in hypertensive patients. 1-3 In recent years, nocturnal BP measured by home BP monitoring (HBPM) has become available for clinical practice, and a recent meta-analysis showed that the clinical significance of nocturnal BP measured by HBPM is comparable to that of nocturnal BP measured by ABPM. 4 Owing to its simplicity, convenience, and tolerability, HBPM has been rapidly adopted by many clinics and is now recommended by numerous hypertension guidelines. 5-10 The potential advantages of nocturnal HBPM as a substitute for nocturnal ABPM are that it permits the collection of nocturnal home BP values over multiple nights, in the manner of conventional home BP measurement, which can be measured in the morning and evening. On the other hand, participants are likely to measure nocturnal BP levels depending on their own lifestyle. Recently developed HBPM devices permit participants to set specific lengths of time after their chosen bedtime for the measurement of nocturnal
Clinical significance of nocturnal home blood pressure monitoring and nocturnal hypertension in Asia
The Journal of Clinical Hypertension, 2021
Nocturnal home blood pressure (BP) monitoring has been used in clinical practice for ~20 years. The authors recently showed that nocturnal systolic BP (SBP) measured by a home BP monitoring (HBPM) device in a Japanese general practice population was a significant predictor of incident cardiovascular disease (CVD) events, independent of office and morning home SBP levels, and that masked nocturnal hypertension obtained by HBPM (defined as nocturnal home BP ≥ 120/70 mmHg and average morning and evening BP < 135/85 mmHg) was associated with an increased risk of CVD events compared with controlled BP (nocturnal home BP < 120/70 mmHg and average morning and evening BP < 135/85 mmHg). This evidence revealed that (a) it is feasible to use a nocturnal HBPM device for monitoring nocturnal BP levels, and (b) such a device may offer an alternative to ambulatory BP monitoring, which has been the gold standard for the measurement of nocturnal BP. However, many unresolved clinical proble...