Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA.
Am J Hypertens. 2013 Aug;26(8):1011-6. doi: 10.1093/ajh/hpt064. Epub 2013 May 15.
African Americans have higher rates of nocturnal hypertension and less nocturnal blood pressure (BP) dipping compared with whites. Although nocturnal hypertension is associated with increased cardiovascular morbidity and mortality, its clinical significance among those with normal daytime BP is unclear. This paper reports the prevalence and correlates of isolated nocturnal hypertension (INH) in a population-based cohort of African Americans enrolled in the Jackson Heart Study (JHS).
The study sample included 425 untreated, normotensive and hypertensive JHS participants who underwent 24-hour ambulatory BP monitoring (ABPM), echocardiography, and 24-hour urine collection. Multiple logistic regression and 1-way analysis of variance models were used to test the hypothesis that those with INH have worse target organ damage reflected by greater left ventricular (LV) mass and proteinuria compared with normotensive participants.
Based on 24-hour ABP profiles, 19.1% of participants had INH. In age and sex-adjusted models, participants with INH had greater LV mass compared with those who were normotensive (P = 0.02), as well as about 3 times the odds of LV hypertrophy and proteinuria (Ps < 0.10). However, multivariable adjustment reduced the magnitude and statistical significance of each of these differences.
INH was associated with increased LV mass compared with normo tension in a population-based cohort of African Americans enrolled in the JHS. There were trends toward a greater likelihood of LV hyper trophy and proteinuria among participants with INH vs. those who were normotensive. The clinical significance of the noted target organ damage should be explored in this population.
与白人相比，非裔美国人夜间高血压和夜间血压（BP）下降的发生率更高。尽管夜间高血压与心血管发病率和死亡率增加有关，但在日间血压正常的人群中，其临床意义尚不清楚。本文报告了在参加 Jackson 心脏研究（JHS）的基于人群的非裔美国人群中，孤立性夜间高血压（INH）的患病率和相关因素。
研究样本包括 425 名未经治疗的、正常血压和高血压的 JHS 参与者，他们接受了 24 小时动态血压监测（ABPM）、超声心动图和 24 小时尿液收集。使用多因素逻辑回归和单因素方差分析模型来检验以下假设，即与正常血压的参与者相比，存在 INH 的患者的靶器官损伤更严重，表现为左心室（LV）质量和蛋白尿增加。
根据 24 小时 ABPM 图谱，19.1%的参与者存在 INH。在年龄和性别调整模型中，与正常血压的参与者相比，存在 INH 的参与者的 LV 质量更大（P = 0.02），并且 LV 肥大和蛋白尿的可能性约为 3 倍（P < 0.10）。然而，多变量调整降低了这些差异的幅度和统计学意义。
在 JHS 中招募的基于人群的非裔美国人群中，与正常血压相比，INH 与 LV 质量增加相关。与正常血压的参与者相比，存在 INH 的参与者更有可能发生 LV 肥大和蛋白尿。在该人群中，应探讨注意到的靶器官损伤的临床意义。
