Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
Kinoshita Clinic, Hiroshima, Japan.
Am J Hypertens. 2023 May 21;36(6):287-296. doi: 10.1093/ajh/hpad014.
Nocturnal hypertension assessed by a home blood pressure monitoring (HBPM) device is associated with an increased risk of cardiovascular events. However, it is still difficult to assess nighttime blood pressure (BP) frequently. The purpose of this cross-sectional study was to identify significant correlates of nocturnal hypertension assessed by an HBPM device in patients with hypertension who are treated with antihypertensive drugs.
We measured nighttime BP, morning BP, and evening BP by an HBPM device for 7 consecutive days in 365 medicated patients with hypertension.
Of the 365 subjects, 138 (37.8%) had nocturnal hypertension defined as a mean nighttime systolic BP of ≥ 120 mm Hg. Receiver operating characteristic curve analyses showed that the diagnostic accuracy of morning systolic BP for subjects with nocturnal hypertension was significantly superior to that of evening systolic BP (P = 0.04) and that of office systolic BP (P < 0.001). Multivariate analysis revealed that morning systolic BP of 125-<135 mm Hg (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.13-4.58; P = 0.02), morning systolic BP of ≥ 135 mm Hg (OR, 16.4; 95% CI, 8.20-32.7; P < 0.001), and a history of cerebrovascular disease (OR, 3.99; 95% CI, 1.75-9.13; P = 0.001) were significantly associated with a higher risk of nocturnal hypertension and that bedtime dosing of antihypertensive drugs was significantly associated with a lower risk of nocturnal hypertension (OR, 0.56; 95% CI, 0.32-0.97; P = 0.04).
Morning systolic BP of ≥ 125 mm Hg, a history of cerebrovascular disease, and bedtime dosing were significant correlates of nocturnal hypertension in medicated patients with hypertension, and may help detect this risky BP condition.
University Hospital Medical Information Network Clinical Trials Registry (UMIN000019173).
通过家庭血压监测（HBPM）设备评估的夜间高血压与心血管事件风险增加相关。然而，频繁评估夜间血压（BP）仍然很困难。本横断面研究的目的是确定在接受降压药物治疗的高血压患者中，通过 HBPM 设备评估的夜间高血压的显著相关因素。
我们对 365 名高血压药物治疗患者进行了为期 7 天的 HBPM 设备连续测量夜间、早晨和傍晚血压。
在 365 名受试者中，138 名（37.8%）有夜间高血压，定义为平均夜间收缩压≥120mmHg。受试者工作特征曲线分析显示，早晨收缩压对夜间高血压的诊断准确性明显优于傍晚收缩压（P=0.04）和诊室收缩压（P<0.001）。多变量分析显示，125-<135mmHg 的早晨收缩压（比值比[OR]，2.26；95%置信区间[CI]，1.13-4.58；P=0.02）、≥135mmHg 的早晨收缩压（OR，16.4；95%CI，8.20-32.7；P<0.001）和脑血管病史（OR，3.99；95%CI，1.75-9.13；P=0.001）与夜间高血压的风险显著相关，而降压药物的睡前给药与夜间高血压的风险显著相关（OR，0.56；95%CI，0.32-0.97；P=0.04）。
在接受降压药物治疗的高血压患者中，早晨收缩压≥125mmHg、脑血管病史和睡前给药是夜间高血压的显著相关因素，可能有助于发现这种危险的血压状况。
大学医院医疗信息网临床试验注册（UMIN000019173）。
