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


RESULTS
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).


CONCLUSIONS
INH predicts cardiovascular outcome in patients who are normotensive on office or on ambulatory daytime BP measurement.
Center for Epidemiological Studies and Clinical Trials, and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Hong-Qi
HQ
Fan
Yan
Y
Li
Lutgarde
L
Thijs
Tine W
TW
Hansen
José
J
Boggia
Masahiro
M
Kikuya
Kristina
K
Björklund-Bodegård
Tom
T
Richart
Takayoshi
T
Ohkubo
Jørgen
J
Jeppesen
Christian
C
Torp-Pedersen
Eamon
E
Dolan
Tatiana
T
Kuznetsova
Katarzyna
K
Stolarz-Skrzypek
Valérie
V
Tikhonoff
Sofia
S
Malyutina
Edoardo
E
Casiglia
Yuri
Y
Nikitin
Lars
L
Lind
Edgardo
E
Sandoya
Kalina
K
Kawecka-Jaszcz
Yutaka
Y
Imai
Hans
H
Ibsen
Eoin
E
O'Brien
Jiguang
J
Wang
Jan A
JA
Staessen
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002940:Circadian Rhythm / Q000502:physiology*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors