Further support linking nocturnal hypertension with CVD risk

By Melanie Hinze
Antihypertensive strategies targeting night-­time systolic blood pressure (BP) are particularly important for reducing total cardiovascular event rates, in particular for heart failure (HF), according to new research published in Circulation.

The latest European, US and Japanese hypertension guidelines all recommend ambulatory or home BP monitoring for the diagnosis and management of hyper­tension, as it is increasingly recognised that undetected nocturnal hypertension can predict future cardiovascular disease, particularly HF.

In line with this, the Japan Ambulatory Blood Pressure Monitoring Prospective (JAMP) study, looked at the association between nocturnal hypertension and night­-time BP dipping patterns and the occurrence of cardiovascular events.

The practitioner­-based, nationwide, multicentre, prospective, observational study assessed 6359 patients with at least one cardiovascular risk factor, who were free of symptomatic cardiovascular disease at baseline. Patients were recruited from 116 different institutions, including primary practices, hospital­-based outpatient clinics and hospitals; 48% were men, 77% were taking antihypertensives and their mean age was 68.6 years. Participants underwent 24­-hour ambulatory BP monitoring and were then followed annually.

Over a mean follow up of 4.5 years, 306 cardiovascular events occurred, including 119 strokes, 99 coronary artery disease events and 88 episodes of HF.

Night­-time systolic BP was found to be significantly associated with the risk of atherosclerotic cardiovascular disease and HF.

When compared with those with a normal circadian rhythm, a night­-time BP higher than day­time BP was significantly associated with higher overall cardiovascular disease risk. In particular, it carried an almost 2.5 times increased risk of HF.

Associate Professor Aaron Sverdlov, Director of Heart Failure at the Hunter Medical Research Institute, University of Newcastle and Cardiologist at the John Hunter Hospital, Newcastle, said, ‘This paper highlights the importance of blood pressure control, especially at night time, on cardiovascular health’.

Professor Sverdlov added that, ‘It also underscores the utility of 24­-hour ambulatory blood pressure, which allows the diagnosis of night­-time hypertension.’
Circulation 2020; 142: 1810-1820.