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Isolated nocturnal hypertension: an unsolved problem—when to start treatment and how low should we go?

Journal of Human Hypertension volume 34, pages 739–740 (2020)Cite this article

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Arterial hypertension (HTN) is the leading cause of premature death in the world [1]. The 2018 European Society of Cardiology and European Society of Hypertension Guidelines for HTN define arterial hypertension as office blood pressure (BP) levels of ≥140 mmHg systolic and ≥90 mmHg diastolic and ≥135/85 mmHg for home blood pressure monitoring (HBPM) [2]. Also, the use of 24-h ambulatory blood pressure monitoring (ABPM) as a valid out-of-office tool for the diagnosis of HTN has been emphasized [2]. The threshold for hypertension on ABPM is ≥130/80 mmHg for 24-h monitoring, ≥135/85 mmHg for the daytime values and ≥120/70 mmHg for the night-time average levels [2].

Until recently, ABPM was the only diagnostic tool that could interpret night-time BP. However, Kairo et al. showed that nocturnal home blood pressure measurements made at 1 h intervals also have a good predictive value for cardiovascular events, independent of office and morning home blood pressure measurements [3]. Night-time levels lower than 120 mmHg for systolic blood pressure (sBP) and lower than 70 mmHg for diastolic blood pressure (dBP) are considered to be normal while levels higher than these are defined as nocturnal HTN [4]. On the other hand, the isolated nocturnal hypertension (INH) is defined as nocturnal hypertension with normal daytime values [5] and it seems that more than one third of patients with nocturnal HTN have INH [6].

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References

  1. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mmHg, 1990–2015. JAMA. 2017;317:165–82. https://doi.org/10.1001/jama.2016.19043

    Article  Google Scholar 

  2. Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39:3021–104. https://doi.org/10.1093/eurheartj/ehy339

    Article  Google Scholar 

  3. Kario K, Kanegae H, Tomitani N, Okawara Y, Fujiwara T, Yano Y, et al. Nighttime blood pressure measured by home blood pressure monitoring as an independent predictor of cardiovascular events in general practice. Hypertension. 2019;73:1240–8. https://doi.org/10.1161/HYPERTENSIONAHA.118.12740

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Parati G, Stergiou G, O’Brien E, Asmar R, Beilin L, Grzeorgz B, et al. Cardiovascular variability. European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring. J Hypertens. 2014;32:1359–66. https://doi.org/10.1097/HJH.0000000000000221

    Article  CAS  PubMed  Google Scholar 

  5. Li Y, Staessen JA, Lu L, Li LH, Wang GL, Wang JG. Is isolated nocturnal hypertension a novel clinical entity? Findings from a Chinese population study. Hypertension. 2007;50:333–9. https://doi.org/10.1161/HYPERTENSIONAHA.107.087767

    Article  CAS  PubMed  Google Scholar 

  6. Salazar MR, Espeche WG, Balbín E, Leiva Sisnieguez CE, Minetto J, Leiva Sisnieguez BC, et al. Prevalence of isolated nocturnal hypertension according to 2018 European Society of Cardiology and European Society of Hypertension office blood pressure categories. J Hypertens. 2019;38:434–40. https://doi.org/10.1097/HJH.0000000000002278

    Article  CAS  Google Scholar 

  7. Mancia G, Verdecchia P. Clinical value of ambulatory blood pressure: evidence and limits. Circulation Res. 2015;116:1034–45. https://doi.org/10.1161/CIRCRESAHA.116.303755

    Article  CAS  PubMed  Google Scholar 

  8. Salles GF, Reboldi G, Fagard RH, Cardoso C, Pierdomenico S, Verdecchia P, et al. Prognostic effect of the nocturnal blood pressure fall in hypertensive patients: the ambulatory blood pressure collaboration in patients with hypertension (ABC-H) meta-analysis. Hypertension. 2016;67:693–700. https://doi.org/10.1161/HYPERTENSIONAHA.115.06981

    Article  CAS  PubMed  Google Scholar 

  9. Tadic M, Cuspidi C, Grassi G, Mancia G. Isolated nocturnal hypertension: what do we know and what can we do? Integr Blood Press Control. 2020;13:63–9. https://doi.org/10.2147/IBPC.S223336

    Article  PubMed  PubMed Central  Google Scholar 

  10. Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res. 2019;42:1235–481. https://doi.org/10.1038/s41440-019-0284-9

    Article  PubMed  Google Scholar 

  11. Grossman E. Ambulatory blood pressure monitoring in the diagnosis and management of hypertension. Diabetes Care. 2013;36:S307–11. https://doi.org/10.2337/dcS13-2039

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kario K, Hoshide S, Haimoto H, Yamagiwa K, Uchiba K. Nagasaka; SJ-HOP study group. Sleep blood pressure self-measured at home as a novel determinant of organ damage: Japan Morning Surge Home Blood Pressure (J-HOP) Study. J Clin Hypertens. 2015;17:340–8. https://doi.org/10.1111/jch.12500

    Article  CAS  Google Scholar 

  13. Fan HQ, Li Y, Thijs L, Hansen TW, Boggia J, Kikuya M, et al. International Database on Ambulatory Blood Pressure In Relation to Cardiovascular Outcomes Investigators. Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations. J Hypertens. 2010;28:2036–45. https://doi.org/10.1097/HJH.0b013e32833b49fe

    Article  CAS  PubMed  Google Scholar 

  14. Boggia J, Li Y, Thijs L, Hansen TW, Kikuya M, Björklund-Bodegård K, et al. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet. 2007;370:1219–29. https://doi.org/10.1016/S0140-6736(07)61538-4

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute for Treatment and Rehabilitation Niska Banja, Nis, Serbia

    Milovan Stojanovic, Marina Deljanin-Ilic & Bojan Ilic

  2. Faculty of Medicine, University of Nis, Nis, Serbia

    Marina Deljanin-Ilic

  3. Clinic for Cardiovascular Diseases Cardio Point, Nis, Serbia

    Stevan Ilic

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  1. Milovan Stojanovic
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Correspondence to Milovan Stojanovic.

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Stojanovic, M., Deljanin-Ilic, M., Ilic, S. et al. Isolated nocturnal hypertension: an unsolved problem—when to start treatment and how low should we go?. J Hum Hypertens 34, 739–740 (2020). https://doi.org/10.1038/s41371-020-00403-5

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