Clinical significance of nocturnal home blood pressure monitoring and nocturnal hypertension in Asia

Fujiwara, Takeshi; Hoshide, Satoshi; Tomitani, Naoko; Cheng, Hao‐Min; Soenarta, Arieska Ann; Turana, Yuda; Chen, Chen Huan; Minh, Huynh Van; Sogunuru, Guru Prasad; Tay, Jam Chin; Wang, Tzung‐Dau; Chia, Yook Chin; Verma, Narsingh; Li, Yan

doi:10.1111/jch.14218

Cited by 17 publications

(18 citation statements)

References 61 publications

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“…This may increase the possibility of miss leading in identifying dipping or non-dipping pattern, despite the fact that it will be difficult to perform repeated ABPM in the clinical settings. Home BP monitoring (HBPM) is promising in identifying the nocturnal BP pattern with property of accessibility and reproducibility, but the reliable devices and standardized assessment conditions and measurement frequency, as well as the prognosis value of nocturnal BP measured with HBPM, are yet to be established ( 33 , 34 ). Secondly, the time of antihypertensive agents administration in the trial are pre-specified, which might be inconsistent with the true sleep/waking cycle of individual.…”

Section: Discussionmentioning

confidence: 99%

Dosing Time Matters? Nighttime vs. Daytime Administration of Nifedipine Gastrointestinal Therapeutic System (GITS) or Amlodipine on Non-dipper Hypertension: A Randomized Controlled Trial of NARRAS

Liu

Nie

et al. 2021

Front. Cardiovasc. Med.

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Background: Non-dipper hypertension is often characterized by a blunted decrease of nocturnal blood pressure (BP) and is associated with increased risk of target organ damage and cardiovascular (CV) events, while the optimal treatment strategy is yet to be established. This trial was designed to evaluate whether nocturnal BP reduction and arterial stiffness improvement differ from antihypertensive agents and time of administration.Methods: Young and middle-aged adults (18–65 years) with non-dipper hypertension were randomly assigned to nifedipine GITS (gastrointestinal therapeutic system) 30 mg or amlodipine besylate 5 mg once daily for 8 weeks, either taken in the morning or at night. Dose was doubled at 4-week if BP is not at goal. Twenty-four hour ambulatory BP monitoring (ABPM) and arterial stiffness were evaluated before and after 8 weeks of pharmacotherapy. The primary efficacy measure was the average nighttime systolic BP reduction.Results: A total of 98 non-dipper hypertensive patients (mean age 46.3 years) were randomized during Dec, 2016 and Dec, 2020, of whom 72 (73%) patients completed all ABPM and follow-up evaluations. Nighttime systolic BP significantly reduced at 8 weeks vs. baseline with nifedipine GITS or amlodipine, irrespective of dosing at nighttime (−9.9 vs −9.9 mmHg, P > 0.05) or daytime (−11.5 vs. −10.9 mmHg, P > 0.05). No difference was seen between these two agents, when combining the data of nighttime and daytime dosing together (−10.8 vs. −10.5 mmHg, respectively, P = 0.898). Daytime, 24-h systolic BP, diastolic BP at different time and pulse wave velocity reduced significantly and comparably, and recovery of dipping rhythm were similar among groups.Conclusion: Nighttime dosing of long-acting antihypertensive preparations, nifedipine GITS or amlodipine demonstrated similar effects on nocturnal BP reduction, dipping rhythm restoration and arterial elasticity improvement in younger subjects with non-dipper hypertension. These effects were comparable with morning dosing.

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Section: Discussionmentioning

confidence: 99%

Dosing Time Matters? Nighttime vs. Daytime Administration of Nifedipine Gastrointestinal Therapeutic System (GITS) or Amlodipine on Non-dipper Hypertension: A Randomized Controlled Trial of NARRAS

Liu

Nie

et al. 2021

Front. Cardiovasc. Med.

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“…В последнее время особое внимание сосредоточено на ночном периоде суточного профиля АД. Оценка эффективности антигипертензивной терапии ночью актуальна в связи с большим прогностическим значением результатов АД, полученных в это время суток, по сравнению с дневным периодом [24,27]. Этот факт был обоснованием для проведения подробного анализа ночного уровня АД.…”

Section: Discussionunclassified

“…Показатель степени ночного снижения (СНС) АД считают плохо воспроизводимым [27]. Он уступает в этом отношении усредненным ночным величинам АД, хуже коррелируя с повреждением органов-мишеней [27,29,30]. Тем не менее, продемонстрированная в нашем исследовании положительная динамика СНС АД за счет увеличения доли пациентов с нормализацией этого показателя и сокращения доли больных с наиболее нежелательными её вариантами заслуживает внимания.…”

Section: Discussionunclassified

“…Оценка ИС вызывает интерес при изучении эффективности лечения ТФК, т.к. известно, что этот показатель коррелирует с регрессией массы миокарда левого желудочка на фоне монотерапии [27] и дает независимую от динамики средних величин информацию об антигипертензивном эффекте [23]. Его считают равномерным, если ИС >0,7 [22,23,29].…”

Section: Discussionunclassified

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Twenty-four-hour and office blood pressure measurement in a comprehensive assessment of the effectiveness of 12-week therapy with a triple fixed-dose combination of amlodipine/indapamide/perindopril in hypertensive patients in actual clinical practice

Горбунов¹,

Карпов

Platonova³

et al. 2021

Russ J Cardiol

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Aim. To study the efficacy and safety of the triple fixed-dose combination (FDC) of amlodipine/indapamide/perindopril on blood pressure (BP) profile in patients with grade I-II hypertension (HTN) in actual clinical practice.Material and methods. Data from 54 patients with paired 24-hour ambulatory BP monitoring (ABPM) data were included in the TRICOLOR subanalysis (ClinicalTrials. gov study ID — NCT03722524). The mean 24-hour, daytime, and nighttime BP were calculated at baseline and after 12-week follow-up. We determined the proportion of patients with nocturnal HTN (≥120/70 mm Hg) and nocturnal hypotension (<100/60 and <90/50 mm Hg) initially and after 12 weeks of triple FDC therapy. Patients with nocturnal BP decrease included dippers (D; 10-20%), reduced dippers (RD; 0-10%) and extreme dippers (ED; >20%), as well as those without nocturnal BP decrease (>0%, non-dipper (ND)). The smoothness index (SI) was analyzed as the ratio of the mean hourly SBP fall to its mean standard deviation in paired ABPM. To assess the BP phenotypes, two methods were used with reference values of <130/80 and <140/90 mm Hg for ABPM and office BP, respectively. Controlled hypertension (CHT), uncontrolled hypertension (UHT), white coat hypertension (WHT) and masked ineffectiveness of antihypertensive therapy were distinguished.Results. Among 1247 participants of the TRICOLOR study, 54 patients with valid paired ABPM were selected (men, 46%; mean age, 57,7 [12,1] years; mean office BP, 150,4 [16,6]/93,3 [10,7] mm Hg; HTN duration, 8,3 [7,5] years). Initially, the mean 24-hour, daytime and nighttime BP was 141,1 [15,4]/85,9 [9,9], 144,2 [15,5]/88,8 [10,5] and 132,6 [18,0]/78,1 [9,9] mm Hg, respectively. After 12-week follow-up, the mean 24-hour, daytime and nighttime BP was 123,1 [10,5]/75,6 [8,5], 125,7 [10,9]/77,9 [8,7] and 115,4 [10,2]/68,6 [8,8] mm Hg, respectively (p<0,001). After 12-week follow-up, the proportion of patients with nocturnal hypertension decreased from 64,8% to 25,0% (2,6 times) (p<0,001). The proportion of NDs and EDs decreased from 16,7% and 7,4% to 5,8% and 0%, respectively (p=0,048); the proportion of patients with RD and D patterns increased from 42,6% and 33,3 to 57,7% and 36,5%, respectively (p=0,048). With triple FDC therapy, the SI during the day was higher than 0,73 in half of the cases. According to the two methods, the proportion of patients with UHT decreased from 81,6% to 4,4%, WHT from 12,2% to 0%. The prevalence of CHT increased from 4,1% to 57,8%, while masked ineffectiveness of antihypertensive therapy — from 2,0% to 37,8%.Conclusion. Twelve-week FDC therapy of amlodipine/indapamide/perindopril led to a significant fall in the mean 24-hour, daytime and nighttime BP values. Comprehensive analysis of two techniques (24-hour and office BP measurement) identified patients requiring further triple FGC titration.

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2022

Essential Manual of 24‐Hour Blood Pressure Management

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Clinical significance of nocturnal home blood pressure monitoring and nocturnal hypertension in Asia

Cited by 17 publications

References 61 publications

Dosing Time Matters? Nighttime vs. Daytime Administration of Nifedipine Gastrointestinal Therapeutic System (GITS) or Amlodipine on Non-dipper Hypertension: A Randomized Controlled Trial of NARRAS

Dosing Time Matters? Nighttime vs. Daytime Administration of Nifedipine Gastrointestinal Therapeutic System (GITS) or Amlodipine on Non-dipper Hypertension: A Randomized Controlled Trial of NARRAS

Twenty-four-hour and office blood pressure measurement in a comprehensive assessment of the effectiveness of 12-week therapy with a triple fixed-dose combination of amlodipine/indapamide/perindopril in hypertensive patients in actual clinical practice

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