Is Isolated Nocturnal Hypertension a Novel Clinical Entity?

Abstract

Abstract-We reported previously that normotensive Chinese had higher nighttime diastolic blood pressure compared with non-Chinese. We, therefore, studied the prevalence and characteristics of isolated nocturnal hypertension (HT) and its association with arterial stiffness, an intermediate sign of target organ damage. We recorded ambulatory blood pressure, the central and peripheral systolic augmentation indexes, the ambulatory arterial stiffness index, and brachial-ankle pulse wave velocity in 677 Chinese enrolled in the JingNing population study (53.6% women; mean age: 47.6 years). [5][6][7][8] corroborated that an elevated nocturnal blood pressure is a harbinger of an unfavorable outcome. In Ohasama residents, each 5% decrease in the nocturnal blood pressure fall was associated with an Ϸ20% greater risk of cardiovascular mortality. 3 Similarly, in an Irish cohort of referred patients, each 10-mm Hg increment in the nighttime systolic pressure resulted in a 21% higher cardiovascular mortality, whereas the corresponding estimate for a 5-mm Hg diastolic increment amounted to 9%. 8 Several studies suggested that Asians 3,9 and blacks 10,11 have less nocturnal blood pressure dipping than whites. Along these lines, we noticed previously that, among the normotensive subjects enrolled in 7 population studies, Chinese compared with non-Chinese consistently had a nighttime diastolic blood pressure that was, on average, 3 to 12 mm Hg higher. 12 Based on these observations, 9,11,12 we envisaged that some subjects might have an elevated nighttime blood pressure in the presence of a normal daytime level, a condition that we termed isolated nocturnal hypertension. We further hypothesized that this special type of hypertension, which can only be diagnosed by 24-hour ambulatory monitoring, might be associated with target organ damage. To test our hypothesis, we studied the prevalence and characteristics of isolated nocturnal hypertension in a Chinese population and examined its association with various indexes of arterial stiffness. Methods Study PopulationIn the framework of our ongoing Chinese study on genes involved in hypertension, 13,14 from 2003 through 2005, we recruited participants from 14 villages in the JingNing County, a rural area Ϸ500 km south of Shanghai. The ethics committee of Ruijin Hospital and Shanghai Jiaotong University Medical School approved the study. We invited all of the villagers with a minimum age of 12 years to take part. Of

Association of nighttime hypertension with central arterial stiffness and urinary albumin excretion in dipper hypertensive subjects

“…Our findings are in accordance with previous studies that have linked c-f PWV, ACR and hs-CRP 9,16,17 to nighttime BP in hypertension Abbreviations: BP, blood pressure; c-f PWV, carotid to femoral pulse wave velocity; hs-CRP, high sensitivity C reactive protein.…”

Job control and ambulatory blood pressure

“…High influence at work or skill discretion was consistently associated with high SBP and DBP in clinic and ABPM readings with the exception of clinic SBP. This could result in increased cardiovascular risk (32)(33)(34). Possibility for development did not show the same significant associations.…”

Elevated circulating endothelial microparticles and brachial–ankle pulse wave velocity in well-controlled hypertensive patients

“…[23][24][25] Detections of circulating EMPs and baPWV are interesting and valuable tools to appreciate the ongoing and progression of hypertensive patients as well. Hypertension is accompanied by the reduced arterial elasticity and impaired endothelial function, which synergistically contribute to the pathogenesis of vascular disease.…”