The association of nocturnal hypertension and nondipping blood pressure with treatment‐resistant hypertension: The Jackson Heart Study

Abstract

Apparent treatment‐resistant hypertension (aTRH), nocturnal hypertension, and nondipping blood pressure (BP) have shared risk factors. The authors studied the association between aTRH and nocturnal hypertension and aTRH and nondipping BP among 524 black Jackson Heart Study participants treated for hypertension. Nocturnal hypertension was defined by mean nighttime systolic BP ≥120 mm Hg or diastolic BP ≥70 mm Hg. Nondipping BP was defined by mean nighttime to daytime systolic BP ratio >0.90. aTRH was defined by mean clinic systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg with three medication classes or treatment with four or more classes. The risk for developing aTRH associated with nondipping BP and nocturnal hypertension was estimated. After multivariable adjustment, participants with aTRH were more likely to have nocturnal hypertension (prevalence ratio, 1.20; 95% confidence interval, 1.03–1.39) and nondipping (prevalence ratio, 1.25; 95% confidence interval, 1.09–1.43). Over a median 7.3 years of follow‐up, nocturnal hypertension and nondipping BP at baseline were not associated with developing aTRH after adjustment.

Isolated nocturnal hypertension in pediatric kidney transplant recipients

“…Irvin et al found that adults with apparent treatment‐resistant hypertension (aTRH) were 1.2 times more likely to have INH than patients with hypertension that was not treatment‐resistant. Additionally, aTRH was associated with higher prevalence of non‐dipping status 81 . These associations raise concern about the ability to control INH in patients with aTRH.…”

“…Additionally, aTRH was associated with higher prevalence of non-dipping status. 81 These associations raise concern about the ability to control INH in patients with aTRH.…”

Refractory hypertension focus on nighttime blood pressure and nondipping

“…The cross‐sectional findings provided by Irvin and colleagues, conducted in 540 patients with treated hypertension (mean age 62 ± 9 years, 76% female) from a community‐based cohort of blacks with prevalent obesity (57%) and type 2 diabetes mellitus (33%), add a new piece of information in this research area, showing that RH is associated with nondipping status and nocturnal hypertension, independently of several confounders such as age, sex, obesity, obstructive sleep apnea risk, physical activity, current smoking, diabetes mellitus, chronic kidney disease, prior cardiovascular disease, and daytime systolic and diastolic BP.…”

“…In conclusion, the study by Irvin and colleagues raises some important issues regarding the complex relationship between RH, nocturnal BP phenotypes, and the influence of certain classes of drugs on circadian BP rhythm. These topics need to be further clarified in order to optimize treatment strategies and cardiovascular prevention in patients with uncontrolled hypertension.…”

“…In this issue of the Journal, Irvin and colleagues report the results of a comprehensive observational study aimed at answering two relevant questions: (1) Is there a relationship between refractory hypertension (RH) and nighttime hypertension and/or nondipping pattern? and (2) Are nighttime hypertension or nondipping pattern independent predictors of incident RH?…”