Can nocturnal hypertension predict cardiovascular risk?

Figures & data

Table 1 Studies addressing independent prognostic significance of nocturnal blood pressure on all-cause mortality and/or cardiovascular mortality/morbidity

Primary author	Year	Source of publication	Country of primary author’s affiliation	Sample size	Study design
Ohkubo^Citation5,Citation145	1997^a	Am J Hypertens	Japan	1542	Prospective cohort
	2002	J Hypertens
Staessen^Citation6	1999	JAMA	Belgium	808	Prospective cohort
Dolan^Citation122	2005	Hypertension	Ireland	5292	Prospective cohort
Ben-Dov^Citation121	2007	Hypertension	Israel	3957	Prospective cohort
Fagard^Citation123	2008	Hypertension	Belgium	3468	Meta-analysis
Bjorklund^Citation146	2004	J Hypertens	Sweden	872	Prospective cohort
Kikuya^Citation124	2005	Hypertension	Japan	1332	Prospective cohort
Ingelsson^Citation147	2006	JAMA	Sweden	951	Prospective cohort
Sega^Citation148	2005	Circulation	Italy	2051	Prospective cohort
Boggia^Citation81	2007	Lancet	Uruguay	7458	Meta-analysis
Clement^Citation149	2003	N Engl J Med	Belgium	1963	Prospective cohort
Hansen^Citation150,Citation151	2005	Hypertension	Denmark	1700	Prospective cohort
	2006	Am J Hypertens
Verdecchia^Citation152	1994	Hypertension	Italy	959	Prospective cohort
Brotman^Citation153	2008	Am J Hypertens	USA	621	Retrospective cohort

a Pilot analysis.

Table 3 Studies addressing independent prognostic significance of nocturnal blood pressure on all-cause mortality and/or cardiovascular mortality/morbidity

Primary author	F/U (yrs)	Ascertainment of nighttime period	Adjusted HR for all-cause mortality	Adjusted HR for cardiovascular mortality	Adjusted HR for cardiovascular morbidity^a
Ohkubo^Citation5,Citation145	5.1 9.2	Sleep diary	Riser: 2.12 Attenuated dipper: 1.35 (NS)	Riser: 4.97^b and 3.79^c Attenuated dipper: 2.88^b and 2.66^c Non-dipper and 24-hour BP ≥ 135/80: 5.37 Non-dipper and 24-hour BP < 135/80: 2.35	NA
Staessen^Citation6	4.4	0000–0600 h	10 mmHg ↑ sBP: 1.21^b	10 mmHg ↑ sBP: 1.21^b (NS)	10 mmHg ↑ sBP: 1.26^b 10% ↑ night-to-day sBP ratio: 1.41^c
Dolan^Citation122	7.9	0100–0600 h	10 mmHg ↑ sBP: 1.18^b 10 mmHg ↑ dBP: 1.23^b	10 mmHg ↑ sBP: 1.21^b 10 mmHg ↑ dBP: 1.19^b	NA
Ben-Dov^Citation121	6.5	Sleep diary	Riser: 1.96^* Attenuated dipper: 1.30^b	NA	NA
Fagard^Citation123	6.7	0000–0600 h	1 SD ↑ sBP: 1.34^b 1 SD ↑ dBP: 1.28^b	1 SD ↑ sBP: 1.34^b 1 SD ↑ dBP: 1.40^b	1 SD ↑ sBP: 1.36^b 1 SD ↑ dBP: 1.21^b
Bjorklund^Citation146	6.6	0000–0600 h	NA	NA	1 SD ↑ sBP: 1.18 1 SD ↑ dBP: 1.05 (NS)
Kikuya^Citation124	10.8	Sleep diary	NA	10 mmHg ↑ sBP: 1.32^*	NA
Ingelsson^Citation147	9.1	0000–0600 h	NA	NA	1 SD ↑ sBP: 1.41^c (NS) 1 SD ↑ dBP: 1.47^c (heart failure hospitalization)
Sega^Citation148	10.9	2300–0700 h	10 mmHg ↑ sBP: 1.42 10 mmHg ↑ dBP: 1.47	10 mmHg ↑ sBP: 1.75 10 mmHg ↑ dBP: 1.87	NA
Boggia^Citation81	9.6	0000–0600 h (Europe, South America) 2200–0400 h (Asia)	1 SD ↑ sBP: 1.22^b 1 SD ↑ dBP: 1.20^* Riser: 1.56^c Attenuated dipper: 1.19^c	1 SD ↑ sBP: 1.22^b 1 SD ↑ dBP: 1.24^b Riser: 1.45^c Attenuated dipper: 1.08^c (NS)	1 SD ↑ sBP: 1.21^b 1 SD ↑ dBP: 1.20^b Riser: 1.30^c Attenuated dipper: 1.05^c (NS)
Clement^Citation149	5.0	0000–0600 h	1 SD ↑ sBP: 1.06 (NS) 1 SD ↑ dBP: 1.07 (NS)	NA	1 SD ↑ sBP: 1.27 1 SD ↑ dBP: 1.18 (NS)
Hansen^Citation150,Citation151	9.5	Diary	10 mmHg ↑ sBP: 1.19 10 mmHg ↑ dBP: 1.35	10 mmHg ↑ sBP: 1.41 10 mmHg ↑ dBP: 1.85	10 mmHg ↑ sBP: 1.27 10 mmHg ↑ dBP: 1.54 Non-dipper and daytime BP ≥ 135/85: 1.68^c Non-dipper and daytime BP < 135/85: 0.58^c (NS)
Verdecchia^Citation152	3.2	1000–0600 h	NA	NA	Non-dipper and male: 1.04 (NS) Non-dipper and female: 6.26
Brotman^Citation153	6.3	2300–0600 h	Non-dipper: 1.47^c	NA	NA

a Includes fatal and non-fatal cardiovascular events unless otherwise specified.

b Includes adjustment for daytime blood pressure.

c Includes adjustment for 24-hour blood pressure.

Abbreviations: BP, blood pressure; dBP, diastolic blood pressure; F/U, follow-up; HR, hazard ratio; NA, not available; NS, not significant; sBP, systolic blood pressure; SD, standard deviation.

Table 2 Studies addressing independent prognostic significance of nocturnal blood pressure on all-cause mortality and/or cardiovascular mortality/morbidity

Primary author	Age (yrs)	Male (%)	BMI (kg/m^2)	Current/exsmoker (%)	DM (%)	Prevalent CVD (%)	Mean daytime BP (mmHg)	HTN (%)
Ohkubo^Citation5,Citation145	61.6	36.6	NA	21.7	NA	4.5	128.6/76.1	30.7
Staessen^Citation6	69.6	38.5	26.7	35.5	NA	26.6	151.4/84.1	100
Dolan^Citation122	53.3	46.3	27.4	23.8	5.2	10.6	146.1/89.0	100
Ben-Dov^Citation121	55.0	47.0	27.2	NA	9.0	NA	NA	70.4
Fagard^Citation123	60.8	44.8	27.7	13.7	8.4	0	143.5/87.1	100
Bjorklund^Citation146	71.0	100	26.0	20.6	13.5	0	NA	30.1
Kikuya^Citation124	61.8	34.5	NA	20.4	17.4	5.6	128.9/76.1	30.4
Ingelsson^Citation147	50.0	100	26.2	20.4	10.0	13.9	140.0/79.0	49.2
Sega^Citation148	52.9	52.8	NA	28.4	2.3	4.8	129.0/81.4	44.2
Boggia^Citation81	56.8	54.3	NA	29.3	7.5	8.3	132.4/80.1	46.1
Clement^Citation149	56.4	51.3	27.9	17.2	11.0	5.9	139.1/88.3	100
Hansen^Citation150,Citation151	55.8	47.9	25.3	44.3	2.2	0	131.0/78.0	8.9
Verdecchia^Citation152	52.9	49.8	27.0	23.7	9.8	3.1	146.4/93.0	100
Brotman^Citation153	61.3	48.1	27.8	21.1	10.8	13.5	NA	74.4

Abbreviations: BMI, body mass index; BP, blood pressure; CVD, cardiovascular disease; DM, diabetes mellitus; HTN, hypertension; NA, not available.

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