Influence of elevated sleep-time blood pressure on vascular risk and hypertension-mediated organ damage

ABSTRACT

We report the analysis of 252 hypertensive patients whose blood pressure (BP) was assessed by around-the-clock ambulatory BP monitoring compared to office BP measurement during a follow-up investigation of 8.7 y (SD: 2.43 y) that evaluated the added value of measuring sleep-time BP values. We found that 37.3% of the patients had mismatched diagnoses between the two techniques of BP assessment, with 11.5% of the patients showing white-coat hypertension and 25.8% masked hypertension. Only 12.3% of the diagnosed and treated patients presented normal BP values. Nocturnal (sleep-time) hypertension was present in 70.63%. The sleep-time systolic BP mean was found to be an independent vascular risk factor (F = 9.005, p < .001), indirectly measured through the 10-year risk of morbidity and mortality. Additionally, the elevated sleep-time systolic BP mean was a better marker of subclinical hypertension-mediated organ damage (ρ = 0.19, p < .01) than either the awake (ρ = 0.168, p < .01) or 24 (ρ = 0.184, p < .01) systolic BP means. In conclusion, the accuracy and sleep-time measurements provided by ambulatory BP make it particularly relevant in hypertension diagnosis and management. The use of the ambulatory BP measurement method could end up modifying current therapeutic targets, with sleep-time systolic BP mean becoming a main one, in order to optimize hypertension control and reduce hypertension-related organ pathology and cardiovascular disease morbidity and mortality.

KEYWORDS:

• Ambulatory blood pressure measurement
• nocturnal hypertension
• sleep-time systolic blood pressure mean
• 24-hour systolic blood pressure mean
• vascular risk
• hypertension-mediated organ damage
• clinically established vascular disease

Acknowledgements

We thank the Hypertension Unit of the University Hospital of Salamanca for the data compilation.

Disclosure statement

The authors declare that they have no conflict of interest.

Additional information

Funding

The studies carried out by the authors have been supported by grants from the Ministerio de Economía y Competitividad of Spain (SAF2013-45784-R to ARB), Sociedad Española de Nefrología (SENEFRO to ARB), and Junta de Castilla y León (UIC 206 to ARB)