Management of nocturnal hypertension

Abstract

Nocturnal hypertension is a common complication of essential and secondary hypertension. Abnormal circadian blood pressure patterns associated with elevated sleep blood pressure include nondipping and reverse dipping, both of which are associated with increased target-organ damage and adverse cardiovascular outcomes. Nocturnal hypertension can be treated with several approaches that include both lifestyle changes, such as sodium restriction and potassium supplementation, and pharmacological treatments, primarily through the use of bedtime dosing of antihypertensive agents. Evening administration of blockers of the renin–angiotensin–aldosterone system is the most consistently effective of these treatment strategies. In this review, we provide a detailed discussion of the options available for the management of nocturnal hypertension.

Keywords::

• ambulatory blood pressure monitoring
• cardiovascular disease
• circadian rhythm
• hypertension
• nondipper
• reverse dipper
• sleep blood pressure
• treatment

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

^*Conditions often associated with a reversal of the normal circadian rhythm (i.e., sleep blood pressure > awake blood pressure).