Nighttime Blood Pressure Phenotype and Cardiovascular Prognosis: Practitioner-Based Nationwide JAMP Study
Cardiovascular events can be better-predicted with ambulatory and home blood pressure (BP) monitoring parameters than office BP monitoring parameters, but there is less knowledge available on heart failure (HF) risk. Especially in patients who have initiation and intensification of antihypertensive medication based on office or home BP, there is an increasing importance of nighttime BP in predicting cardiovascular risk. Kario and colleagues (2020) published a study titled “Nighttime Blood Pressure Phenotype and Cardiovascular Prognosis: practitioner-based Nationwide JAMP Study” in the American Heart Association Journal. The summary of the study is given below:
Objectives:
To investigate the association between both nocturnal hypertension and nighttime BP dipping patterns with the occurrence of cardiovascular events including, HF in patients with hypertension.
Method:
It is a practitioner-based, prospective, nationwide, multicenter, observational study including patients with at least 1 cardiovascular risk factor, preferably hypertension, and independent of symptomatic cardiovascular disease at baseline. 24-hour ambulatory BP monitoring at baseline was recorded for all patients. Annual follow up was conducted to determine the occurrence of primary endpoint cardiovascular events (HF and atherosclerotic cardiovascular disease).
Findings:
The study reports a direct proportion between nocturnal BP and nighttime BP with cardiovascular risk and HF. Additionally, it was found that the risk of HF is independent of nighttime BP and daytime BP is associated with only ASCVD risk factors. Furthermore, in patients with strict-controlled 24-hour SBP, those with disrupted diurnal BP variation (i.e., extreme dipper) are found to have a greater relative risk of stroke. On the other hand, those with higher diurnal BP variation (i.e., riser) had the greatest relative risk of developing HF. The increased relative risk of ASCVD was observed with an increase of each 20-mm Hg in daytime SBP. Investigators suggest that nocturnal BP measurements with the use of a home device were a better predictor of ASCVD events, independent of office, morning, and evening home BP.
Thus, the study highlights the potential benefits of antihypertensive medication strategies targeting nocturnal BP.
Limitation:
The authors acknowledge few limitations of the study such as ambulatory BP data were obtained only at baseline, and there was no information on the contribution of subsequent changes in ambulatory BP throughout medical condition Additionally, use of effective antihypertensive therapy is likely to weaken the study, rather than strengthening the associations between baseline ambulatory BP and cardiovascular outcomes. This analysis focused on SBP, rather than DBP, because of the older age of the study population. Study evaluations did not include echocardiography, preventing differentiation between HF with preserved versus reduced ejection fraction. The study population was Japanese; hence the findings can’t be generalized.
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