Korean Circ J.  2019 Sep;49(9):818-828. 10.4070/kcj.2019.0245.

Clinical Significance and Therapeutic Implication of Nocturnal Hypertension: Relationship between Nighttime Blood Pressure and Quality of Sleep

• Cho MC

• KMID: 2455787
• DOI: http://doi.org/10.4070/kcj.2019.0245

Abstract

Recent global hypertension guidelines recommend an early, strict and 24-hour blood pressure (BP) control for the prevention of target organ damage and cardiovascular events. Out-of-office BP measurement such as ambulatory BP monitoring and home BP monitoring is now widely utilized to rule out white-coat hypertension, to detect masked hypertension, to evaluate the effects of antihypertensive medication, to analyze diurnal BP variation, and to increase drug adherence. Nocturnal hypertension has been neglected in the management of hypertension despite of its clinical significance. Nighttime BP and non-dipping patterns of BP are stronger risk predictors for the future cardiovascular mortality and morbidity than clinic or daytime BP. In addition to ambulatory or home daytime BP and 24-hour mean BP, nocturnal BP should be a new therapeutic target for the optimal treatment of hypertension to improve prognosis in hypertensive patients. This review will provide an overview of epidemiology, characteristics, and pathophysiology of nocturnal hypertension and clinical significance, therapeutic implication and future perspectives of nocturnal hypertension will be discussed.

Keyword

Nocturnal hypertension; Circadian BP rhythm; Chronotherapy

MeSH Terms

Blood Pressure*
Chronotherapy
Epidemiology
Humans
Hypertension*
Masked Hypertension
Mortality
Prognosis

Figure

• 

  Figure 1 Four different dipping patterns of nocturnal BP and morning BP surge. Both nocturnal hypertension and morning hypertension are the new targets for the perfect 24-hour BP control for the prevention of target organ damage and cardiovascular events (modified from Kario K. Nocturnal hypertension: new technology and evidence. Hypertension 2018;71:997-100911)). BP = blood pressure.

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