Nighttime Blood Pressure: A Target for Therapy?
- 208 Downloads
Ambulatory blood pressure (BP) monitoring is increasingly used in the evaluation of hypertensive patients. The ability to monitor BP throughout the day and night allows the detection of abnormal nocturnal BP patterns, the most common being a “nondipping” pattern, which is associated with increased cardiovascular risk; its correction appears to have a positive impact on cardiovascular outcome. Antihypertensive treatment should be individually adjusted to control BP during both daytime and nighttime. However, drug-induced lowering of nocturnal BP, if excessive, could amplify the morning BP surge in patients with daytime BP elevation, increasing the risk of developing a cardiovascular event. Ambulatory BP monitoring therefore represents a unique tool to establish the most appropriate antihypertensive drug regimen for the individual patient.
KeywordsAmbulatory blood pressure Morning surge Nighttime blood pressure Cardiovascular risk Dipper pattern Nondipping pattern
Conflicts of Interest: B. Waeber: consultant for Novartis and Menarini; honoraria from Novartis, AstraZeneca, Servier, and Menarini; J-J. Mourad: none; E. O’Brien: none.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 2.Sega R, Facchetti R, Bombelli M, et al.: Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation 2005, 111:1777–1783.CrossRefPubMedGoogle Scholar
- 8.O’Brien E: Ambulatory blood pressure measurement is indispensable to good clinical practice. J Hypertens 2003, 21:S11–S18.Google Scholar
- 34.• de la Sierra A, Redon J, Banegas JR, et al.: Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients. Hypertension 2009, 53:466–472. A lot of knowledge has been accumulated owing to this large survey performed in Spain by doctors in everyday practice to compare ABPM and casual office blood pressure.Google Scholar
- 35.• Hermida RC, Ayala DE, Calvo C, et al.: Chronotherapy of hypertension: administration-time-dependent effects of treatment on the circadian pattern of blood pressure. Adv Drug Deliv Rev 2007, 59:923–939. This extensive review discusses in detail the current knowledge on chronotherapy.Google Scholar
- 40.• Li Y, Thijs L, Hansen TW, et al.: Prognostic value of the morning blood pressure surge in 5645 subjects from 8 populations. Hypertension 2010, 55:1040–1048. An International Database on Ambulatory Blood Pressure was used to assess the prognostic value of the morning blood pressure surge. This is a very appealing approach to accumulate data and gain new insight into ABPM.Google Scholar