Cardiovascular events risk in office-masked nocturnal hypertension defined by home blood pressure monitoring

Journal article

Background
Nocturnal home blood pressure monitoring (HBPM) may identify people at higher cardiovascular disease (CVD) risk than expected.

Objectives
The aim of this study was to examine the association between office-masked nocturnal hypertension, defined by HBPM, and CVD risk in a clinical practice-based population.

Methods
Prospective observational study including Japanese high cardiovascular-risk participants. Three office blood pressures (OBPs) were taken on 2 different occasions. Nocturnal home blood pressure (HBP) was measured 3 times per night for 2 weeks. The association between office-masked nocturnal hypertension and time to first CVD events (fatal and nonfatal stroke or coronary heart disease) was examined using Cox regression.

Results
The cohort included 2,545 participants who were followed for a median of 7.8 years (18,116 person-years), during which 152 CVD events occurred. The proportions of participants with nocturnal normotension (OBP <140/90 mm Hg and nocturnal HBP <120/70 mm Hg), white-coat nocturnal hypertension (OBP ≥140/90 mm Hg and nocturnal HBP <120/70 mm Hg), office-masked nocturnal hypertension (OBP <140/90 mm Hg and nocturnal HBP ≥120/70 mm Hg), and sustained nocturnal hypertension (OBP ≥140/90 mm Hg and nocturnal HBP ≥120/70 mm Hg) were 25.3%, 14.4%, 23.2%, and 37.1%, respectively. Relative to nocturnal normotension, those with both office-masked nocturnal hypertension (adjusted HR: 1.72; 95% CI: 1.01-2.92) and sustained nocturnal hypertension (adjusted HR: 1.75; 95% CI: 1.03-2.96) had similarly increased CVD risk, even after adjustment for daytime HBP values.

Conclusions
Screening for office-masked nocturnal hypertension with HBPM identifies a potentially important group of patients with increased risk for incident CVD events for whom additional preventative measures may be appropriate.

Authors: Fujiwara, T; Hoshide, S; Sheppard, JP; McManus, RJ; Kario, K

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: JACC: Advances
• Volume: 3
• Issue: 11
• Article number: 101352
• Place of publication: United States
• Publication date: 2024-11-07
• Acceptance date: 2024-09-16
• DOI: 10.1016/j.jacadv.2024.101352
• EISSN: 2772-963X
• ISSN: 2772-963X
• Pmid: 39600985
• Language: English
• Keywords: cardiovascular disease risk; office-masked nocturnal hypertension; home blood pressure monitoring; nocturnal blood pressure