Key result
Nocturnal hypertension affects ~61% of patients, presenting more often in diabetics at lower morning BP thresholds.
Why the study?
Nocturnal hypertension, particularly with well-controlled daytime blood pressure, has emerged as a significant cardiovascular risk factor, but its prevalence across morning home blood pressure cut-offs and associated characteristics required investigation.
What is the prevalence of nocturnal hypertension at various morning home blood pressure thresholds, and what patient characteristics are associated with it?
What is the prevalence of nocturnal hypertension at various morning home blood pressure thresholds, and what patient characteristics are associated with it?
A significant proportion of patients have nocturnal hypertension despite well-controlled morning home blood pressure, particularly those with diabetes, while diuretic use is associated with a lower prevalence.
May warrant nocturnal BP assessment in diabetics despite controlled morning readings; leaves open whether targeted interventions improve outcomes.
Objectives Nocturnal hypertension, especially with well-controlled daytime blood pressure (BP), has emerged as a significant risk factor for cardiovascular disease. This study investigated its prevalence by morning home BP cut-off values and examined associated patient characteristics using data from the Japan Morning Surge-Home Blood Pressure (J-HOP) study. Methods This post hoc analysis included 2675 participants from the J-HOP study who had complete data on nighttime home BP, measured using validated automatic oscillometric devices. Nocturnal hypertension was defined as a nighttime systolic BP greater than or equal to 120 mmHg and diastolic BP greater than or equal to 70 mmHg. Results Among the participants, 60.5% had nocturnal hypertension. The proportion of patients with nocturnal hypertension decreased as the cut-off value for morning home BP was lowered: 40.5, 32.1, 23.7, and 14.6% for less than 135/85 mmHg, less than 130/80 mmHg, less than 125/75 mmHg, and less than 120/70 mmHg, respectively. The prevalence of nocturnal hypertension was significantly higher in individuals with diabetes compared with those without, at morning home BP thresholds of less than 135/85 mmHg (48.1 vs. 39.3%; P = 0.03) and less than 130/80 mmHg (41.0 vs. 30.6%; P = 0.01). Individuals taking diuretics had a significantly lower prevalence of nocturnal hypertension compared with those not taking diuretics, at a morning home BP threshold of less than 135/85 mmHg (35.3 vs. 42.9%; P = 0.01). Conclusion A considerable number of patients continued to show nocturnal hypertension even at lower morning home BP thresholds. Diabetes may contribute to nocturnal hypertension despite well-controlled morning BP, while diuretic use may help prevent it.
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Sato et al. (2026) studied this question. 60.5% of participants had nocturnal hypertension, with higher prevalence in diabetics compared to non-diabetics at lower morning BP thresholds.
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