Key result
In untreated hypertensive patients with afternoon peak blood pressure greater than or equal to morning blood pressure, afternoon peak systolic blood pressure was independently associated with left ventricular hypertrophy (OR 1.046).
Why the study?
It was unclear whether diurnal blood pressure peak characteristics influence the association between left ventricular damage and morning versus afternoon peak blood pressure components in untreated hypertensives.
Does afternoon peak blood pressure monitoring improve the detection of left ventricular damage compared to morning blood pressure monitoring in untreated hypertensives?
Cross-Sectional (n=1,084)
No
Does afternoon peak blood pressure monitoring improve the detection of left ventricular damage compared to morning blood pressure monitoring in untreated hypertensives?
Afternoon peak blood pressure monitoring may be more effective than morning blood pressure monitoring for assessing 24-h blood pressure and target organ damage in a significant proportion of untreated hypertensives.
Afternoon BP monitoring may warrant consideration in untreated hypertension; leaves open whether targeting peaks reduces LVH.
We aimed to explore whether diurnal blood pressure (BP) peak characteristics have a significant influence on the association between left ventricular damage with the two BP components (morning BP vs. afternoon peak BP) in untreated hypertensives. This cross‐sectional study included 1084 hypertensives who underwent echocardiography and 24‐h ambulatory BP monitoring. Participants were stratified according to the relationship between morning systolic BP (MSBP; average SBP within 2 h of waking up) and afternoon peak systolic BP (ASBP; average SBP between 16:00 and 18:00). Afternoon and morning hypertension was defined as ≥ 135/85 mm Hg. The morning and afternoon peak BPs occurred at around 7:00 and 17:00, respectively. In general hypertensives, morning BP and afternoon peak BP are significantly different in absolute values (for binary SBP, McNemar's χ 2 = 6.42; p = .014). ASBP was more pronounced than MSBP in 602 patients (55.5%), in whom 24‐h SBP showed higher consistency with ASBP than with MSBP (Kappa value: 0.767 vs 0.646, both p < .01). In subjects with ASBP ≥ MSBP, ASBP was associated with left ventricular hypertrophy independent of MSBP (logistic regression analysis odds ratio: 1.046, p < .01), and left ventricular mass index was more strongly correlated with ASBP than with MSBP (multiple regression coefficient β: 0.453, p < .01), in which the relationships held true independently of 24‐h SBP. The opposite results were obtained in subjects with MSBP > ASBP. Peak BP‐guided monitoring may serve as an effective approach to out‐of‐office hypertension monitoring and control, providing the best consistency with 24‐h average SBP and highest discrimination performance for target organ damage, independently of 24‐h SBP.
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Gong et al. (2020) conducted a cross-sectional in Untreated hypertension (n=1,084). Afternoon peak systolic blood pressure (ASBP) vs. Morning systolic blood pressure (MSBP) was evaluated on Association with left ventricular hypertrophy (LVH) in subjects with ASBP ≥ MSBP (OR 1.046, 95% CI 1.020-1.072, p=<0.01). In untreated hypertensive patients with afternoon peak blood pressure greater than or equal to morning blood pressure, afternoon peak systolic blood pressure was independently associated with left ventricular hypertrophy (OR 1.046).
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