Key result
Approximately 39.4% of treated hypertensive patients with controlled morning blood pressure had masked uncontrolled nocturnal hypertension, which was associated with worse subclinical target organ damage.
Why the study?
It was unclear whether morning BP control reflects BP control across other periods and whether it associates more closely with subclinical target organ damage.
Cross-Sectional (n=1,140)
No
Relying solely on morning blood pressure to monitor hypertension is insufficient, as nearly 40% of treated patients with controlled morning BP have masked nocturnal hypertension which is independently associated with target organ damage.
Morning BP control incompletely reflects other periods and shows variable TOD links; leaves open whether period-specific targeting improves outcomes.
To investigate whether the control of morning blood pressure (MBP) reflects the control of blood pressure (BP) in other periods (daytime, nighttime and 24-hour) and to assess whether morning BP displays a closer association with subclinical target organ damage (TOD) than the BP measured in other periods.One thousand one hundred forty patients with primary hypertension who completed subclinical TOD detection and 24-hour ambulatory BP monitoring were included in the analysis. Pearson correlation analysis, Kappa consistency test, multiple linear regression analysis, and area under the receiver operating curve were used to analyze the data.Morning BP and daytime BP displayed good agreement, but not 24-hour BP , particularly the nighttime BP (all P < .001). Approximately 39.4% of the hypertensive patients receiving drug treatment who had achieved control of the morning BP presented masked nocturnal hypertension, which was associated with worse subclinical TOD. The BP measured in all periods correlated with subclinical TOD, and the correlation was more obvious in the treatment subgroup. However, morning BP did not independently affect subclinical TOD. Morning BP appeared to exhibit less discriminatory power than nighttime BP, particularly with respect to the urinary albumin to creatinine ratio.The use of morning BP for monitoring during hypertension management may not be enough. Masked uncontrolled nocturnal hypertension should be screened when morning BP is controlled.
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Liu et al. (2020) conducted a cross-sectional in Primary hypertension (n=1,140). Morning blood pressure control vs. Nighttime blood pressure control was evaluated on Masked nocturnal hypertension in treated patients with controlled morning blood pressure. Approximately 39.4% of treated hypertensive patients with controlled morning blood pressure had masked uncontrolled nocturnal hypertension, which was associated with worse subclinical target organ damage.
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