Nighttime blood pressure-targeted antihypertensive treatment

Objectives: Nocturnal hypertension is increasingly recognized as a significant risk factor for cardiovascular events. However, there is limited information on whether antihypertensive treatment directly targeting nighttime blood pressure (BP) improves cardiovascular outcomes in medicated patients with hypertension. In this prospective multicenter study, we investigated whether aggressive adjustments in antihypertensive drug treatment targeting nighttime BP can effectively normalize nocturnal hypertension and assessed the safety of this approach. Methods: Nighttime BP was measured using a home BP monitoring device at baseline and at 6 months in 264 medicated patients with hypertension (161 men and 103 women; mean age, 68.5 ± 9.9 years) between October 2015 and March 2019. All patients with nocturnal hypertension, defined as mean nighttime SBP at least 120 mmHg, at baseline received aggressive adjustments in antihypertensive drug treatment targeting nighttime BP. Morning and evening measurements were taken in some patients. Results: Of the 264 patients, 90 had nocturnal hypertension at baseline. After 6 months of medication adjustments, nocturnal hypertension was normalized in 48 (53.3%) of the 90 patients, with values decreasing from 127.8 ± 6.6 to 112.5 ± 6.6 mmHg. Normalization of nocturnal hypertension was accompanied by significant reductions in both morning BP (135.9 ± 12.7 to 126.4 ± 10.8 mmHg, P < 0.001) and evening BP (130.8 ± 10.9 to 121.9 ± 10.3 mmHg, P < 0.001). The incidence of nonserious adverse events was higher in patients with nocturnal hypertension, but these events were not deemed specific to the treatment targeting nighttime BP. Conclusion: Aggressive adjustments in antihypertensive drug treatment directly targeting nighttime BP can safely normalize nocturnal hypertension in over half of medicated patients with hypertension within a 6-month period.