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Nighttime Blood Pressure Phenotype and Cardiovascular Prognosis: Practitioner-Based Nationwide JAMP Study
Kazuomi Kario1, Satoshi Hoshide1, Hiroyuki Mizuno1
1Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., S.H., H.M., T. Kabutoya, M.N., T.Y., N.T., H.K.). Washiya Hospital, Tochigi, Japan (K.K., H.M.). Minamisanriku Hospital, Motoyoshigun, Japan (M.N.). Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.). Abe Internal Medicine Clinic, Kobe, Japan (H.A.). Katsuya Clinic, Hyogo, Japan (T. Katsuya). Department of Clinical Gene Therapy, Osaka University Graduate School of Medicine, Osaka, Japan (T. Katsuya). Fujita Neurosurgical Clinic, Mitoyo, Japan (Y.F.). National Center for Global Health and Medicine, Tokyo, Japan (O.O.). Department of Family Medicine and Community Health, Duke University, Durham, NC (Y.Y.). Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.).
Insights
Ambulatory blood pressure monitoring reveals that elevated nighttime blood pressure and disrupted dipping patterns significantly increase cardiovascular event risk, especially heart failure. Targeting nighttime blood pressure is crucial for effective hypertension management.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- Ambulatory blood pressure (BP) monitoring predicts cardiovascular events better than office BP.
- Limited data exists on ambulatory BP and heart failure (HF) risk.
- The Japan Ambulatory Blood Pressure Monitoring Prospective (JAMP) study investigated these associations.
Purpose of the Study:
- To determine the association between nocturnal hypertension and BP dipping patterns with cardiovascular events, including HF.
- To evaluate the predictive value of ambulatory BP monitoring in hypertensive patients.
Main Methods:
- A nationwide, multicenter, prospective, observational study of 6,359 patients with cardiovascular risk factors.
- All patients underwent 24-hour ambulatory BP monitoring at baseline.
- Annual follow-up to record cardiovascular events (atherosclerotic cardiovascular disease and HF).
Main Results:
- Nighttime systolic BP was significantly associated with increased risk of atherosclerotic cardiovascular disease and HF.
- A riser BP pattern (nighttime BP > daytime BP) was linked to higher overall cardiovascular disease risk and significantly higher HF risk.
- Adjusted hazard ratios indicated increased risk with higher nighttime BP and riser patterns.
Conclusions:
- Nighttime BP levels and riser patterns are independent predictors of cardiovascular events, particularly HF.
- These findings underscore the importance of antihypertensive strategies targeting nighttime BP.
- Ambulatory BP monitoring provides critical insights into cardiovascular risk stratification.
Background:
Ambulatory and home blood pressure (BP) monitoring parameters are better predictors of cardiovascular events than are office BP monitoring parameters, but there is a lack of robust data and little information on heart failure (HF) risk. The JAMP study (Japan Ambulatory Blood Pressure Monitoring Prospective) used the same ambulatory BP monitoring device, measurement schedule, and diary-based approach to data processing across all study centers and determined the association between both nocturnal hypertension and nighttime BP dipping patterns and the occurrence of cardiovascular events, including HF, in patients with hypertension.
Methods:
This practitioner-based, nationwide, multicenter, prospective, observational study included patients with at least 1 cardiovascular risk factor, mostly hypertension, and free of symptomatic cardiovascular disease at baseline. All patients underwent 24-hour ambulatory BP monitoring at baseline. Patients were followed annually to determine the occurrence of primary end point cardiovascular events (atherosclerotic cardiovascular disease and HF).
Results:
A total of 6,359 patients (68.6±11.7 years of age, 48% men) were included in the final analysis. During a mean±SD follow-up of 4.5±2.4 years, there were 306 cardiovascular events (119 stroke, 99 coronary artery disease, 88 HF). Nighttime systolic BP was significantly associated with the risk of atherosclerotic cardiovascular disease and HF (hazard ratio adjusted for demographic and clinical risk factors per 20-mm Hg increase: 1.18 [95% CI, 1.02-1.37], P=0.029; and 1.25 [95% CI, 1.00-1.55], P=0.048, respectively). Disrupted circadian BP rhythm (riser pattern, nighttime BP higher than daytime BP) was significantly associated with higher overall cardiovascular disease risk (1.48 [95% CI, 1.05-2.08]; P=0.024), and especially HF (2.45 [95% CI, 1.34-4.48]; P=0.004) compared with normal circadian rhythm.
Conclusions:
Nighttime BP levels and a riser pattern were independently associated with the total cardiovascular event rate, in particular for HF. These findings suggest the importance of antihypertensive strategies targeting nighttime systolic BP. Registration: URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000020377.
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