Optimizing the Diagnosis and Management of Nocturnal Hypertension: An Expert Consensus from India

Nocturnal hypertension, characterized by high blood pressure (BP) during nighttime, is a critical but often overlooked contributor to heart disease and organ damage. Globally, nocturnal hypertension is estimated to affect 6-20% of the population. Data indicating the prevalence of nocturnal hypertension in India is not available. Detection of nocturnal hypertension typically involves 24-hour ambulatory BP monitoring, which is a trusted method for detecting nocturnal BP variations such as nondipping and reverse-dipping that increase cardiovascular risk. Despite its clinical significance, nocturnal hypertension remains underdiagnosed due to various factors, and there are no specific Indian guidelines addressing its management. This expert consensus highlights key strategies for identifying and managing nocturnal hypertension in India. Lifestyle changes, such as reducing salt intake, managing stress, and improving sleep, are essential for treatment. Long-acting antihypertensive medications, including angiotensin receptor blockers, calcium channel blockers, and β-blockers, are recommended for better 24-hour BP control and reducing health risks. Additionally, newer therapies such as sodium-glucose cotransporter 2 inhibitors and angiotensin receptor-neprilysin inhibitors are promising options for patients with difficult-to-control BP or other conditions, such as diabetes or kidney disease. The consensus emphasizes the importance of tailored treatment strategies, regular BP monitoring, and integration of innovative therapies to address nocturnal hypertension effectively. These strategies aim to reduce the associated risks and improve health outcomes for patients in India.