Factors Associated with the Failure to Achieve Nocturnal Blood Pressure Control

Area of Science:

• Cardiology
• Hypertension Management
• Clinical Research

Background:

• The Hiroshima NOCTURNE study investigated normalizing elevated nighttime blood pressure (BP) in patients already on antihypertensive medication.
• Home blood pressure monitoring (HBPM) was used to assess BP.
• This subanalysis focused on factors contributing to the failure to normalize nocturnal hypertension.

Purpose of the Study:

• To identify factors associated with the failure to normalize nocturnal hypertension.
• To understand challenges in managing nighttime hypertension in treated patients.

Main Methods:

• Included patients with nocturnal hypertension (mean nighttime systolic BP ≥120 mmHg) at baseline.
• A six-month intervention guided by nighttime BP measurements was performed.
• Treatment decisions were physician-dependent.

Main Results:

• 46.7% of patients failed to normalize nighttime BP (<120 mmHg).
• Higher baseline nighttime systolic BP and baseline diuretic use were significantly associated with treatment failure.
• Diabetes mellitus showed a trend towards association with failure to normalize.

Conclusions:

• Failure to normalize nocturnal hypertension is linked to elevated baseline nighttime BP and diuretic use.
• Diabetes mellitus may also contribute to treatment resistance.
• Individualized therapeutic strategies are crucial for patients on diuretics or with diabetes.