Nocturnal Hypertension and Prognosis in Patients of Very Advanced Age

Nocturnal blood pressure (BP) is a better predictor of health outcomes than office or daytime BP. However, the clinical significance of nocturnal hypertension in patients of very advanced age remains unexplored. We aimed to assess the association between nocturnal hypertension and composite cardiovascular outcomes in this population.

This was a prospective observational study including Japanese elderly outpatients aged ≥80 years. All patients underwent 24-hour ambulatory BP monitoring at baseline. Nocturnal hypertension was defined as nocturnal systolic BP ≥120 mm Hg or diastolic BP≥70 mm Hg. Daytime hypertension was defined as daytime systolic BP ≥135 mm Hg and diastolic BP ≥85 mm Hg. The association between those BP phenotypes and composite cardiovascular outcomes (including fatal and nonfatal cardiovascular disease and all-cause mortality) was examined using Cox regression analysis.

A total of 485 patients were followed for a median of 3.9 years (1734 person-years), during which 72 (14.8%) composite cardiovascular outcomes occurred. The median age (interquartile range) was 82 (81-85) years; 44.7% were male; and 89.3% took antihypertensive medications. Nocturnal hypertension and daytime hypertension were present in 54.2% and 33.6% of patients, respectively. Relative to nocturnal normotension (nocturnal systolic BP <120 mm Hg and diastolic BP <70 mm Hg), nocturnal hypertension was associated with an increased risk of composite cardiovascular outcomes, even after adjustment for daytime BP values (adjusted hazard ratio, 2.15 [95% CI, 1.18-3.93]). Daytime hypertension showed no such association.

Screening for nocturnal hypertension identifies a high-risk group for composite cardiovascular outcomes among patients of very advanced age.