Wrist-Measured Nighttime Home BP and Left Ventricular Hypertrophy: The WISDOM-HMOD Study

Nighttime blood pressure (BP) assessed by ambulatory BP monitoring is linked to left ventricular hypertrophy and its sequelae, including heart failure. However, the association between nighttime BP measured by a wrist-type oscillometric home BP monitor-designed to be less intrusive than brachial devices-and left ventricular hypertrophy remains unclear.

The WISDOM-HMOD study (Wrist ICT-based Sleep and Circadian Blood Pressure Monitoring Program-Hypertension-Mediated Organ Damage), a substudy of the WISDOM-Night study, included 1218 patients with hypertension or heart failure (mean age, 67.2±12.0 years; 53.9% men) who were recruited between 2021 and 2024. Nighttime BPs (2:00, 3:00, and 4:00 am and 4 hours after bedtime) and morning/evening BPs over 7 days were measured using a wrist-type home BP monitor (HEM9601T; Omron).

The average nighttime systolic/diastolic BP was 110.5±13.0/63.5±8.8 mm Hg, and 70.4% of patients had well-controlled nighttime BP (<120/70 mm Hg). The average left ventricular mass index assessed by echocardiography was 90.1±23.6 g/m² in men and 80.3±19.3 g/m² in women. An increase in nighttime systolic BP was significantly associated with a higher left ventricular mass index, independent of office BP, morning home BP, and evening home BP. Furthermore, elevated nighttime systolic BP was a risk factor for left ventricular hypertrophy in both sexes (odds ratio per 10-mm Hg increase, 1.36 [95% CI, 1.15-1.60] overall; 1.54 [95% CI, 1.19-2.00] in men; and 1.27 [95% CI, 1.01-1.58] in women), independently of covariates including office and morning home BP.

This study shows that nighttime home BP measured using a less sleep-disturbing wrist-type device is an independent risk factor for left ventricular hypertrophy and its potential sequelae, including new-onset or recurrent heart failure, with high-risk nighttime BP thresholds differing by sex.