Value of Measuring Awake Blood Pressure at Different Time on Predicting Nocturnal Hypertension in Patients With Hypertension / 中国循环杂志

ABSTRACT

Objectives:The purpose of this cross-sectional study was to determine the predictive value of measuring awake blood pressure(BP)at different time points on nocturnal hypertension by ambulatory blood pressure monitoring(ABPM)device in patients with hypertension. Methods:A total of 204 consecutive hypertensive outpatients seeking medical care at the First Affiliated Hospital of Fujian Medical University from April 2023 to July 2023 were enrolled.We measured office BP and out-office BP.Out-office BP include evening BP,bedtime BP,morning BP and mean morning BP which were measured by ABPM device and BP daily record.Nocturnal hypertension was defined by the mean nocturnal systolic blood pressure≥120 mmHg(1 mmHg=0.133 kPa).ROC curve analyses of different awake blood pressure was established to identify significant correlates to nocturnal hypertension.The serial test was also performed.The value of the two indexes in predicting nocturnal hypertension was compared.The predictors of nocturnal hypertension were evaluated by multivariate analysis. Results:Of the 204 subjects,104(51.0%)had nocturnal hypertension.The repeated measures analysis of variance(ANOVA)showed that mean nighttime systolic BP and bedtime systolic BP were similar(P=0.641).Nocturnal hypertension was present in 75.7%(84/111)of patients with bedtime systolic BP≥120 mmHg,in 94.2%(49/52)of patients with bedtime systolic BP≥135 mmHg and in 88.2%(75/85)of patients with mean morning systolic BP≥135 mmHg.ROC curve analyses showed that the diagnostic accuracy of mean morning systolic BP(AUC 0.903,P＜0.05)for subjects with nocturnal hypertension was significantly superior to that of office systolic BP,evening systolic BP,bedtime systolic BP,morning systolic BP.Multivariate logistic regression analysis revealed that mean morning systolic BP and bedtime systolic BP were significantly associated with a higher risk of nocturnal hypertension(P＜0.05).ROC curve analyses of predicted probability of bedtime systolic BP and mean morning systolic BP showed higher diagnostic accuracy(AUC 0.929,P＜0.05).The serial test showed that nocturnal hypertension was present in 98.0%(49/50)of patients with bedtime systolic BP≥130 mmHg and mean morning systolic BP≥135 mmHg. Conclusions:Mean morning BP and bedtime BP are significant correlates of nocturnal hypertension in patients with hypertension,and combined mean morning BP with bedtime BP showed higher diagnostic accuracy,which might used for predicting nocturnal hypertension with high efficiency.