Aug 2026· American Journal of Hypertension· 0 citations
Medicine
TL;DR
Individuals with high morning home BP were more likely to show abnormal diurnal BP variability, and incorporation of room temperature into home BP assessments may provide additional context when interpreting home BP measurements.
Abstract
Background
Elevated nighttime blood pressure (BP), nocturnal non-dipping, and exaggerated morning BP surge (MBPS) are established risk factors for cardiovascular events. These diurnal BP variability patterns can be assessed by ambulatory BP monitoring (ABPM) but not by conventional home BP monitors. We aimed to examine whether home BP data are associated with these BP variability patterns.
Methods
Treated hypertensive participants in the HI-JAMP study underwent 24-hour ABPM followed by home BP monitoring (HBPM). Home BP was measured twice each morning and evening for 5 days using a multisensor device that also recorded room temperature. A total of 2,248 participants with complete ABPM and HBPM data were analyzed.
Results
Among 2,248 participants, ABPM-defined nocturnal hypertension was present in 679 (30.2%), exaggerated MBPS in 171 (7.7%), and nocturnal non-dipping in 969 (43.1%). Of these, 39 participants (1.8%) had both nocturnal hypertension and exaggerated MBPS. Nocturnal hypertension, exaggerated MBPS, and non-dipping were each associated with elevated morning home systolic BP (SBP) of ≥ 135 mmHg measured by HBPM (odds ratios: 3.76, 2.00, and 1.33, respectively). Nocturnal hypertension (odds ratio: 1.84) and non-dipping (odds ratio: 1.69) were associated with higher room temperature, whereas exaggerated MBPS (odds ratio: 1.86) was associated with lower room temperature, independent of elevated morning home SBP.
Conclusions
Individuals with high morning home BP were more likely to show abnormal diurnal BP variability. Incorporating room temperature into home BP assessments may provide additional context when interpreting home BP measurements.
CLINICAL TRIAL REGISTRATION
University Hospital Medical Information Network Clinical Trials Registry, UMIN000029151 (HI-JAMP study).
BACKGROUND Ambulatory blood pressure monitoring (ABPM) provides important information about circadian blood pressure variation. Normally, blood pressure declines by 10–20% during sleep (nocturnal dipping). Abnormal patterns such as non-dipping, extreme dipping, and reverse dipping are associated with increased cardiovascular risk. Data regarding nocturnal dipping patterns in the Nepalese population are limited.
AIMS To evaluate the prevalence of nocturnal dipping patterns and their association with cardiovascular risk factors among patients undergoing ABPM.
METHODS This observational cross-sectional study was conducted in the Department of Cardiology at B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan. A total of 66 patients aged ≥18 years undergoing ABPM were included. Twenty-four-hour ABPM was performed using a validated oscillometric device. Patients were categorized into normal dipper, non-dipper, extreme dipper, and reverse dipper based on the percentage decline in nighttime systolic blood pressure. Demographic variables and cardiovascular risk factors were recorded. Statistical analysis was performed using descriptive statistics and chi-square test.
RESULTS Among 66 patients in the study, reverse dipping was the most common pattern observed in 26 patients (39.4%), followed by non-dipping in 24 patients (36.4%), normal dipping in 13 patients (19.7%), and extreme dipping in 3 patients (4.5%). In this study reverse dipping was more frequently observed in the 41–49 and 50–59 year age groups, although the association between age groups and dipping pattern was not statistically significant (p = 0.216). Similarly, there was no significant association between dipping patterns and cardiovascular risk factors including diabetes mellitus (p = 0.39), hypertension (p = 0.36), and smoking (p = 0.24).
CONCLUSION Reverse dipping and non-dipping patterns were highly prevalent among patients undergoing ABPM in this study. However, no statistically significant association was found between dipping patterns and age groups or major cardiovascular risk factors in this study.
Pawan Chaurasia, N. Pandey, Rajan Thapa et al.· Journal of Advances in Inter...· 0 citations
In this community-based cohort of older adults, HBPM provided stable BP estimates within three days (can be non-consecutive within an 8-day period) using morning and evening sessions with ≥2 readings each, supporting shorter, less burdensome HBPM protocols in clinical guidelines for hypertension management in older adults.
Frances M Wang, Hannah V Col, F. L. Kwapong et al.· American Journal of Hyperten...· 0 citations
In young individuals asymptomatic HMOD is associated with both nocturnal hypertension and non-dipping, however, nighttime BP levels seem to have the primary contributing role.
Aikaterini G. Theodosiadi, A. Kollias, E. Stambolliu et al.· Journal of Hypertension· 0 citations
Short‐term blood pressure variability (BPV) and circadian BP abnormalities are important cardiovascular risk predictors of mean BP levels, but their combined prognostic significance in essential hypertension remains incompletely understood. To evaluate the independent and combined prognostic value of 24‐hour BPV and circadian BP patterns for predicting major adverse cardiovascular events (MACE) in patients with essential hypertension. This retrospective cohort study included 500 adults with essential hypertension who underwent 24‐hour ambulatory BP monitoring. Short‐term BPV was assessed using the standard deviation of 24‐hour systolic BP. Circadian patterns were classified as dipper, non‐dipper, or reverse dipper based on nighttime systolic BP decline. The primary outcome was MACE, including myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Cox proportional hazards regression models were used to evaluate associations with outcomes. During a median follow‐up of 4.2 years, 128 patients (25.6%) experienced MACE. High BPV was associated with a significantly greater incidence of MACE than low BPV (34.2% vs. 17.1%, p < 0.001) and remained an independent predictor (adjusted HR 1.89, 95% CI 1.32–2.71, p < 0.001). Reverse dipping was also associated with increased risk. Patients with both elevated BPV and abnormal circadian patterns had the highest risk. Elevated short‐term BPV and abnormal circadian BP patterns are independent predictors of MACE in essential hypertension. Their coexistence identifies a particularly high‐risk phenotype. ABPM‐based dynamic BP assessment may improve cardiovascular risk stratification beyond mean BP levels.
Qin Ma, Shao-Hong Wang, Hua Chen· The Journal of Clinical Hype...· 0 citations
Background Abnormal nocturnal blood pressure (BP) profiles may expose the left atrium to persistent hemodynamic load before overt remodeling occurs. This study evaluated the association between nocturnal systolic blood pressure (SBP) dipping patterns and left atrial reservoir strain (LARS) in untreated adults with office-defined grade 1 essential hypertension. Methods This single-center retrospective cross-sectional study enrolled 315 adults who underwent 24-h ambulatory blood pressure monitoring (ABPM) and transthoracic echocardiography within 7 days. BP dipping patterns were classified as dipper, non-dipper, reverse-dipper, or extreme-dipper. Continuous LARS was the primary outcome; low LARS (<35%) was the operational secondary outcome. The primary model was adjusted for age, sex, body mass index (BMI), 24-h SBP, fasting plasma glucose, natural-log-transformed triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and estimated glomerular filtration rate (eGFR). Results There were 126 dippers (40.0%), 124 non-dippers (39.4%), 45 reverse-dippers (14.3%), and 20 extreme-dippers (6.3%); 300 participants (95.2%) met ambulatory criteria for sustained hypertension, and 100 (31.7%) had low LARS. LARS differed across patterns (P < 0.001). Compared with dippers, non-dippers and reverse-dippers had lower adjusted LARS [β = −3.44, 95% confidence interval (CI) −4.68 to −2.20; β = −5.92, 95% CI −7.80 to −4.04] and higher odds of low LARS [non-dippers odds ratio (OR) = 3.68, 95% CI 1.83–7.39; reverse-dippers OR = 8.12, 95% CI 3.00–21.98; both P < 0.001]. Extreme-dipping was not associated with either outcome. When nighttime SBP replaced 24-h SBP, the associations were attenuated but remained statistically significant; the direction of association did not change in analyses restricted to participants with complete sleep diaries or sustained hypertension. Restricted cubic spline (RCS) analysis suggested nonlinearity. Conclusion Non-dipping and reverse-dipping BP patterns were associated with lower LARS and a higher likelihood of low LARS. Prospective multicenter studies are needed to determine prognostic and incremental clinical value.
Lei Zha, Haoqin Zhu, Jiajia Liu et al.· Frontiers in Cardiovascular...· 0 citations
Circadian changes in blood pressure are a key factor in determining cardiovascular risk. A normal dipper pattern shows a decrease in blood pressure at night, whereas a non-dipper pattern shows a smaller decrease at night. Changes in the distribution of bodily fluids may affect how blood vessels work and how blood pressure changes over the course of a day. This study aimed to examine the correlation between total body water percentage and circadian blood pressure patterns in individuals classified as prehypertensive. This retrospective cross-sectional study comprised 300 prehypertensive individuals who underwent 24-hour ambulatory blood pressure monitoring and body composition measurement via bioelectrical impedance. Patients were classified into two groups according to the magnitude of nocturnal blood pressure decline: dipper and non-dipper. Clinical, echocardiographic, and hydration characteristics were compared between the dipper and non-dipper groups. In the study population, 124 patients exhibited a dipper pattern, while 176 displayed a non-dipper pattern. Non-dipper patients exhibited a markedly reduced total body water percentage in comparison to dipper persons. Echocardiographic measures, such as interventricular septal thickness and left ventricular end-diastolic diameter, were markedly elevated in the non-dipper cohort. In multivariable logistic regression analysis, total body water percentage persisted as an independent predictor of non-dipper blood pressure pattern. A lower percentage of total body water is linked to a non-dipper blood pressure pattern in individuals who are prehypertensive. These findings indicate that modifications in body fluid content may play a role in circadian blood pressure dysregulation and heightened cardiovascular risk.
Ahmet Cimbek, Ahmet Özderya· OSMANGAZİ JOURNAL OF MEDICIN...· 0 citations