The Role Of Ambulatory Blood Pressure Monitoring In Target Organs Damage And Prognosis Evaluation In Patients With Isolated Nocturnal Hypertension

Objective:The purpose of this study was to investigate ambulatory blood pressure monitoring in relation to target organs damage and the occurrence of adverse events of heart,brain and kidney in patients with isolated nocturnal hypertension.Methods:The subjects were 77 isolated nocturnal hypertension patients(mean daytime blood pressure <135/85 mmHg and average nocturnal blood pressure ≥120/70 mmHg),75 patients with all day hypertension(average daytime blood pressure ≥135/85 mmHg and average nocturnal blood pressure ≥120/70 mmHg),and 79 normotensive participants(day average blood pressure <135/85 mmHg and nocturnal mean blood pressure <120/70 mmHg,and the circadian rhythm of blood pressure 10% to 20%,morning peak pressure <35mmHg).Ambulatory blood pressure monitoring indicators include 24 h mean systolic pressure,24 h mean diastolic pressure,daytime mean systolic pressure,daytime mean diastolic pressure,nocturnal mean systolic pressure,nocturnal mean diastolic pressure,daytime systolic blood pressure standard deviation,daytime diastolic pressure standard deviation,nocturnal systolic blood pressure standard deviation,night diastolic pressure standard deviation,circadian rhythm of systolic blood pressure,circadian rhythm of diastolic pressure,morning peak blood pressure,and ambulatory arterial stiffness index.Carotid plaque,left ventricular hypertrophy and enlargement,serum creatinine and urinary microalbumin were used to assess vascular,cardiac and renal damage,respectively.Adverse events including cardiovascular,cerebrovascular and renal events(acute myocardial infarction,stroke,heart failure,renal failure and death)were followed up.Results:(1)There was no significant difference in the detection rate of cardiac enlargement(22.1% vs.32.0%)and carotid artery plaque(55.8% vs.68.0%)between patients with nocturnal hypertension and patients with all day hypertension,but the detection rates in both groups were all higher than that in normotensive participants(7.6% and 32.9%)(P< 0.0167).There were no significant differences in serum creatinine and microalbuminuria between patients with nocturnal hypertension(68.0±23.5μmol/L and 15.9±19.6mg/L)and normotensive participants,while serum creatinine and microalbuminuria in both groups were less than that in all day hypertensive patients(80.9±43.1μmol/Land 53.5±80.0mg/L)(P<0.05).(2)For patients with nocturnal hypertension,there were no differences in ambulatory blood pressure indexes between with and without carotid artery plaque;Nocturnal diastolic blood pressure was higher with cardiac enlargement than that without cardiac enlargement(77.6±5.5 vs.74.9±4.6 mmHg)(P<0.05);There were no differences in ambulatory blood pressure indexes between with and without abnormal serum creatinine;Standard deviation of nocturnal systolic blood pressure and nocturnal diastolic blood pressure were higher with abnormal urinary microalbumin than that without(14.1±3.9 vs.11.3±3.2 mmHg,10.6±3.0 vs.8.6±2.6mmHg)(P<0.05).(3)The incidence of cardiovascular and renal adverse events in patients with nocturnal hypertension(10.4%)and patients with all day hypertension(10.7%)were all higher than that in normal group(1.3%)(P<0.0167).Univariate non-conditional binary logistic regression analysis showed that nocturnal mean systolic blood pressure >130mmHg [OR=10.889,95%CI=(1.268,93.512)] and diastolic blood pressure circadian rhythm was reversedipper blood pressure(<0%)[OR=6.548,95%CI=(1.394,30.755)] were risk factors for cardiovascular and kidney adverse events;While multivariate logistic regression analysis found no significant independent correlation between nocturnal mean systolic blood pressure >130mmHg [OR=4.095,95%CI=(0.352,47.698)]or diastolic blood pressure circadian rhythm was reversedipper blood pressure(<0%)[OR=2.112,95%CI=(0.290,15.390)] and the incidence of adverse events in isolated nocturnal hypertensive patients.Conclusion:Ambulatory blood pressure monitoring can be used to evaluate target organs damage in patients with isolated nocturnal hypertension.Nocturnal mean systolic blood pressure and diastolic blood pressure circadian rhythm are associated with the risk of heart and kidney,but both indexes have not yet reached independent prediction levels.