Nocturnal Hypertension: 8 Essential Questions
Strict control of awake blood pressures (BP), ie, clinic BP and home BP measured in the morning and evening, would be effective for reducing the risk of cardiovascular events associated with hypertension if it were not for one inconvenient fact: even after daytime BPs are controlled, hypertension management involves a residual risk in the form of masked uncontrolled nocturnal hypertension.
A comprehensive review article published in Hypertension summarizes the clinical implications of night-time BP control based on the pathophysiology and recent evidence. Try these 8 questions to test your knowledge of essential points about this dangerous phenotype.
1. According to the 2017 ACC/AHA guidelines, all BPs measured during the awake period and daytime ambulatory BPs should be controlled to what level?
Answer: C. All BPs measured during the awake period and daytime ambulatory BPs should be controlled to A.<130/80 mm Hg.
2. How do night-time BP levels change from daytime BP levels in healthy persons?
Answer: D. Night-time BP levels decrease from daytime BP levels by 10% - 20% in healthy persons.
3. To what level did the 2017 AHA/ACC guidelines lowered the cutoff value of nocturnal hypertension?
Answer: B. The 2017 AHA/ACC guidelines lowered the cutoff value of nocturnal hypertension to 110/56 mm Hg from 120/70 mm Hg.
4. True or False: Nocturnal hypertension is associated with subclinical organ damages.
Answer: A. True. Silent cerebrovascular diseases often are found in patients with nocturnal hypertension.
5. Which conditions are most frequently associated with nocturnal hypertension?
Answer: C. DM, CKD, and OSA are frequently associated with nocturnal hypertension.
6. What are the main causes of nocturnal hypertension?
Answer: D. A. Advanced structural vascular disease, B. Increase in sodium sensitivity, and C. High-sodium diet are the primary causes of nocturnal hypertension.
7. True or False: Sympathetic drive-induced night-time BP surges are NOT associated with night-time onset of CV events.
Answer: B. False. Sympathetic drive-induced night-time BP surges may trigger night-time onset of CV events and is one of several heterogeneous pathophysiological mechanisms that account for the specific risk of nocturnal hypertension.
8. True or False: In clinical practice, morning home BP-guided titration of antihypertensive drugs is the first step to achieve perfect 24-hour BP control.
Answer: A. True. Morning home BP-guided titration of antihypertensive drugs is the first step to achieve 24-hour BP control.
Reference: Kario K. Nocturnal hypertension: new technology and evidence. Hypertension. 2018;71:997–1009. doi:10.1161/HYPERTENSIONAHA.118.10971
