Essential Manual of 24-Hour Blood Pressure Management

From Morning to Nocturnal Hypertension

Kazuomi Kario

• Publisher: Wiley-Blackwell
• Year: 2022
• ISBN:
  9781119799405
• Edition: 2
• Topic: Medicine
• Subtopic: Surgery & Surgical Medicine

ESSENTIAL MANUAL OF 24-HOUR BLOOD PRESSURE MANAGEMENT

Hypertension is one of the greatest threats to human health. The World Health Organization (WHO) estimates that 1.13 billion people worldwide have hypertension. In 2017, new guidelines for managing hypertension were published by the American Hypertension Association (AHA), guidelines which lowered the diagnosis thresholds of hypertension, and thereby increased the prevalence of hypertension. As such, hypertension is now recognized as a more serious and widespread a condition than ever before.

In this new edition of the Essential Manual of 24-Hour Blood Pressure Management, the author emphasizes that lowering the blood pressure (BP) and restoring the BP profile with adequate circadian rhythm is essential for a long life without cardiovascular events. The author also introduces updated evidence for managing hypertension throughout 24-hour periods, from morning to nocturnal hypertension.

The Essential Manual of 24-Hour Blood Pressure Management, Second Edition, will be an essential companion for doctors who wish to provide evidence-based medicine and be familiar with the most cutting edge technology on monitoring BP. Medical researchers and students will also value the author's many insights, drawn from his distinguished career.

CHAPTER 1
Evidence and scientific rationale for ambulatory blood pressure monitoring (ABPM)

Diurnal BP variation and the concept of “perfect 24‐hour BP control”

Blood pressure (BP) always varies over time, including beat‐by‐beat, trigger‐induced, orthostatic, diurnal, day‐by‐day, weekly, seasonal, and age‐related variations. Of these different BP variability components, circadian rhythm is the central component of individual BP variability, and there is a large body of accumulating evidence highlighting the importance of this parameter.

Basic circadian rhythm forms the basis of individual diurnal BP variation (Figure 1.1) [1] . The circadian rhythm of BP is physiologically determined partly by the intrinsic rhythm of central and peripheral clock genes, which regulate the neurohumoral factor and cardiovascular systems, and partly by the sleep‐wake behavioral pattern, and is associated with various pathological conditions.

In addition to different patterns of circadian rhythm, short‐term BP variability such as morning blood pressure surge (MBPS), physical or psychological stress‐induced daytime BP, and nighttime BP surge triggered by hypoxic episodes in obstructive sleep apnea, arousal, rapid‐eye‐movement sleep, and nocturnal behavior (e.g. nocturia) modulates the circadian rhythm of BP, resulting in the different individual diurnal BP variation.

It is well‐known that elevated 24‐hour BP is a more important cardiovascular risk factor than office BP. In addition, disrupted circadian rhythm and exaggerated forms of short‐term BP variability (e.g. MBPS) are associated with an increased risk of cardiovascular events [2] . We hypothesized that “perfect 24‐hour BP control,” which includes lowering the average 24‐hour BP (quantity of BP control), maintaining adequate circadian rhythm, and stabilizing BP variability (quality of BP control), is the ideal goal (Figure 02) [3] . In particular, control of 24‐hour BP to <130/80 mmHg is important to minimize organ damage, independent of any regional differences in the risk of cardiovascular disease (Figure 1.2) [4] .

Figure 1.1 Components of nocturnal hypertension and determinants—nocturnal dipping status and surge in blood pressure. BP, blood pressure; CHF, chronic heart failure; CKD, chronic kidney disease; OSA, obstructive sleep apnea; REM, rapid eye movement.

Source: Kario. Hypertension. 2018; 71: 997–1009 [1] .

Figure 1.2 Regional differences in the impact of 24‐hour blood pressure control on cardiovascular remodeling and target organ damage (n = 596). IMT, intima‐media thickness; LVMI, left ventricular mass index; NS, not statistically significant.

Source: Created based on data from Yano et al. Am J Hypertens. 2011; 24: 437–443 [4] .

Nocturnal hypertension and nocturnal BP dipping status

Nocturnal BP dipping status

Different patterns of the circadian rhythm of BP can be determined using ambulatory BP monitoring (ABPM). Population‐based and clinical studies using ABPM have shown that nighttime BP is a better predictor of cardiovascular diseases than daytime BP [5, 6]. Nocturnal hypertension (where nighttime BP is high) and a non‐dipper/riser pattern (where nighttime BP is higher than daytime BP, even if office and 24‐hour BP readings are within the normal range) both increase the risk of target organ damage and subsequent cardiovascular events [7–10].

In healthy subjects, nighttime BP falls by 10–20% from daytime BP (normal dipper pattern). Patients with hypertension who do ...

Table of contents

• Cover
• Table of Contents
• Title Page
• Copyright Page
• Author biography
• Preface – Direction to “Perfect 24‐hour Blood Pressure Control”
• Acknowledgments
• CHAPTER 1: Evidence and scientific rationale for ambulatory blood pressure monitoring (ABPM)
• CHAPTER 2: Scientific rationale for HBPM
• CHAPTER 3: Practical use of ABPM and HBPM
• CHAPTER 4: BP targets, when to initiate antihypertensive therapy, and nonpharmacological treatment
• CHAPTER 5: Antihypertensive medication
• CHAPTER 6: Renal denervation
• CHAPTER 7: Blood pressure linked telemedicine and telecare
• CHAPTER 8: Asia perspectives
• References
• Index
• End User License Agreement