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. 2025 Feb 14;18(1):2463435.
doi: 10.1080/20523211.2025.2463435. eCollection 2025.

Home blood pressure during night-time sleep - a feasible treatment target for patients with hypertension: a proof-of-concept randomised controlled trial

Eric Kam-Pui Lee  1 , Shuqi Wang  1 , Benjamin Hon-Kei Yip  1 , Esther Yee-Tak Yu  2 , Shuk-Yun Leung  3 , Jinghao Han  3 , Yue-Kwan Choi  3 , Kam-Fai Chow  3 , Wai-Ho Chung  3 , Byran P Yan  4 , Anastasia S Mihailidou  5   6 , Richard J McManus  7 , Samuel Yeung-Shan Wong  1
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Home blood pressure during night-time sleep - a feasible treatment target for patients with hypertension: a proof-of-concept randomised controlled trial

Eric Kam-Pui Lee et al. J Pharm Policy Pract. .

Abstract

Background: This trial assessed the feasibility of titrating evening dosing of anti-hypertensive medications based on nighttime home blood pressure measurement (HBPM) readings in primary care for hypertensive (HT) patients.

Methods: 78 patients with nocturnal HT and stage I daytime HT were randomly assigned in a 1:1 ratio to either nighttime HBPM measurements (intervention group) or daytime HBPM measurements (control group). Nighttime blood pressure (BP) was measured 3x per night for at least two nights over 1 week using an automatic and validated HBPM device. The intervention group and control group aimed to achieve systolic BP <120 mmHg on nocturnal HBPM and systolic BP <135 mmHg on daytime HBPM respectively. All patients were seen every four weeks and followed the same drug titration algorithm.

Results: The trial achieved a recruitment rate of 6.5 persons per month and a retention rate of 96.1%. In the intervention group, patients provided ≥6 (considered adequate) and ≥9 nighttime HBPM readings for 77.5% and 63.8% of their follow-ups, respectively. At 6-month, both groups had similar nighttime, 24-hour, and daytime BP on ambulatory BP monitoring, as well as similar numbers of non-dippers and healthcare utilisation. Most patients reported that they learned more from their HBPM nighttime readings and found the intervention well-tolerated.

Conclusion: Adjusting evening dosage of anti-HT medications based on nighttime HBPM is a potential and feasible treatment approach for patients with nocturnal HT in primary care. This approach is well-accepted by patients and results in at least non-inferior BP control. Although titrating medications according to nighttime HBPM readings may improve nighttime BP, the small sample size limited statistical significance and the single-centre design restricted generalizability. Additionally, a few patients exhibited fair adherence to nighttime HBPM. Further randomised controlled trials are required to confirm that targeting nocturnal BP should be the primary treatment goal for HT.

Keywords: Blood pressure; home blood pressure measurement; hypertension; randomised controlled trial.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

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Figure 1.
Patient flow chart.
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