Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2025 May 1;43(5):887-896.
doi: 10.1097/HJH.0000000000003998. Epub 2025 Mar 5.

Nighttime blood pressure-targeted antihypertensive treatment

Tatsuya Maruhashi  1 , Yoshihiko Kinoshita  2 , Ryoji Ozono  3 , Mitsuaki Nakamaru  4 , Masanori Ninomiya  5 , Jiro Oiwa  6 , Takuji Kawagoe  7 , Osamu Yoshida  8 , Toshiyuki Matsumoto  9 , Yasuo Fukunaga  10 , Kotaro Sumii  11 , Hironori Ueda  12 , Nobuo Shiode  13 , Kosuke Takahari  14 , Yasuhiko Hayashi  15 , Yujiro Ono  16 , Yukiko Nakano  14 , Masakazu Takahashi  17 , Yasuki Kihara  14 , Yukihito Higashi  1   18 ; the Hiroshima NOCTURNE Research Group
Affiliations
Clinical Trial

Nighttime blood pressure-targeted antihypertensive treatment

Tatsuya Maruhashi et al. J Hypertens. .

Abstract

Objectives: Nocturnal hypertension is increasingly recognized as a significant risk factor for cardiovascular events. However, there is limited information on whether antihypertensive treatment directly targeting nighttime blood pressure (BP) improves cardiovascular outcomes in medicated patients with hypertension. In this prospective multicenter study, we investigated whether aggressive adjustments in antihypertensive drug treatment targeting nighttime BP can effectively normalize nocturnal hypertension and assessed the safety of this approach.

Methods: Nighttime BP was measured using a home BP monitoring device at baseline and at 6 months in 264 medicated patients with hypertension (161 men and 103 women; mean age, 68.5 ± 9.9 years) between October 2015 and March 2019. All patients with nocturnal hypertension, defined as mean nighttime SBP at least 120 mmHg, at baseline received aggressive adjustments in antihypertensive drug treatment targeting nighttime BP. Morning and evening measurements were taken in some patients.

Results: Of the 264 patients, 90 had nocturnal hypertension at baseline. After 6 months of medication adjustments, nocturnal hypertension was normalized in 48 (53.3%) of the 90 patients, with values decreasing from 127.8 ± 6.6 to 112.5 ± 6.6 mmHg. Normalization of nocturnal hypertension was accompanied by significant reductions in both morning BP (135.9 ± 12.7 to 126.4 ± 10.8 mmHg, P < 0.001) and evening BP (130.8 ± 10.9 to 121.9 ± 10.3 mmHg, P < 0.001). The incidence of nonserious adverse events was higher in patients with nocturnal hypertension, but these events were not deemed specific to the treatment targeting nighttime BP.

Conclusion: Aggressive adjustments in antihypertensive drug treatment directly targeting nighttime BP can safely normalize nocturnal hypertension in over half of medicated patients with hypertension within a 6-month period.

PubMed Disclaimer

References

    1. Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res 2019; 42:1235–1481.
    1. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71:e13–e115.
    1. Mancia G, Kreutz R, Brunstrom M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens 2023; 41:1874–2071.
    1. McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, et al. ESC Scientific Document Group. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J 2024; 45:3912–4018.
    1. Banegas JR, Ruilope LM, de la Sierra A, Vinyoles E, Gorostidi M, de la Cruz JJ, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. New Engl J Med 2018; 378:1509–1520.

Substances

LinkOut - more resources