Abstract
A comprehensive approach to hypertension requires out-of-office determinations by
home and/or ambulatory monitoring. The 4 phenotypes comparing office and out-of-office
pressures in treated and untreated patients include normotension, hypertension, white-coat
phenomena, and masked phenomena. Components of out-of-office pressure may be equally
as important as mean values. Nighttime pressures are normally 10 – 20% lower than
daytime (normal “dipping”). Abnormalities include dipping more than 20% (extreme dippers),
less than 10 % (non-dippers), or rising above daytime (risers) and have been associated
with elevated cardiovascular risk. Nighttime pressure may be elevated (nocturnal hypertension)
in isolation or together with daytime hypertension. Isolated nocturnal hypertension
theoretically changes white-coat hypertension to true hypertension and normotension
to masked hypertension. Pressure normally peaks in the morning hours (“morning surge”)
when cardiovascular events are most common. Morning hypertension may result from residual
nocturnal hypertension or an exaggerated surge and has been associated with enhanced
cardiovascular risk, especially in Asian populations. Randomized trials are needed
to determine whether altering therapy based solely on either abnormal dipping, isolated
nocturnal hypertension, and/or an abnormal surge is justified.
Key words
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Article info
Publication history
Accepted:
February 27,
2023
Received:
February 19,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of interest: EJF: none; AJF: none; GVN: consultant to Sanofi, Glaxo, Smith Kline, Acesion, Milestone
Funding: none
Identification
Copyright
© 2023 Published by Elsevier Inc.
