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Cited by 324Blood Pressure and Hypertension StudiesCardiovascular Health and Disease PreventionSodium Intake and Health

Nighttime Blood Pressure Phenotype and Cardiovascular Prognosis: Practitioner-Based Nationwide JAMP Study

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Kario, Kazuomi, Hoshide, Satoshi, Mizuno, Hiroyuki, Kabutoya, Tomoyuki, Nishizawa, Masafumi, Yoshida, Tetsuro, Abe, Hideyasu, Katsuya, Tomohiro +6 more·2020·Circulation
DOI 10.1161/circulationaha.120.049730PMC PMC7643792
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Abstract

Background: Ambulatory and home blood pressure (BP) monitoring parameters are better predictors of cardiovascular events than are office BP monitoring parameters, but there is a lack of robust data and little information on heart failure (HF) risk. The JAMP study (Japan Ambulatory Blood Pressure Monitoring Prospective) used the same ambulatory BP monitoring device, measurement schedule, and diary-based approach to data processing across all study centers and determined the association between both nocturnal hypertension and nighttime BP dipping patterns and the occurrence of cardiovascular events, including HF, in patients with hypertension. Methods: This practitioner-based, nationwide, multicenter, prospective, observational study included patients with at least 1 cardiovascular risk factor, mostly hypertension, and free of symptomatic cardiovascular disease at baseline. All patients underwent 24-hour ambulatory BP monitoring at baseline. Patients were followed annually to determine the occurrence of primary end point cardiovascular events (atherosclerotic cardiovascular disease and HF). Results: A total of 6,359 patients (68.6±11.7 years of age, 48% men) were included in the final analysis. During a mean±SD follow-up of 4.5±2.4 years, there were 306 cardiovascular events (119 stroke, 99 coronary artery disease, 88 HF). Nighttime systolic BP was significantly associated with the risk of atherosclerotic cardiovascular disease and HF (hazard ratio adjusted for demographic and clinical risk factors per 20-mm Hg increase: 1.21 [95% CI, 1.03–1.41], P =0.017; and 1.36 [95% CI, 1.08–1.71], P =0.009, respectively). Disrupted circadian BP rhythm (riser pattern, nighttime BP higher than daytime BP) was significantly associated with higher overall cardiovascular disease risk (1.48 [95% CI, 1.05–2.08]; P =0.024), and especially HF (2.45 [95% CI, 1.34–4.48]; P =0.004) compared with normal circadian rhythm. Conclusions: Nighttime BP levels and a riser pattern were independently associated with the total cardiovascular event rate, in particular for HF. These findings suggest the importance of antihypertensive strategies targeting nighttime systolic BP. Registration: URL: https://www.umin.ac.jp/ctr/ ; Unique identifier: UMIN000020377.

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Authors
Kario, K., Hoshide, S., Mizuno, H., Kabutoya, T., Nishizawa, M., Yoshida, T., Abe, H., Katsuya, T., Fujita, Y., Okazaki, O., Yano, Y., Tomitani, N., Kanegae, H., & On behalf of the JAMP Study Group
Affiliations
Jichi Medical University (JP)
Corresponding author
Kario, Kazuomi
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-11-10
Volume
142
Issue
19
Pages
1810-1820
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.120.049730
PMC
PMC7643792
OpenAlex
W3096735544
Cited by
324
References
6
Citations by year
2026: 57 · 2025: 59 · 2024: 63 · 2023: 47 · 2022: 54 · 2021: 40 · 2020: 4
FWCI
22.43
Type
journal article
Language
en
Update notices
correction (2020-12-21)
Open access
Licence
cc-by-nc-nd
Locations
  • Circulation (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
Japan Society for the Promotion of Science (17K09522)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
  • Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
Keywords
nocturnal blood pressure, nighttime systolic blood pressure, circadian blood pressure rhythm, nocturnal hypertension, nocturnal blood pressure dipping, heart failure risk, atherosclerotic cardiovascular disease, cardiovascular events, hypertension, ambulatory blood pressure monitoring, stroke, coronary artery disease, cardiovascular prognosis, cardiovascular risk
MeSH terms
Aged, Aged, 80 and over, Circadian Rhythm, Humans, Hypertension, Japan, Middle Aged, Prospective Studies, Risk Factors, Blood Pressure Monitoring, Ambulatory

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