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Hypertension Global Newsletter #3 Hype
Hype
When all risk factors were combined into a single unweighted
z-score, the risk of CV events was even higher with an HR of n oisnetr
2.71 (85% CI 2.23–3.29) for fatal events and 2.75 (95% CI
2.48–3.06) for fatal or nonfatal events per unit increase.

In a subgroup analysis of 13,401 participants who had data
on adult risk factors, the adult combined-risk z-score was
associated with adult CV events both alone and when paired
with the childhood combined-risk z-score. These results
demonstrate that five known CV risk factors (BMI, SBP,
total cholesterol level, triglyceride level, and youth smoking)
beginning in early childhood, especially when combined, are
associated with adult CV events and death from CV causes
before the age of 60 years.

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TREATMENT

Bedtime dosing of antihypertensive medications: Systematic review and
consensus statement: International Society of Hypertension position paper
endorsed by World Hypertension League and European Society of Hypertension

Stergiou G, et al. J Hypertens. 2022 Oct 1;40(10):1847-1858.

While antihypertensive treatment is the most efficient medical intervention for Research question: Is bedtime
preventing disability and death globally, there is accumulating evidence suggesting administration of antihypertensive
an adverse prognosis with nighttime hypertension, nondipping BP profile, and medication superior to standard morning
morning BP surge, with an increased incidence of CV events during the first few administration in reducing CV events risk?
morning hours. These observations suggested complete 24 h BP control is an
important goal of antihypertensive treatment.

A diurnal rhythm of BP manifests as higher values during the daytime and lower
during nighttime, and may be due to several factors, including genetic factors,
circadian rhythm of the RAAS, changes in sympathetic drive, plasma adrenergic
neurotransmitters, diurnal fluctuations in renal volume and sodium excretion,
rhythmicity in atrial natriuretic peptide secretion, circadian melatonin excretion, and
thyroid hormones.

Nocturnal hypertension, defined as nighttime (asleep) systolic ambulatory BP of 120
mm Hg or higher and/or diastolic 70 mm Hg or higher, and a nondipping BP pattern,
defined as attenuated BP fall during nighttime sleep, are both common in older adults and individuals who are salt-sensitive,
obese, with CKD, OSAS, diabetes, African ancestry, insomnia, nocturia, neurodegenerative diseases (e.g., Parkinson’s
disease), treatment with short-acting antihypertensive medications, and with resistant and some types of secondary

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