Abstract
BACKGROUND: Nocturnal hypertension (NH) is associated with adverse cardiovascular outcomes beyond and even independent of daytime hypertension (DH). Although cohort studies have evaluated correlates of NH, there is comparably less data available from real-world clinical practice and for population subsets that tend to be under-represented in cohort studies. METHODS: This retrospective cohort study included all patients who underwent ambulatory blood pressure monitor (ABPM) testing at a large US academic medical center from 1 January 2013 to 31 December 2023. We used multivariable-adjusted logistic regression to assess DH as a correlate of NH, covariates related to the co-occurrence of DH and NH, and correlates of isolated NH. RESULTS: Of 1,566 patients, 812 (51.9%) had DH, 1,125 (71.8%) had NH, and 363 (23.2%) had isolated NH. A total of 762 (48.7%) patients had co-occurring daytime and NH. In multivariable analysis, significant correlates of NH included DH, male sex, age, Black race, and Hispanic ethnicity. By comparison, significant correlates of co-occurrent DH and NH included male sex, age, Asian race, Black race, and renal disease; coronary artery disease (CAD) was inversely associated with this co-occurrence. Among all covariates, only CAD was associated with isolated NH. CONCLUSIONS: Our real-world study results highlight the generally under-recognized prominence of isolated NH, as well as the presence of NH among Hispanic and Asian-American populations. Further prospective investigations are needed to evaluate whether broader ABPM screening for NH is needed across all populations at risk, including but not limited to persons with more easily identified DH.