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Is night-time hypertension worse than daytime hypertension? A study on cardiac damage in a general population

the PAMELA study

Cuspidi, Cesare; Facchetti, Rita; Bombelli, Michele; Sala, Carla; Tadic, Marijana; Grassi, Guido; Mancia, Giuseppe

doi: 10.1097/HJH.0000000000001193

Aim: Scanty information is available about the association of isolated daytime hypertension (IDH) and isolated night-time hypertension (INH) with subclinical cardiac damage in the general population. We examined this issue in patients enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni study.

Methods: The analysis included 2021 participants with valid ambulatory blood pressure (BP) monitoring at baseline evaluation. IDH and INH were defined according to current guidelines. Subclinical organ damage was assessed by validated electrocardiographic and echocardiographic criteria.

Results: A total of 1258 patients (62.3%) had daytime/night-time normotension, 376 (18.6%) daytime/night-time hypertension, 231 (11.4%) INH and 156 (7.7%) IDH, respectively. Participants with hypertension, compared with their normotensive counterparts were older, included a higher fraction of men, had higher BMI, LDL cholesterol, triglyceride and glucose levels and exhibited a greater subclinical cardiac involvement. Furthermore, INH and IDH patients showed a similar degree of cardiac damage (i.e. left ventricular mass index: 89 ± 18 vs 90 ± 20 g/m2), intermediate between normotensive (82 ± 19 g/m2) and day–night hypertensive patients (99 ± 24 g/m2).

Conclusion: The present study shows that IDH and INH exert similar detrimental effects on cardiac structure. In a practical perspective, appropriate antihypertensive chrono-therapeutic approaches in these opposite ambulatory hypertensive subtypes may have important implications in cardiovascular prevention.

aDepartment of Health Science, University of Milano-Bicocca

bIstituto Auxologico Italiano IRCCS

cDepartment of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore Policlinico, Milano, Italy

dUniversity Clinical Hospital Centre ‘Dragisa Misovic’, Belgrade, Serbia

eIRCCS Multimedica, Sesto San Giovanni, Milano, Italy

Correspondence to Prof Cesare Cuspidi, MD, Istituto Auxologico Italiano, Clinical Research Unit, Viale della Resistenza 23, 20036 Meda, Italy. Tel: +0039 0362 772433; fax: +0039 0362 772416; e-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; BP, blood pressure; IDH, isolated daytime hypertension; INH, isolated night-time hypertension; IVS, interventricular septum; LV, left ventricular; LVEDD, LV end-diastolic diameter; LVH, left ventricular hypertrophy; LVM, left ventricular mass; PAMELA, Pressioni Monitorate e Loro Associazioni study; PWT, posterior wall thickness

Received 30 July, 2016

Revised 1 October, 2016

Accepted 28 October, 2016

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