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Night and day: what blood pressure matters?

There is ample evidence that ambulatory blood pressure is significantly correlated with long-term prognosis. Such prognostic value holds true even after adjustment for the traditional risk factors and, more importantly, for office blood pressure.1 Therefore, ambulatory blood pressure monitoring is very useful when facing the decision to start treatment in hypertensive patients and to perform adequate follow-up. However, even with all of the technical improvements, 24-hour recordings are not always accepted well by the patients, because it may disturb both their daytime activities and sleep quality.

A logical question arising in this respect is to what extent we need the full 24-hour recordings to assess such prognostic information. Are there periods in the 24 hours that carry a heavier weight in prognosis? In particular, do we need nighttime recordings? These are considered by many patients as the most unpleasant part of the monitoring.

This has opened a controversy in the literature about the value of nighttime blood pressure, including the discussion around the significance of dipping versus nondipping patterns. One can find as many advocates in favor of the value of nighttime blood pressure and dipping2,3 as opponents.4 In the Office Versus Ambulatory Pressure Study,1 systolic blood pressure at night significantly correlated with long-term prognosis, but the correlation was not stronger, even weaker, than …