Nocturnal Hypertension in Patients with Controlled Daytime Blood Pressure
Bibliographic record
Abstract
Background: 24-hour ambulatory blood pressure monitoring (ABPM) is the modality of choice for the diagnosis of hypertension (HTN). Besides assessment of blood pressure (BP) and its variability while awake, it also provides BP readings during sleep. Sleep BP is the single most important factor for adverse HTN related cardiovascular outcomes. 24-hour ABPM is underutilized, misclassifying many patients as ‘treated or controlled’ based solely on awake BP while in fact they have persistent nocturnal hypertension. Methods: The study was carried out at the Renal hypertension program of The Ottawa Hospital which is a tertiary care hospital based HTN program serving catchment area of approximately 1.2 million people. We extracted data from completed and technically satisfactory 24-hour ABPMs from incident patients treated in our clinic from January 01, 2019 to March 31, 2023. For each patient who underwent 24-hour ABPM, only the first report was considered for this study. We defined daytime HTN as mean systolic BP >=140 mmHg and/or mean diastolic BP>=90 mmHg and nocturnal HTN as mean nighttime systolic BP >= 125 mmHg and/or mean diastolic BP >=75 mmHg. Results: Our cohort included 1024 patients. Mean (SD) age was 60.6 (16.3) years, females 486 (46.7%), mean BMI (SD) 30.0 (7.9) kg/m2. 388 (37.2%) patients had uncontrolled HTN during daytime, and out of these, 272 (26.1%) also had nocturnal HTN. More importantly though, in patients with controlled day time HTN (n= 654, 62.8%), 21.5% (n=141) had nocturnal HTN with mean (SD) nocturnal BP of 132/75 (6.3/10.4). Conclusions: Our data show that a significant segment of patients with controlled daytime HTN (documented by ABPM) still have nocturnal HTN. As nocturnal BP is an important factor for adverse HTN related cardiovascular outcomes, one could certainly consider low utilization of 24-hour ABPM among patients with HTN as a missed treatment opportunity contributing to unnecessary and potentially preventable adverse cardiovascular events. We advocate for a broader utilization of 24-hour ABPM in patients with HTN. Funding: Commercial Support - Otsuka
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".