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Abstract: TH-PO222

Nocturnal Hypertension in Patients with Controlled Daytime Blood Pressure

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical


  • Biyani, Nandini M., University of Ottawa, Ottawa, Ontario, Canada
  • Ruzicka, Marcel, University of Ottawa, Ottawa, Ontario, Canada
  • Sood, Manish M., University of Ottawa, Ottawa, Ontario, Canada
  • Hundemer, Gregory L., University of Ottawa, Ottawa, Ontario, Canada
  • Akbari, Ayub, University of Ottawa, Ottawa, Ontario, Canada

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.


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.


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).


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.


  • Commercial Support – Otsuka