Table of ContentsView AllTable of ContentsDefinitionSymptomsCauses and Risk FactorsComplicationsDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Definition
Symptoms
Causes and Risk Factors
Complications
Diagnosis
Treatment
Read on to learn about nocturnal hypertension and its symptoms, causes, and management.
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Nocturnal Hypertension Definition
Daytime blood pressure higher than 120/80 mmHg (millimeters of mercury, a measurement unit of pressure) is considered elevated. Nighttime blood pressure is typically lower than daytime. Nocturnal hypertension refers to any blood pressure above 110/65 mmHg at night.
Patterns of Nocturnal Blood Pressure
Non-dipping is common in those with high blood pressure. In one large study, non-dipping patterns were seen in 32–46% of people with hypertension, and reverse-dipping patterns were seen in 5–19%. Normal dipping patterns were seen in 27–54%.
If you have high blood pressure, these statistics should be of interest: There is a 50/50 chance that you may not have the normal nighttime lowering of blood pressure, which can add to your risk ofcomplications.
Nocturnal Hypertension Symptoms
High blood pressure does not usually present with symptoms, so it’s commonly referred to as a “silent killer.“This is also true of nocturnal hypertension. Symptoms of nocturnal hypertension include:
Nocturnal Hypertension Causes and Risk Factors
Nocturnal hypertension has many causes and risk factors. Scientists are actively researching this topic, attempting to discern what may trulycausenocturnal hypertension versus conditions that are justassociatedwith nocturnal hypertension.
The following is a list of potential causes/risk factors for nocturnal hypertension:
Complications of Nocturnal Hypertension
Nocturnal hypertension shares many of thecomplications of high blood pressurein general and has been associated with the following:
Nocturnal Hypertension Diagnosis
The best way to measure nighttime blood pressure is throughambulatoryblood pressure monitoring(ABPM).With ABPM, a blood pressure cuff worn for at least 24 hours intermittently checks blood pressure every 15 minutes to an hour. This generates a report that provides average blood pressure and the 24-hour blood pressure pattern.
Treatment of Nocturnal Hypertension
Nocturnal hypertension treatment is similar to high blood pressure treatment in general, including lifestyle considerations and medication. Thetiming of blood pressure medicationis important. Some conditions that cause nocturnal hypertension warrant specific treatments.
Lifestyle
Many of our lifestyle choices and habits can affect blood pressure. If you have elevated blood pressure, the following adjustments are recommended:
Medications
When it comes to treating high blood pressure, there are many medications available. Once-a-day pills are a convenient option that can be easier to remember to take. However, once-a-day blood pressure medications may not last a full 24 hours and can result in untreated high blood pressure at night.
One tactic to prevent this is to simply take one or more of your blood pressure medications at night. This is referred to as “chronotherapy,” and studies have shown that people who take blood pressure medication at night have better control of their blood pressure throughout the 24-hour period, including at night. Some studies have even suggested this leads to a lower risk of high blood pressure complications.
If you are on medication for high blood pressure and are concerned that you have high nighttime blood pressure, speak with your healthcare provider about the possibility of taking one or more of your medications at night instead of in the morning. Note thatdiureticsare typically not a good choice of medication to take at night because they will cause you to urinate more frequently at night.
Treatment of Underlying Causes
Treating and managing underlying causes and risk factors for nocturnal hypertension are also important. Those with symptoms of sleep apnea should see a sleep specialist for diagnosis and make sure to stick to treatment (such ascontinuous positive airway pressureorCPAP) if prescribed.
Limiting nighttime disturbance and setting aside time for adequate sleep is another essential aspect of treating nocturnal hypertension. Those withinsomniamay benefit from treatments like melatonin or prescription medications ifsleep hygieneefforts have failed.
Summary
When it comes to blood pressure, having a daytime blood pressure reading that is at goal once a year at your healthcare provider’s office doesn’t tell the whole story, especially if you are still treated for high blood pressure. Nocturnal hypertension or a lack of the typical blood pressure dip that should occur at night can increase the risk of serious complications. There are many potential causes and associated conditions, the most common of which are sleep apnea, diabetes, and kidney disease.
Diagnosis is achieved with ambulatory blood pressure monitoring, which requires wearing an automated blood pressure cuff that checks blood pressure intermittently throughout the day and night. Treatment includes many of the lifestyle considerations and medications that treat high blood pressure in general, with special consideration for the timing of blood pressure medication. Ensuring adequate, good-quality sleep is essential.
A Word From Verywell
It may be disheartening to hear about all the ways high blood pressure can be lurking and the risks it poses. Know that there are actionable things you can do to lower your blood pressure. Seeing a healthcare provider for regular follow-ups, setting your own detailed plan for achieving lifestyle goals, and adhering to medications are effective ways to feel and have better control of your health.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kario K.Nocturnal hypertension: New technology and evidence.Hypertension. 2018 Jun;71(6):997-1009. doi:10.1161/HYPERTENSIONAHA.118.10971. Epub 2018 Apr 30. PMID: 29712746.Whelton PK, Carey RM, Aronow WS, et al.2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Hypertension. 2018;71:e13–e115. doi:10.1161/HYP.0000000000000065Di Raimondo D, Musiari G, Pinto A.Nocturnal blood pressure patterns and cardiac damage: there is still much to learn.Hypertens Res. 2020 Mar;43(3):246-248. doi:10.1038/s41440-019-0372-xSalles GF, Reboldi G, Fagard RH, et al; ABC-H Investigators.Prognostic effect of the nocturnal blood pressure fall in hypertensive patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis.Hypertension. 2016 Apr;67(4):693-700. doi:10.1161/HYPERTENSIONAHA.115.06981American Heart Association.Why high blood pressure is a silent killer.Sieminski M, Partinen M.Nocturnal systolic blood pressure is increased in restless legs syndrome.Sleep Breath. 2016 Sep;20(3):1013-9. doi:10.1007/s11325-016-1333-0.Elijovich F, Weinberger MH, Anderson CAM, et al; on behalf of the American Heart Association Professional and Public Education Committee of the Council on Hypertension; Council on Functional Genomics and Translational Biology; and Stroke Council.Salt sensitivity of blood pressure: a scientific statement from the American Heart Association.Hypertension.2016;68:e7–e46. doi: 10.1161/HYP.0000000000000047Bowles NP, Thosar SS, Herzig MX, Shea SA.Chronotherapy for hypertension.Curr Hypertens Rep. 2018 Sep 28;20(11):97. doi:10.1007/s11906-018-0897-4.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kario K.Nocturnal hypertension: New technology and evidence.Hypertension. 2018 Jun;71(6):997-1009. doi:10.1161/HYPERTENSIONAHA.118.10971. Epub 2018 Apr 30. PMID: 29712746.Whelton PK, Carey RM, Aronow WS, et al.2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Hypertension. 2018;71:e13–e115. doi:10.1161/HYP.0000000000000065Di Raimondo D, Musiari G, Pinto A.Nocturnal blood pressure patterns and cardiac damage: there is still much to learn.Hypertens Res. 2020 Mar;43(3):246-248. doi:10.1038/s41440-019-0372-xSalles GF, Reboldi G, Fagard RH, et al; ABC-H Investigators.Prognostic effect of the nocturnal blood pressure fall in hypertensive patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis.Hypertension. 2016 Apr;67(4):693-700. doi:10.1161/HYPERTENSIONAHA.115.06981American Heart Association.Why high blood pressure is a silent killer.Sieminski M, Partinen M.Nocturnal systolic blood pressure is increased in restless legs syndrome.Sleep Breath. 2016 Sep;20(3):1013-9. doi:10.1007/s11325-016-1333-0.Elijovich F, Weinberger MH, Anderson CAM, et al; on behalf of the American Heart Association Professional and Public Education Committee of the Council on Hypertension; Council on Functional Genomics and Translational Biology; and Stroke Council.Salt sensitivity of blood pressure: a scientific statement from the American Heart Association.Hypertension.2016;68:e7–e46. doi: 10.1161/HYP.0000000000000047Bowles NP, Thosar SS, Herzig MX, Shea SA.Chronotherapy for hypertension.Curr Hypertens Rep. 2018 Sep 28;20(11):97. doi:10.1007/s11906-018-0897-4.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Kario K.Nocturnal hypertension: New technology and evidence.Hypertension. 2018 Jun;71(6):997-1009. doi:10.1161/HYPERTENSIONAHA.118.10971. Epub 2018 Apr 30. PMID: 29712746.Whelton PK, Carey RM, Aronow WS, et al.2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Hypertension. 2018;71:e13–e115. doi:10.1161/HYP.0000000000000065Di Raimondo D, Musiari G, Pinto A.Nocturnal blood pressure patterns and cardiac damage: there is still much to learn.Hypertens Res. 2020 Mar;43(3):246-248. doi:10.1038/s41440-019-0372-xSalles GF, Reboldi G, Fagard RH, et al; ABC-H Investigators.Prognostic effect of the nocturnal blood pressure fall in hypertensive patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis.Hypertension. 2016 Apr;67(4):693-700. doi:10.1161/HYPERTENSIONAHA.115.06981American Heart Association.Why high blood pressure is a silent killer.Sieminski M, Partinen M.Nocturnal systolic blood pressure is increased in restless legs syndrome.Sleep Breath. 2016 Sep;20(3):1013-9. doi:10.1007/s11325-016-1333-0.Elijovich F, Weinberger MH, Anderson CAM, et al; on behalf of the American Heart Association Professional and Public Education Committee of the Council on Hypertension; Council on Functional Genomics and Translational Biology; and Stroke Council.Salt sensitivity of blood pressure: a scientific statement from the American Heart Association.Hypertension.2016;68:e7–e46. doi: 10.1161/HYP.0000000000000047Bowles NP, Thosar SS, Herzig MX, Shea SA.Chronotherapy for hypertension.Curr Hypertens Rep. 2018 Sep 28;20(11):97. doi:10.1007/s11906-018-0897-4.
Kario K.Nocturnal hypertension: New technology and evidence.Hypertension. 2018 Jun;71(6):997-1009. doi:10.1161/HYPERTENSIONAHA.118.10971. Epub 2018 Apr 30. PMID: 29712746.
Whelton PK, Carey RM, Aronow WS, et al.2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Hypertension. 2018;71:e13–e115. doi:10.1161/HYP.0000000000000065
Di Raimondo D, Musiari G, Pinto A.Nocturnal blood pressure patterns and cardiac damage: there is still much to learn.Hypertens Res. 2020 Mar;43(3):246-248. doi:10.1038/s41440-019-0372-x
Salles GF, Reboldi G, Fagard RH, et al; ABC-H Investigators.Prognostic effect of the nocturnal blood pressure fall in hypertensive patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis.Hypertension. 2016 Apr;67(4):693-700. doi:10.1161/HYPERTENSIONAHA.115.06981
American Heart Association.Why high blood pressure is a silent killer.
Sieminski M, Partinen M.Nocturnal systolic blood pressure is increased in restless legs syndrome.Sleep Breath. 2016 Sep;20(3):1013-9. doi:10.1007/s11325-016-1333-0.
Elijovich F, Weinberger MH, Anderson CAM, et al; on behalf of the American Heart Association Professional and Public Education Committee of the Council on Hypertension; Council on Functional Genomics and Translational Biology; and Stroke Council.Salt sensitivity of blood pressure: a scientific statement from the American Heart Association.Hypertension.2016;68:e7–e46. doi: 10.1161/HYP.0000000000000047
Bowles NP, Thosar SS, Herzig MX, Shea SA.Chronotherapy for hypertension.Curr Hypertens Rep. 2018 Sep 28;20(11):97. doi:10.1007/s11906-018-0897-4.
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