What is nocturnal hypertension? How it increases the risk of health complications

Hypertension, or high blood pressure, is a disease whose increasing frequency is a worldwide problem. The main reason for this is the various and serious health complications it causes.

Nocturnal hypertension, i.e. high blood pressure during sleep, makes it worse.

It is also referred to as the silent killer.

Why, you ask?

The reason is its hidden course.
In a large number of cases, it goes unrecognized in its early stages.
A person suffering from this disease has no problems.

And suddenly, from full health...

It causes a heart attack or stroke.

High blood pressure is said to occur when blood pressure readings of more than 140/90 are repeatedly measured.

Facts about hypertension:
Half of the adult population in developed countries has high blood pressure.
Only half of those affected know about it.
And only half are treated properly.
Worldwide, it affects about 25% of the population.
Hypertension can shorten life by up to 10 years.

The cause of high blood pressure may not be known. It is then referred to as primary or also essential hypertension.

If it arises as a result of another disease, it is secondary hypertension.

The main risk factors that cause it include:

1. age, with pressure rising with age
2. gender, blood pressure increases especially in women after transition
3. genetic predisposition and family history
4. impaired vasomotor regulation, muscle regulation of blood vessels
5. overweight and obesity
6. insulin resistance
7. excessive salt intake
8. magnesium, potassium and calcium deficiency
9. smoking
10. alcoholism
11. persistent stress and psychological strain
12. sedentary lifestyle and lack of exercise
13. environmental pollution
14. other diseases such as diabetes and others

However, it is high blood pressure that is risky in that it gradually damages various tissues, organs and organ systems, causing their function to malfunction.

Hypertension adversely affects the heart, blood vessels, brain, kidneys, eyes.
It causes heart attacks or strokes.
It is also responsible for kidney failure and damage to the retina of the eye.

Arterial hypertension increases the risk of developing:

• coronary heart disease, coronary artery disease and heart attack
• chronic heart failure
• left ventricular hypertrophy
• damage to the aorta and peripheral blood vessels
• stroke
• renal failure
• hypertrophic retinopathy (damage to the retina)

The risk of complications increases with the height of the blood pressure.

Do you remember how it can manifest itself?

Possible symptoms of hypertension include:

• Fatigue and weakness
• headache, but also unpleasant sensations in the head, pressure, tension, etc.
• dizziness, light-headedness
• impaired balance, feeling of being pulled sideways
• tinnitus, whistling, buzzing - tinnitus
• visual disturbance, blurred or double vision
• redness of skin, face
• or, conversely, paleness of the skin
• hot flushes
• feeling cold
• increased sweating
• heaviness in the stomach, feeling sick or vomiting
• shivering of the body, limbs
• sleep disturbances
• impaired concentration
• restlessness
• nosebleeds (epistaxis)
• chest pain, pressure, tightness, burning or other unpleasant sensations
• heart palpitations
• difficulty breathing, shortness of breath (dyspnoea)
• swelling of the body, limbs
• and so on

Blood pressure readings during the day and night

Blood pressure is not constant. Its value fluctuates during the day, rising and falling, depending on a variety of stimuli.

These can be internal or external.

Internal regulation, hormones, metabolism and external stimuli such as physical or mental activity.

Plus.

The human body also knows: circadian rhythm.

The circadian rhythm is a biological rhythm (biorhythm). It expresses the variation of activity over a 24-hour period, and it is the case of different bodily processes, metabolism or wakefulness.

Diurnal = diurnal, tied to the time of day, cycling during the day, but possibly over 24 hours.
Nocturnal = nocturnal, in association with night.

Diurnal rhythm in blood pressure = blood pressure variability over a 24 hour period.

That blood pressure has a rising and falling curve during the day has been known for a long time. Pressure values are lower at night, rise early in the morning before waking, and vary during the day depending on activity and psychological well-being.

The nocturnal drop in pressure is a manifestation of the normal diurnal rhythm.

Changes in pressure also occur over longer periods of time, over a range of weeks, months or seasons.

Although the time dependence has been known for a long time, only the newer method of monitoring blood pressure has helped to give a more accurate picture. Individual blood pressure measurements do not give a more detailed picture.

Further in the article, you will read:
What is ambulatory blood pressure monitoring?
What is nocturnal hypertension?
What are the risks?
How is it assessed?

Outpatient blood pressure monitoring

This is 24-hour blood pressure monitoring to assess the rate of rise and fall of blood pressure during real-life conditions.

Names such as:
Ambulatory blood pressure monitoring
Pressure Holter
Ambulatory Holter-type blood pressure monitoring
Ambulatory blood pressure monitoring

Based on 24-hour blood pressure monitoring, average ambulatory blood pressure monitoring values are assessed.

The table shows the average values of normal ambulatory blood pressure monitoring for adults

Blood pressure limit values in the table

Outpatient blood pressure monitoring values and degree of hypertension in the table

According to the data in the table, it can be seen that the method of monitoring blood pressure over 24 hours has its place in the diagnosis of hypertension. Standard and individual measurement of pressure either in the GP's office or at home cannot produce a detailed picture of blood pressure.

The pressure readings are recorded by time. The person keeps a diary. He notes his daily activity. On the basis of this data, hypertension is further evaluated.

Diurnal variation of pressure

In the context of 24-hour pressure monitoring, the term dipping is introduced. Dipping is a measure of the fall in pressure relative to the diurnal rhythm. It was discussed as early as 1988 by O'Brien, who defined dipping status.

Pressure is normally physiologically higher during wakefulness. Under normal conditions, it falls during sleep.

Physiological drop in blood pressure during sleep = dip.

Evaluation of dipping status in the table

A rise in blood pressure in the morning is associated with an increase in cardiovascular events. Morning hypertension increases the risk of complications and organ damage.

A rise in blood pressure in the morning is normal, but excessive rises would have a pathological effect.

In this context, certain risk factors are mentioned such as:

• older age
• smoking
• alcoholism
• history of hypertension
• diabetes
• obesity
• metabolic syndrome
• long sleep
• poor quality sleep and sleep disorders
• late wake-up time
• seasons - especially winter
• day of the week - Monday
• night work

When monitoring blood pressure, a curve is assessed which can take 5 forms.

1. Normal ambulatory blood pressure monitoring values

The curve has normal average blood pressure values over a 24 hour period.
Both during the day while awake and during sleep.

2. Daytime hypertension during ambulatory blood pressure monitoring

The curve has elevated blood pressure during the day.
At night, the blood pressure has normal values.

3. Daytime and nighttime hypertension of ambulatory blood pressure monitoring

Increase in pressure is noted on the curve during wakefulness, that is, day and night, during sleep.

4. Isolated nocturnal hypertension

The blood pressure curve has normal values during the day.
However, during sleep the blood pressure rises.

5. Significantly higher morning blood pressure

The blood pressure value is significantly elevated 2 to 3 hours after getting up in the morning.
And this is compared to the blood pressure values during sleep.

Nocturnal hypertension and isolated nocturnal hypertension

Nocturnal hypertension can stem from a variety of causes that may not be known.

Among the main factors, disorders of sodium metabolism, changes in arterial stiffness (the stiffness of the arterial wall), atherosclerosis or obstructive sleep apnoea are cited. An imbalance between the sympathetic and parasympathetic nervous systems is also an example.

Diabetes, elevated cholesterol, smoking, alcoholism are also predisposing factors.

Nocturnal hypertension can also be present in the case of high blood pressure during the day.

The second form is isolated nocturnal hypertension. In its case, pressure values during the day are kept within normal limits. It is characterized by a rise in pressure at night, that is, during sleep.

Isolated nocturnal hypertension is defined as:

The average blood pressure at night is 120/70 or more. The average blood pressure during the day is below 135/85 mmHg.

This type of nocturnal hypertension is mainly found in Chinese and Japanese or South Africans. In Europe, the prevalence is approximately 6-8%.

High blood pressure at night is an increasing risk factor for health complications, especially in terms of organ damage throughout the body.

Organ damage and increased mortality rates from cardiovascular disease are the impact of nocturnal hypertension.

Elevated blood pressure at night causes excessive stress on the heart, blood vessels or kidneys.

Increased risk of complications:

• cardiovascular system
• left ventricular hypertrophy
• heart rhythm disturbances
• ischaemic heart disease
• heart failure
• myocardial infarction
• stroke - ischaemic or haemorrhagic

The higher the pressure value, the higher the risk. The situation is more burdensome for people with severe hypertension, diabetes, kidney damage or autonomic nervous system disorders.

The risk rises all the more especially in the category of people over 70 years of age.

When is this method of measuring blood pressure for 24 hours chosen?

The 24-hour blood pressure monitoring is of importance in people who are not yet treated for hypertension. It is, of course, equally important in people already treated when the situation requires it.

Certain points are made in connection with the indication:

• suspected hypertension
• suspected hypotension (low blood pressure)
• recurrent collapse conditions
• diagnosis of hypertension in pregnancy
• determination of the severity of hypertensive disease
• verification of the effectiveness of hypertension treatment and its justification
• diagnosis of conditions such as:
  • white coat syndrome
  • masked hypertension
  • isolated nocturnal hypertension
  • treatment-resistant hypertension

For more information on the symptoms, course and treatment of hypertension, see the separate article:
High blood pressure

Don't forget...

When you have hypertension, it is important to follow certain guidelines:

1. regular blood pressure measurements
2. adherence to treatment and doctor's recommendations
3. reducing weight and maintaining a normal weight
4. not smoking
5. limit alcohol
6. plenty of fruit and vegetables in the diet
7. reduce intake of table salt and sodium
8. sensible use of fats and oils
9. plenty of physical exercise, reduce sedentary lifestyle
10. day and night routines, alternation of activity and sufficient sleep, sleep hygiene

Home blood pressure control

For hypertensives (people being treated for high blood pressure), home measurement and control of blood pressure should be a matter of course.

Checking blood pressure at home should be regular.

Of course, a person should be sure to measure their blood pressure when health problems occur. These may be related to fluctuations in blood pressure to high or low values.

The pressure readings taken at home should be recorded in a diary. On the basis of these, the doctor can assess the treatment given so far and the need for adjustment.

Digital shoulder blood pressure monitors are suitable. Wrist blood pressure monitors are unreliable.

The person repeatedly records the values of blood pressure and heart rate. When taking the values, it is also necessary to mark the time of measurement and the date.

The home method is also helpful due to the absence of tension when the doctor measures the pressure. At that time, the person may have anxiety and increased mental tension. This may be reflected when higher pressure readings are taken.

This phenomenon is referred to and known as both the white coat syndrome and the white coat phenomenon.

These are higher pressure readings when measured by a doctor or in a hospital. A 10-20% incidence is reported.

It is necessary to follow the correct measurement procedure:

1. measurement in a quiet environment
2. measuring the pressure at the shoulder
3. appropriate cuff width for pressure measurement
4. sitting quietly for at least 5 minutes
5. rest for more than 30 minutes after heavy physical activity
6. no smoking or drinking alcohol before the measurement
7. avoid stress
8. the rolled-up sleeve cannot pinch the limb above the cuff of the blood pressure monitor
9. cuff at heart level
10. measurements on the arm where blood pressure readings are repeatedly higher
11. measuring the pressure before taking blood pressure medication
12. no talking or moving during the measurement
13. two consecutive measurements one minute apart
14. the average of the readings or the second blood pressure reading will be the reference value
15. third measurement - when the difference between the two pressures is too great

In case of more severe arrhythmia, the blood pressure monitor may not measure the correct blood pressure values. Then it is better to check with a competent doctor. In addition to measuring blood pressure, it can also complement the ECG examination.

When monitoring blood pressure at home for the purpose of evaluation by a doctor, it is advisable to observe:

Repeated daily measurements in the morning and evening.
At least 7 days a week.
Before taking medication.
Recording the values with time.

Home monitoring will supplement the measurement and monitoring of blood pressure by the doctor. It will serve in the evaluation of the treatment. The doctor will use it to determine whether the treatment is effective or needs to be changed.

In addition to writing down the measurements and time, it is also useful to note down the health problems that occurred during the episode of elevated pressure.

The patient should be instructed by his general practitioner or internist or cardiologist on what to do in the event of an episode of raised blood pressure. What medication he can top up. Alternatively, the doctor will prescribe medication for use only in the event of an episode of hypertension.

If too high blood pressure readings and health problems are measured, we recommend contacting or seeking professional help.

Serious increase in blood pressure and threat to health or life = contact the emergency medical services.

Read also.

One more important warning before we finish:

Taking blood pressure measurements every day without purpose is not recommended.

It unnecessarily stresses the person and relatives.