TOCHIGI, Japan — People who have high blood pressure while asleep are more likely to suffer cardiovascular disease, especially heart failure, in the future, a new study reveals. In fact, researchers at Jichi Medical University in Japan warn that even when a patient’s daytime blood pressure is within normal ranges, they are still more likely to have a heart attack or a stroke.

Medical practitioners typically use in-office and daytime blood pressure measurements to determine a patient’s hypertension medication needs and dosages. But many patients may have undetected high blood pressure while sleeping, also known as nocturnal hypertension, scientists say.

“Nighttime blood pressure is increasingly being recognized as a predictor of cardiovascular risk,” says lead author Professor Kazuomi Kario, a professor of cardiovascular medicine, in a statement to the American Heart Association. “This study provides much more in-depth information about the cardiovascular risk associated with high nighttime blood pressure and different nighttime blood pressure phenotypes than have been reported previously.”

Patients’ blood pressure monitored during the day and while sleeping

For the study, data was collected from 6,359 adults from across Japan between 2009 and 2017. Nearly half of the study participants were male, and more than half were at least 65 years old. The patients all had at least one cardiovascular risk factor, and three-quarters of them were taking blood pressure medications. None had symptomatic cardiovascular disease when the study began.

Researchers measured daytime and nighttime blood pressure levels using an at-home, wearable monitor. Measurements were taken for at least 24 hours at a time, and device data were periodically downloaded at a health care clinic. Participants were instructed to self-report their daily activities along with sleep and wake times in a diary. A

Almost every participant recorded 20 daytime and seven night-time automated blood pressure measurements. Follow-ups occurred annually via phone or clinic visit, with total follow up ranging from two to seven years.

Researchers analyzed the rates of cardiovascular disease events, including heart attacks, strokes, heart failure and death, among the participants. The occurrence and timing of heart events in relation to blood pressure variations was analyzed to determine whether there were any associations.

In all, participants experienced a total of 306 cardiovascular events, including 119 strokes, 99 diagnoses of coronary artery disease, and 88 diagnoses of heart failure.

‘Significant, independent risk factor for cardiovascular events’

Authors say that an abnormal reading, or a systolic blood pressure measuring 20 mm Hg above a person’s daytime systolic reading, is significantly linked to the risk of atherosclerotic cardiovascular disease and heart failure. Similarly, participants with an abnormal circadian pattern, which occurs when sleep blood pressure exceeds daytime readings, were at particular risk of developing heart failure and had a greater risk of experiencing any heart disease event.

Excessive reduction of blood pressure during sleep may also be detrimental. Patients with well-controlled hypertension showed a significantly increased risk of stroke when nighttime systolic pressure took extreme dips.

“Results indicate that nighttime systolic blood pressure was a significant, independent risk factor for cardiovascular events,” says Kario. “The study highlights the importance of including nighttime blood pressure monitoring in patient management strategies and will hopefully encourage physicians to ensure that antihypertensive therapy is effectively lowering blood pressure throughout the 24-hour dosing period.”

But the authors note that their study is not without limitations.

Ambulatory data were obtained once at the start of the study. However, no information was available regarding the contributions of subsequent changes in ambulatory blood pressure levels up until the time of diagnosis of a cardiac event. The study also focused on systolic, rather than diastolic, measurements due to the older age of the participants.

The authors say study evaluations did not include echocardiograms, thus preventing some degree of differentiation for types of heart failure.

The new research is published in the American Heart Association’s flagship journal Circulation.

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Women who develop preeclampsia, a form of dangerously high blood pressure during pregnancy, are 5 times more likely to develop end-stage kidney disease later in life than women who have normal blood pressure during pregnancy, a Swedish study suggests.

Preeclampsia has long been linked to an increased risk of events like heart attacks and strokes years later, and some previous research also suggest that this form of high blood pressure might also be one reason why women are more likely to develop advanced kidney disease than men.

For the current study, researchers examined data on almost 2.67 million births among 1.37 million women between 1982 and 2012. A total of 67,273 women, or 4.9%, developed preeclampsia during at least one pregnancy, and 410 women developed end-stage kidney disease.

Women who had preeclampsia in two pregnancies were more than seven times more likely to develop end-stage kidney disease than mothers who never had preeclampsia, the study found.

“This study shows that pre-eclampsia is a sex-specific, independent risk factor for the subsequent development of end-stage kidney disease,” said lead study author Ali Khashan, a public health researcher at University College Cork in Ireland.

“However, the overall end-stage kidney disease risk remains small, and women with a history of preeclampsia should not be overly concerned,” Khashan said by email.

Women who develop preeclampsia earlier in pregnancy – before the halfway point – are more than nine times more likely to develop end-stage kidney disease than mothers with normal blood pressure during pregnancy.

The challenge with preeclampsia is that women often don’t experience symptoms until they have a life-threatening problem, especially when they’re otherwise healthy and have uncomplicated pregnancies.

Kidney failure, also called end-stage kidney disease, is most commonly caused by diabetes or high blood pressure. Other causes can include autoimmune diseases and genetic disorders or chronic urinary tract problems.

With kidney failure, people require an organ transplant or dialysis.

The connection between preeclampsia and kidney failure in the study persisted even after researchers accounted for other factors that can impact maternal health like age, education, and pre-pregnancy health problems like existing kidney disease or cardiovascular disease.

Women in the study who had preeclampsia were older on average and had a higher body mass index (BMI).

Among women with no preeclampsia in the first pregnancy, 14.2% were overweight and 4.9% were obese. Among women who did develop preeclampsia in their first pregnancy, 20.1% were overweight and 11.8% were obese.

The study wasn’t a controlled experiment designed to prove whether or how preeclampsia might lead to kidney failure later in life.

It’s possible that risk factors like obesity, high blood pressure, and diabetes contribute to both preeclampsia and kidney failure down the line, researchers note in PLoS Medicine. It’s also possible that some women who had preeclampsia might have had undiagnosed kidney problems at the time.

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