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Sleep and cardiovascular outcomes in relation to nocturnal hypertension: the J-HOP Nocturnal Blood Pressure Study

Hypertension Research volume 44, pages 1589–1596 (2021)Cite this article

Abstract

There is a lack of data on how nighttime blood pressure (BP) might modify the relationship between sleep duration and cardiovascular disease (CVD) risk. Self-reported sleep duration data were available for 2253/2562 patients from the J-HOP Nocturnal BP study; of these, 2236 had complete follow-up data (mean age 63.0 years, 83% using antihypertensive drugs). CVD outcomes included stroke, coronary artery disease (CAD), and atherosclerotic CVD (ASCVD [stroke + CAD]). Associations between sleep duration and nighttime home BP (measured using a validated, automatic, oscillometric device) were determined. During a mean follow-up of 7.1 ± 3.8 years, there were 133 ASCVD events (52 strokes and 81 CAD events). Short sleep duration (<6 versus ≥6 and <9 h/night) was significantly associated with the risk of ASCVD (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.07–3.22), especially stroke (HR 2.47, 95% CI 1.08–5.63). When nighttime systolic BP was <120 mmHg, those with a sleep duration <6 versus ≥6 and <9 h/night had a significantly higher risk of ASCVD and CAD events (HR [95% CI] 3.46 [1.52–7.92] and 3.24 [1.21–8.69], respectively). Even patients with “optimal” sleep duration (≥6 and <9 h/night) were at significantly higher risk of stroke when nighttime systolic BP was uncontrolled (HR [95% CI] 2.76 [1.26–6.04]). Adding sleep duration and nighttime BP to a base model with standard CVD risk factors significantly improved model performance for stroke (C-statistic 0.795, 95% CI 0.737–0.856; p = 0.038). These findings highlight the importance of both optimal sleep duration and control of nocturnal hypertension for reducing the risk of CVD, especially stroke. Clinical Trial registration: URL: http://www.umin.ac.jp/icdr/index.html. Unique identifier: UMIN000000894.

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Acknowledgements

Medical writing support was provided by Nicola Ryan, an independent medical writer, and Ayako Okura, funded by Jichi Medical University.

Funding

This study was financially supported in part by a grant from the 21st Century Center of Excellence Project run by Japan’s Ministry of Education, Culture, Sports, Science and Technology (to KK); a grant from the Foundation for Development of the Community (Tochigi, Japan); a grant from Omron Healthcare Co., Ltd.; a Grant-in-Aid for Scientific Research (B) (21390247) from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan, 2009 to 2013; and funds from the MEXT-Supported Program for the Strategic Research Foundation at Private Universities, 2011 to 2015 Cooperative Basic and Clinical Research on Circadian Medicine (S1101022). The funding sponsors had no role in designing or conducting this study; in the collection, management, analysis, or interpretation of the data; in the preparation of the article; or in the decision to submit the article for publication.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan

    Kazuomi Kario, Satoshi Hoshide, Yukie Okawara & Hiroshi Kanegae

  2. Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan

    Michiaki Nagai

  3. Genki Plaza Medical Center for Health Care, Tokyo, Japan

    Hiroshi Kanegae

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  1. Kazuomi Kario
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  2. Satoshi Hoshide
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  3. Michiaki Nagai
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  5. Hiroshi Kanegae
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Contributions

K. Kario is the principal investigator of the J-HOP study, supervised its conduct and data analysis, and had primary responsibility for the writing of this paper. S. Hoshide and M. Nagai reviewed/edited the manuscript. H. Kanegae advised on the data analysis under the guidance of K. Kario. K. Kario and S. Hoshide collected the data. Y. Okawara conducted data analysis. All authors have read and given final approval of the version to be published.

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Correspondence to Kazuomi Kario.

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KK has received research grants from Omron Healthcare and A&D Co. The other authors have no conflicts of interest to declare.

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Kario, K., Hoshide, S., Nagai, M. et al. Sleep and cardiovascular outcomes in relation to nocturnal hypertension: the J-HOP Nocturnal Blood Pressure Study. Hypertens Res 44, 1589–1596 (2021). https://doi.org/10.1038/s41440-021-00709-y

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