Table 2.
Final characteristics of patients investigated according to treatment time (either all hypertension medications upon awakening or ≥1 medications at bedtime)
| Awakening | Bedtime | P between groups | |
|---|---|---|---|
| n | 232 | 216 | |
| Primary end points* | |||
| Total events | 54.24 (68) | 19.80 (23) | <0.001 |
| Major events | 17.55 (22) | 5.16 (6) | <0.001 |
| Secondary end points* | |||
| Total death | 6.38 (8) | 2.58 (3) | 0.097 |
| Cardiovascular death | 4.79 (6) | 0.86 (1) | 0.038 |
| Other cause | 1.60 (2) | 1.72 (2) | 0.968 |
| Cardiovascular events | 15.95 (20) | 6.89 (8) | 0.008 |
| Cerebrovascular events | 6.38 (8) | 0.86 (1) | 0.010 |
| Heart failure | 13.56 (17) | 6.02 (7) | 0.020 |
| Other events | 11.96 (15) | 3.44 (4) | 0.005 |
| Hypertension treatment | |||
| Number of medications | 2.6 ± 1.1 | 2.4 ± 1.2 | 0.145 |
| 1 Medication (%) | 23.7 | 28.7 | 0.229 |
| 2 Medications (%) | 15.9 | 19.4 | 0.332 |
| ≥3 Medications (%) | 60.3 | 51.9 | 0.070 |
| ARB (%) | 63.4 | 67.1 | 0.403 |
| ACEI (%) | 27.2 | 20.4 | 0.159 |
| Calcium channel blocker (%) | 50.0 | 49.1 | 0.845 |
| α-Blocker (%) | 29.7 | 28.7 | 0.809 |
| β-Blocker (%) | 21.1 | 22.2 | 0.777 |
| Diuretic (%) | 63.4 | 56.5 | 0.137 |
| Clinic and ambulatory blood pressure | |||
| Clinic SBP (mmHg)† | 150.3 ± 28.6 | 147.9 ± 21.3 | 0.309 |
| Clinic DBP (mmHg)† | 80.5 ± 16.3 | 78.6 ± 14.3 | 0.187 |
| Clinic PP (mmHg)† | 69.8 ± 18.2 | 69.3 ± 14.7 | 0.742 |
| Clinic HR (bpm)† | 73.6 ± 13.8 | 74.6 ± 14.2 | 0.453 |
| Awake SBP mean (mmHg) | 127.1 ± 17.8 | 126.8 ± 14.6 | 0.861 |
| Asleep SBP mean (mmHg) | 122.4 ± 21.8 | 115.0 ± 17.1 | <0.001 |
| 48-h SBP mean (mmHg) | 125.5 ± 18.3 | 122.8 ± 15.0 | 0.097 |
| Sleep time relative SBP decline (%) | 3.7 ± 10.3 | 9.4 ± 7.8 | <0.001 |
| Awake DBP mean (mmHg) | 70.5 ± 10.8 | 71.0 ± 10.7 | 0.621 |
| Asleep DBP mean (mmHg) | 63.7 ± 11.3 | 60.2 ± 10.1 | <0.001 |
| 48-h DBP mean (mmHg) | 68.2 ± 10.4 | 67.4 ± 10.1 | 0.406 |
| Sleep time relative DBP decline (%) | 9.3 ± 11.4 | 14.9 ± 9.2 | <0.001 |
| Nondipper (%) | 76.3 | 49.5 | <0.001 |
| Controlled ambulatory blood pressure (%) | 50.9 | 62.5 | 0.013 |
| Controlled awake blood pressure (%) | 75.4 | 72.2 | 0.439 |
| Controlled asleep blood pressure (%) | 54.7 | 70.8 | <0.001 |
Data are means ± SD. Event rates (95% CIs) are expressed as the number/1,000 patient-years, i.e., ratio of the observed number of events to the total number of patient-years of exposure. Total events include death (from all causes), cardiovascular events (myocardial infarction, angina pectoris, and coronary revascularization), cerebrovascular events (stroke and transient ischemic attack), heart failure, and other events (acute arterial occlusion of lower extremities and thrombotic occlusion of the retinal artery). Major events include cardiovascular deaths, myocardial infarction, ischemic stroke, and hemorrhagic stroke. Comparison of event rates between treatment time groups was done by the Mantel log-rank test. The sleep time relative blood pressure decline, an index of blood pressure dipping, is defined as the percent decline in mean blood pressure during nocturnal sleep relative to the mean blood pressure during daytime activity, and calculated as: [(awake blood pressure mean – asleep blood pressure mean)/awake blood pressure mean] x 100. HR, heart rate; Nondipper, patients with sleep time relative SBP decline <10% using data sampled by ABPM for 48 consecutive hours; PP, pulse pressure.
*Number of events is shown in parentheses.
†Values correspond to the average of six conventional blood pressure measurements obtained for each subject at the clinic before starting ABPM.