Table 6.

Summary of Asian studies investigating the effects of ABPM parameters on cardiovascular prognosis and target organ damage

Author, year (study name)	Design; population	Total subjects (n)	Follow‐up	Main findings
Cardiovascular prognosis
Cheng et al 2017121	Prospective	2020	Median 19.7 y	High sleep‐trough MS rate was significantly associated with increased all‐cause mortality risk (HR 1.666, 95% CI 1.185‐2.341) and CV mortality (HR 2.608, 95% CI 1.554‐4.375), independent of age, sex, BMI, smoking, alcohol, LDL cholesterol, 24‐h SBP, night:day SBP ratio, and antihypertensive treatment
Hsu et al 2016165	Prospective; Community‐based population of pts with untreated HTN or normotension	1257	Median 20 y	In pts with HTN, high vs low ARVd was a significant predictor of CV mortality (HR 2.04, 95% CI 1.19‐3.51) after adjustment for 24‐h SBP and conventional risk factors; no such association was seen in normotensives
Luo et al 2013119	Retrospective case‐control; Primary hypertension (2‐wk washout of antihypertensives) or normotension	340	Unknown	The rate of morning surge in SBP was an independent determinant of MI (OR 1.266, 95% CI 1.153‐1.389, P < .001) and stroke (OR 1.367, 95% CI 1.174‐1.591, P < .001)
Shimizu et al 2011176	Prospective; Elderly hypertensives	514	Mean 41 m	The rate of silent cerebral infarcts was significantly higher in pts in the highest quartile of MS and an hs‐CRP level above the median (OR 2.74, 95% CI 1.42‐5.30) vs pts in lower quartiles of MS and with lower hs‐CRP. The high MS, high hs‐CRP group also had a significantly increased risk of clinical stroke events (HR 5.77, 95% CI 2.11‐15.81), even after adjustment for confounding variables
Eguchi et al 2008156	Prospective; Asymptomatic pts with HTN, with or without diabetes	1268	Mean 50 m	24‐h SBP was independently associated with CVD in patients with (HR 1.44, 95% CI 1.15‐1.80; P < .001) and without (HR 1.32, 95% CI 1.10‐1.58; P = .001) diabetes
Ishikawa et al 2008147	Prospective; Pts aged > 50 y with essential HTN	811	Mean 41 m	After adjustment for 24‐h BP and covariates (including CKD), extreme dipping status remained significantly associated with the occurrence of CV events (HR 2.59, 95% CI 1.26‐5.32; P = .009)
Metoki et al 200652 (Ohasama)	Prospective; General population	1430	Mean 10.4 y	Cerebral infarction risk was significantly higher in subjects with a ≥10% vs <10% nocturnal decline in BP (P = .04). Risk of cerebral hemorrhage was increased with a large morning pressor surge (≥25 mm Hg; P = .04), and intracerebral hemorrhage occurred more frequently in extreme dippers vs dippers (P = .02)
Nakano et al 2004148	Prospective; Pts with type 2 diabetes and no history of vascular disease	392	Mean 86 m	Nighttime SBP was a significant predictor of nonfatal vascular events (adjusted RR 1.03, 95% CI 1.10‐1.06; P = .041)
Kario et al 2003114	Prospective; Elderly hypertensives	519	Mean 41 m	After adjustment for age and 24‐h BP, RR of stroke in the MS vs non‐MS group was 2.7 (P = .04); MS was significantly associated with stroke events independently of 24‐h BP, nocturnal BP dipping status and baseline presence of silent infarct (P = .008)
Liu et al 2003190	Prospective; Hemodialysis pts	80	Mean 33 m	On Cox analysis, non‐dipping was significantly associated with the occurrence of CV events (HR 2.46, 95% CI 1.02‐5.92; P = .038) ad CV mortality (HR 9.62, 95% CI 1.23‐75.42; P = .031)
Ohkubo et al 200254 (Ohasama)	Prospective; General population (age ≥ 40 y)	1542	Mean 9.2 y	On average, each 5% reduction in the decline in nocturnal BP was associated with a ≈20% increase in the risk of CV mortality; this relationship was evident even when 24‐h BP was within the normal range
Kario et al 2001137	Prospective; Elderly pts with sustained hypertension	575	Mean 41 m	Multiple silent cerebral infarct on brain MRI was seen in 53% of extreme dippers, 49% of reverse dippers, 41% of non‐dippers and 29% of dippers. Corresponding values for stroke incidence were 12%, 22%, 7.6%, and 6.1%. Intracranial hemorrhage was more common in reverse dippers (29% of strokes) than in other subgroups (7.7% of strokes, P = .04)
Kikuya et al 2000167 (Ohasama)	Prospective; General population (age ≥ 40 y)	1542	Mean 8.5 y	In a Cox proportional hazards model adjusted for potential confounders, there was a significant linear relationship between increasing daytime systolic, daytime diastolic and nighttime BPV and CV mortality; CV mortality risk was highest in subjects with daytime ambulatory systolic BPV was above the third quintile
Ohkubo et al 1997153 (Ohasama)	Prospective; General population (age ≥ 40 y)	1542	Mean 5.1 y	Adjusted (for age, sex, smoking status, CVD history, use of antihypertensives, and nighttime BP) HR (95% CI) for CV mortality vs dippers were 2.43 (1.05‐5.62) in non‐dippers and 2.66 (1.03‐6.87) in inverted dippers.
Target organ damage
Cho et al 2018203	Cross‐sectional; Ambulatory elderly pts with ≥1 CV risk factor (92% treated with antihypertensives)	232	–	Pts were divided into quartiles based on weighted SD of 24‐h SBP. After adjustment for age and 24‐h SBP, quartile 4 of weighted SD of BP had a lower MoCA‐J score (indicating cognitive impairment) vs quartile 1 and 2 (15.4 vs 17.9; P = .0001)
Wei et al 2014247	Cross‐sectional; Untreated pts referred for ABPM	1047	–	In fully adjusted multivariable models in older and younger pts (≥55 and <55 y, respectively), 24‐h SBP was a significant predictor of target organ damage, including LVMI, UACR, and PWV
Kawai et al 2011179	Cross‐sectional; Pts with or without HTN undergoing renal doppler ultrasound	194 (88 with ABPM)	–	Pts with a larger MS on ABPM had a significantly higher resistance index (RI) on renal doppler ultrasound vs other pts (0.73 ± 0.06 vs 0.70 ± 0.08; P < .05)
Nagai et al 2009193	Cross‐sectional; Elderly hypertensives with ≥1 CV risk factor	55	–	In multiple linear regression analysis adjusted for age, gender and BMI, left insular cortex volume was significantly negatively associated with sleep SBP (P < .01) and positively with nocturnal SBP dipping (P < .05)
Nagai et al 2008192	Cross‐sectional; Unmedicated elderly hypertensives with ≥1 CV risk factor	55	–	Nocturnal SBP dipping was significantly correlated with total brain matter volume (r‐.323; P = .02) and Mini‐Mental State Examination score (r = 0.402; P = .002). In multiple linear regression analysis adjusted for age, sex and BMI, sleep SBP (P = .009) was more significantly negatively associated with total brain matter volume than either 24‐h (P = .035) or awake (P = .020) SBP
Hoshide et al 2007191	Cross‐sectional; Adults undergoing ABPM	165	–	Multiple regression analysis showed that nocturnal SBP was independently associated with IMT (β = .10, P < .05) and RWT (β = .28, P < .001) adjusted for by age, male gender, BMI and self‐measured home SBP
Li et al 200799	Cross‐sectional, population study; Subjects aged ≥12 y	733	–	Subjects with isolated nocturnal HTN showed significantly increased arterial stiffness (based on 4 different measures) vs subjects with ambulatory normotension (all P < .05; adjusted for sex, age, height and pulse rate)
Sakakura et al 2007202	Cross‐sectional; Stable chronic disease pts (including HTN) aged 61‐79 or ≥80 y)	202	–	Exaggerated ambulatory BPV was related to cognitive dysfunction in the elderly (especially the very elderly), and was related to lower QOL in the younger elderly
Kario et al 2004177	Cross‐sectional; Elderly hypertensives	98	≤11 wk	Although age, clinic BP and 24‐h BP were similar, pts with vs without MS had a significantly higher prevalence of LV hypertrophy, multiple silent cerebral infarcts, and number of silent cerebral infarcts (all P < .05). After adjustment for possible confounders (age, sex, BMI, smoking, hyperlipidemia, duration of HTN and dose of doxazosin), both MS (P < .05) and alpha‐adrenergic‐related MS (P < .001) were significantly associated with the number of silent cerebral infarcts
Hoshide et al 2003183	Cross‐sectional; Normotensives	74	–	Non‐dippers vs dippers had higher LV mass index (P < .05), relative wall thickness (P < .01) and levels of atrial (P < .01) and brain (P < .05) natriuretic peptides, and a greater prevalence of concentric hypertrophy (P < .05)
Watanabe et al 1996197	Cross‐sectional, epidemiological survey; Untreated subjects (aged > 55 y)	70	–	Women, but not men, showed a significant positive correlation between the amplitude or the rate of fall in nocturnal BP and the extent of periventricular hyperintensity on MRI (silent cerebral lesions)
Kario et al 1996198	Cross‐sectional; Hypertensive out‐pts aged ≥60 y (untreated for ≥1 m)	131	–	In pts with sustained HTN (n = 100), the extent of silent cerebrovascular damage was greater in extreme dippers and non‐dippers than in those with a dipping pattern; there was a J‐shaped relationship between nocturnal BP fall and brain MRI findings

Abbreviations: ABPM, ambulatory BP monitoring; ARTEMIS, International Ambulatory Blood Pressure Registry: Telemonitoring of Hypertension and Cardiovascular Risk Project; ARVd, average real variability in diastolic BP; ARVs, average real variability in systolic BP; BMI, body mass index; BP, blood pressure; BPV, BP variability; CI, confidence interval; CV, cardiovascular; CVD, cardiovascular disease; DBP, diastolic blood pressure; HR, hazard ratio; hs‐CRP, high‐sensitivity C‐reactive protein; HTN, hypertension; IHD, ischemic heart disease; IMT, intima‐media thickness; LV, left ventricular; LVMI, left ventricular mass index; m, months; MI, myocardial infarction; MoCA‐J, Montreal Cognitive Assessment—Japanese version; MRI, magnetic resonance imaging; MS, morning surge; OR, odds ratio; pts, patients; PWV, pulse wave velocity; RR, relative risk; RWT, relative wall thickness; SBP, systolic blood pressure; UACR, urinary albumin‐creatinine ratio; wk, weeks; y, years.