TY - JOUR T1 - Diagnosing hypertension in primary care: the importance of night-time blood pressure assessment JF - British Journal of General Practice JO - Br J Gen Pract DO - 10.3399/BJGP.2022.0160 SP - BJGP.2022.0160 AU - Laura Catherine Armitage AU - Shaun Davidson AU - Adam Mahdi AU - Mirae Harford AU - Richard McManus AU - Andrew Farmer AU - Peter Watkinson AU - Lionel Tarassenko Y1 - 2022/08/27 UR - http://bjgp.org/content/early/2022/09/13/BJGP.2022.0160.abstract N2 - Background: Ambulatory blood pressure monitoring (ABPM) has become less frequent in primary care since the COVID-19 pandemic, with home blood pressure monitoring (HBPM) often the preferred alternative; however, HBPM cannot measure night-time blood pressure (BP) and patients whose night-time BP does not dip or rises (reverse-dipping) have poorer cardiovascular outcomes. Aim: To investigate the importance of measuring night-time BP when assessing individuals for hypertension. Design and Setting: Retrospective cohort study of two patient populations; the first being hospital patients admitted to four UK acute hospitals and the second being participants of the BP-Eth study recruited from 28 UK GP practices. Method: Using blood pressure data collected for the two cohorts, we studied three systolic blood pressure (SBP) phenotypes (dipper, non-dipper and reverse-dipper). Results: Among the hospital cohort (n=21,739) 48.9% patients were ‘reverse-dippers’, with an average day-night SBP difference of -8.0 mmHg. Among the community cohort (n=585) 10.8% patients were ‘reverse-dippers’ with an average day-night SBP difference of -8.5 mmHg. Non-dipper and reverse-dipper phenotypes both have lower day-time SBP and higher night-time SBP than the dipper phenotype. Average day-time SBP was lowest in the reverse-dipping phenotype (6.5 mmHg and 6.8 mmHg lower than for the dipper phenotype in the hospital and community cohorts, respectively), thus placing them at risk of undiagnosed, or masked hypertension. Conclusion: Not measuring night-time BP puts all groups other than dippers at risk of failure to identify hypertension. We recommend that GPs should offer ABPM to all patients aged ≥60 as a minimum, when assessing for hypertension. ER -