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(Hypertension. 1998;32:377-378.)
© 1998 American Heart Association, Inc.

Letters to the Editor

Effect of Daytime Sleep on Blood Pressure Monitoring in HARVEST Study Results

Michael Bursztyn

Hypertension Unit, Department of Medicine, Hadassah University Hospital, Mount-Scopus, Jerusalem, Israel

To the Editor:

In their recent report on target organ damage in white coat and sustained stage I hypertensive subjects from the HARVEST study, Palatini et al¹ have made a significant contribution by applying different cutoff points for normotension and by matching for ambulatory blood pressure of the normotensives and white coat hypertensives by one of the chosen values. Nevertheless, there is still one caveat. By choosing daytime instead of 24-hour ambulatory blood pressure, Palatini et al ignore the potential contribution to blood pressure load of nocturnal blood pressure. Perhaps even more important is the potential confounding effect of the siesta (daytime sleep, afternoon nap), which is not an uncommon practice in the Mediterranean area (including Italy, where the above-mentioned study took place), Latin America, and other countries. We have found that 30% of those referred for 24-hour ambulatory blood pressure monitoring follow the practice of the siesta.² Inclusion of daytime-sleep blood pressure in daytime blood pressure significantly diminishes its average value.^{2 3 4 5} This is because during the siesta, in our^{2 3 4} and other studies,^{5 6} blood pressure declines to nocturnal levels. If the prevalence of the siesta is not evenly distributed between normotensives, white coat, and sustained hypertensives, it may affect the HARVEST study results, since the normotensive subjects in that study (medical staff and their relations) may be quite different from the population-recruited hypertensives in having less opportunity to practice the siesta.

This caveat may be circumvented by applying corresponding 24-hour ambulatory blood pressure values instead of daytime values. Another option . . . [Full Text of this Article]

Paolo Palatini; ; Paolo Mormino

Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy