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The prevalence of systolic hypertension phenotypes based on simultaneous 24-h brachial (br) and aortic (ao) ambulatory blood pressure monitoring (ABPM) remains unknown. We sought to describe their prevalence and associations with hypertension mediated organ damage (HMOD). Participants with 24-h br and ao ABPM, carotid ultrasound and echocardiography data were categorized into 4 systolic hypertension phenotypes: sustained systolic br and ao normotension (SSN), isolated br systolic hypertension (IbrSH), isolated ao systolic hypertension (IaoSH) and sustained br and ao systolic hypertension (SSH). Different calibrations for peripheral waveforms and cut-offs for 24-h ao systolic pressure were applied. Out of 1024 participants with ABPM, 684 had carotid and 423 echocardiography data. IaoSH ranged from 3.7% to 23.0% of the population, depending on the calibration and the applied cut-off; (SSN: 37.0-56.3%, IbrSH: 0.6-9.5%, SSH: 30.5-39.4%). In adjusted models including diastolic pressure, in comparison with SSN and IbrSH, IaoSH phenotype by 90 th percentile of normalcy for calibration 2 (mean/diastolic pressure) had significantly higher carotid intimal-medial thickness, carotid cross-sectional area and left ventricular mass; the odds ratio (95% confidence intervals) of IaoSH for carotid hypertrophy and left ventricular hypertrophy was 2.57 (1.01-6.56) and 3.29 (1.13-9.55), respectively. Individuals with 24-h IaoSH and IbrSH constitute a non-neglectable percentage (around 10%) of the population. IaoSH cannot be detected by brachial ABPM due to the per se normal 24-h br systolic pressure and it is associated with increased HMOD, possibly leading to increased cardiovascular risk. Further outcome and mortality studies are needed to verify these results., Competing Interests: Compliance with ethical standards. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)

There is scarce evidence of the role of clinic and ambulatory BP indices, as well as blood pressure phenotypes in the prognosis of stroke survivors. We aimed to evaluate the association between ambulatory BP indices and mortality in patients with a previous stroke. Our study was an observational cohort study from individuals included in the Spanish Ambulatory Blood Pressure Registry from March 2004 to December 2014. The Cox model was used to estimate associations between usual clinic and ambulatory BP and mortality, adjusted for confounders and additionally for alternative measures of BP. Two thousand one hundred and eighty-three patients with a previous stroke were included. During a median of 9.2 years, 632 (28.9%) patients died: 236 (10.8%) from cardiovascular causes. In the confounder-adjusted model, clinic systolic BP was not associated with the risk of all-cause or cardiovascular mortality. In contrast, systolic BP indices obtained through ABPM (24 h, day and night) were all associated with all-cause and cardiovascular death. In the simultaneous adjustment of daytime and night-time systolic BP, only night-time systolic BP remained significantly associated with all-cause and cardiovascular death: HR 1.35 (95% CI 01.21-1.51) and 1.44 (1.20-1.72), respectively. For diastolic BP, only night-time BP was associated with all-cause and cardiovascular mortality: HR 1.32 (1.18-1.48) and 1.57 (1.31-1.88), respectively. According to the circadian pattern, a riser pattern was associated with all-cause and cardiovascular mortality: HR 1.49 (1.18-1.87) and 1.70 (1.14-2.52), respectively. In conclusion, in patients who have suffered a stroke, night-time BP is the BP estimate most closely associated with all-cause and cardiovascular mortality., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)