Home blood pressure during night-time sleep – a feasible treatment target for patients with hypertension: a proof-of-concept randomised controlled trial

Article

Author: Choi, Yue-Kwan ; Han, Jinghao ; Wang, Shuqi ; Yip, Benjamin Hon-Kei ; J. McManus, Richard ; Chung, Wai-Ho ; Chow, Kam-Fai ; Mihailidou, Anastasia S. ; Lee, Eric Kam-Pui ; Wong, Samuel Yeung-Shan ; Leung, Shuk-Yun ; Yan, Byran P. ; Yu, Esther Yee-Tak

BackgroundThis trial assessed the feasibility of titrating evening dosing of anti-hypertensive medications based on nighttime home blood pressure measurement (HBPM) readings in primary care for hypertensive (HT) patients.Methods78 patients with nocturnal HT and stage I daytime HT were randomly assigned in a 1:1 ratio to either nighttime HBPM measurements (intervention group) or daytime HBPM measurements (control group). Nighttime blood pressure (BP) was measured 3x per night for at least two nights over 1 week using an automatic and validated HBPM device. The intervention group and control group aimed to achieve systolic BP <120 mmHg on nocturnal HBPM and systolic BP <135 mmHg on daytime HBPM respectively. All patients were seen every four weeks and followed the same drug titration algorithm.ResultsThe trial achieved a recruitment rate of 6.5 persons per month and a retention rate of 96.1%. In the intervention group, patients provided ≥6 (considered adequate) and ≥9 nighttime HBPM readings for 77.5% and 63.8% of their follow-ups, respectively. At 6-month, both groups had similar nighttime, 24-hour, and daytime BP on ambulatory BP monitoring, as well as similar numbers of non-dippers and healthcare utilisation. Most patients reported that they learned more from their HBPM nighttime readings and found the intervention well-tolerated.ConclusionAdjusting evening dosage of anti-HT medications based on nighttime HBPM is a potential and feasible treatment approach for patients with nocturnal HT in primary care. This approach is well-accepted by patients and results in at least non-inferior BP control. Although titrating medications according to nighttime HBPM readings may improve nighttime BP, the small sample size limited statistical significance and the single-centre design restricted generalizability. Additionally, a few patients exhibited fair adherence to nighttime HBPM. Further randomised controlled trials are required to confirm that targeting nocturnal BP should be the primary treatment goal for HT.

08 Apr 2025·Hong Kong Medical Journal

Spread of ‘space oil drug’ (etomidate) abuse in Hong Kong and consequent emergency department presentations

Letter

Author: Tse, ML ; Wong, Irene NK ; Chan, CK

04 Mar 2025·Pain Management

Informal caregivers’ burden and chronic pain in older adults: a dyadic study unveiling the correlation and its impact

Article

Author: Lo, Raymond S. K. ; Lee, Paul H. ; Tse, Mimi Mun Yee ; Cheung, Daphne Sze Ki ; Tang, Angel Shuk Kwan ; Lou, Vivian ; Tse, Percy Poo-See ; Ng, Shamay Sheung Mei ; To, Kin Pong

BACKGROUND AND AIMSOlder adults' chronic pain care includes assisting with daily activities and exercise. But the informal caregivers have stated different challenges in the caring process. This study aims to explore the chronic pain situations of older adults, the burden of their informal caregivers, and the correlation between the severity of chronic pain in older adults and the level of burden experienced by their caregivers.METHODSA total of 150 older adults (mean age: 65.44) with chronic pain and 150 informal caregivers (mean age: 41.06) were recruited for this study. Older adults completed the brief pain inventory and pain self-efficacy questionnaire. Depression, anxiety, stress, and activities of daily living were assessed. Informal caregivers also completed the caregiver burden inventory.RESULTS150 informal caregivers completed the questionnaire. The mean caregiver burden score was 3.73, positively associated with pain conditions and emotional tolls in older adults.CONCLUSIONThe findings highlight the need for healthcare professionals to address the physical and emotional burdens experienced by informal caregivers. Healthcare professionals should investigate the caregiver burden. Comprehensive support strategies should be developed to enhance the well-being of both older adults and their caregivers, ultimately improving pain management and quality of life.

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