Could you tell us something about yourself and your unit?

I am a physician specialized in Internal Medicine and Arterial Hypertension, with a strong academic background in undergraduate medical education. I currently serve as a teaching assistant in the Chairs of Applied Pharmacology and Internal Medicine C and D at the Faculty of Medical Sciences, National University of La Plata. (Fig. 1)

Fig. 1: Julian Minetto, MD.
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Specialist in Internal Medicine and Arterial Hypertension. Specialist in University Teaching. Member of the Cardiometabolic Diseases Unit, Hospital Interzonal General de Agudos “San Martín”, La Plata. Faculty member at the Faculty of Medical Sciences, Chairs of Applied Pharmacology and Internal Medicine C and D, National University of La Plata.

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In parallel, I conduct my clinical and research activities at the Hospital Interzonal General de Agudos “José de San Martín” in La Plata, within the Cardiometabolic Disease Unit, where patient care and clinical research are closely integrated. Both institutions are fully supported and funded by the public health and education systems.

I am also a full member of the Argentine Society of Arterial Hypertension.

Although the Cardiometabolic Disease Unit has developed several research projects, its primary mission is clinical care. Nevertheless, outside regular working hours, many members of the unit—such as Dr. Walter Espeche, Martín Salazar, Gustavo Cerri, and the rest of the team—devote substantial additional time and effort to conducting research activities.

Our main research areas focus on arterial hypertension and ambulatory blood pressure monitoring (ABPM), both in the general population and in specific clinical settings. One of our core lines of investigation involves hypertension during pregnancy, as well as nocturnal and masked hypertension.

Why did you undertake this research?

Isolated nocturnal hypertension is a phenomenon that we observed to be relatively frequent in our population, with an estimated prevalence of approximately 13% [1], and with highly relevant diagnostic and prognostic implications related to cardiovascular risk [2].

Moreover, this increased cardiovascular risk may play a determinant role in particularly vulnerable populations, such as people living with HIV [3], patients with diabetes [4], chronic kidney disease [5], and other high-risk groups.

However, the pathophysiology of isolated nocturnal hypertension has not yet been fully elucidated. While some mechanisms have been proposed—such as dysregulation of the renin–angiotensin system [6]—other authors have suggested that sleep disturbance during ABPM might artificially increase nocturnal blood pressure values, thereby affecting patient classification. For this reason, our study aimed to specifically evaluate this potential association.

What did you learn from this research?

Through this study, we learned that the presence of isolated nocturnal hypertension is not associated with self-reported sleep disturbance or sleep duration on the night of ABPM recording. Understanding this relationship is crucial, as it supports the concept that isolated nocturnal hypertension has genuine pathophysiological and prognostic significance, rather than being a mere artifact related to the ABPM procedure itself.

Could you expand on the significance of your findings?

This cross-sectional study included 2297 individuals (57% women, mean age 49.5 ± 15 years) who underwent ambulatory blood pressure monitoring to assess the relationship between isolated nocturnal hypertension and sleep quality. As a secondary objective, we also evaluated the association between nocturnal blood pressure levels and sleep quality and duration.

Sleep quality and duration were primarily assessed using the Pittsburgh Sleep Quality Index (PSQI) and the STOP-BANG questionnaire. Overall, 64% of participants exhibited poor sleep quality (PSQI > 5), and 18.7% reported sleeping less than 6 h per night. No significant differences in sleep quality were observed across hypertension phenotypes.

Isolated nocturnal hypertension was associated with older age, diabetes, and increased waist circumference. However, neither sleep quality nor sleep duration emerged as independent determinants of this condition. Although nocturnal blood pressure showed a slight association with sleep quality, the magnitude of this relationship was minimal and unlikely to be clinically relevant. (Fig. 2)

Fig. 2: Graphical abstract: Isolated nocturnal hypertension and its association with sleep duration and quality.
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INH isolated nocturnal hypertension, ABPM ambulatory blood pressure measurements, BP blood pressure, PSQI Pittsburgh Sleep Quality Index.

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Can you tell us about any research your currently undertaking that is related to the paper?

We are currently evaluating the prognostic impact of isolated nocturnal hypertension, particularly in high-risk pregnant women—a population in which we have previously conducted research demonstrating the strong prognostic value of nocturnal blood pressure compared with daytime values in predicting maternal–fetal complications [7].

We strongly believe that nocturnal blood pressure averages are essential for the accurate classification of hypertension phenotypes and for proper prognostic assessment. Several of these studies are currently in the publication process.

In addition, we are conducting an interventional research program involving an interdisciplinary collaboration with physical education professionals. Within our Cardiometabolic Disease Unit, which includes an integrated gym facility, we are carrying out a clinical trial comparing two exercise protocols—isometric strength training versus high-intensity interval training (HIIT)—to assess their differential effects on nocturnal blood pressure reduction in patients with isolated nocturnal hypertension.