AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Intermittent Hypoxia and Peak Nocturnal Home Blood Pressure Derived from Multi-Night Monitoring on Incident Stroke: Insights from the J-HOP Study
By KINOSHITA M, Mizuno H, Kabutoya T et al.
Background: Elevated nocturnal blood pressure (BP) is an established risk factor for stroke. Intermittent hypoxia associated with sleep-disordered breathing (SDB) may contribute to nocturnal BP elevation. Although peak nocturnal BP derived from multi-night home BP monitoring may better reflect these BP elevations than mean nocturnal BP, the combined impact of intermittent hypoxia and elevated peak nocturnal BP on stroke risk remains unclear. Hypothesis:Individuals with both elevated intermittent hypoxia and elevated peak nocturnal BP would have a higher risk of incident stroke independent of mean nocturnal BP. Methods: We analyzed 857 participants from the Japan Morning Surge-Home Blood Pressure (J-HOP) Study who underwent both home nocturnal BP monitoring and assessment of SDB. Peak nocturnal home systolic BP (SBP) was measured using a validated home BP device and dichotomized at the median value (125.3 mmHg). Intermittent hypoxia was classified according to a 3% oxygen desaturation index (3%ODI) ≥15 events/hour assessed by overnight pulse oximetry. Participants with both elevated 3%ODI and elevated peak nocturnal home SBP were classified as the combined-risk group (n=77); all others served as the reference group (n=780). The primary endpoint was incident stroke. Kaplan-Meier and Cox proportional hazards analyses were performed. Composite cardiovascular events (stroke and coronary artery disease [CAD]) and four-group analyses stratified by 3%ODI and peak nocturnal SBP were evaluated exploratorily. Results: The mean age was 63.2±10.9 years, 48.0% were women, and mean and peak nocturnal home SBP were 122.9±14.1 and 126.8±14.7 mmHg, respectively (8.9±4.1 monitoring days; 3 measurements/night at 2, 3, and 4 AM). During a median follow-up of 6.2 years, 25 stroke and 19 CAD events occurred. The combined-risk group showed a significantly higher cumulative incidence of stroke than the reference group (8/77 vs. 17/780 events; log-rank P<0.001. Figure 1). This association remained significant after adjustment for age, sex, BMI, and mean nocturnal home SBP (adjusted HR 3.13, 95% CI 1.25-7.87, P=0.015). In contrast, the association with composite cardiovascular events (44 events) was attenuated and no longer significant after multivariable adjustment. Exploratory four-group analyses showed a graded increase in stroke risk, with the highest risk among participants with both elevated 3%ODI and elevated peak nocturnal home SBP; however, one subgroup had no stroke events, limiting estimate stability. Conclusions: The coexistence of intermittent hypoxia and elevated peak nocturnal home SBP was associated with incident stroke independent of mean nocturnal home SBP level. Assessment of peak nocturnal BP derived from multi-night home BP monitoring may provide incremental value for stroke risk stratification beyond mean nocturnal BP in individuals with SDB.