The Diurnal Blood Pressure Profile: A Population Study (original) (raw)
Related papers
American Journal of Hypertension, 2000
An absent or diminished blood pressure (BP) fall during sleep (so-called "nondipping") has been associated with a higher risk of cardiovascular complications, but the long-term reproducibility of dipper status and the relationship between diurnal changes in BP and perceived sleep quality have not been previously documented in untreated hypertensive patients. Ambulatory BP (ABP) and dipping status were examined in 79 subjects (69 hypertensives and 10 normotensives) at 0, 6, and 12 months. Fifty-six percent of subjects had no change in their dipping status, the majority (53%) dipping normally on all three occasions. However, 44% of patients had variable dipping status, and normal nighttime dipping in BP was observed more often when patients perceived their sleep quality to be good during the period of ABP recording. These results highlight significant intrasubject variability in the diurnal fluctuations in ABP and dipper status, which may in part reflect day-today variations in sleep disturbance during ABP monitoring. Classifying hypertensive patients into dippers or nondippers on the basis of a single ABP recording is unreliable and potentially misleading.
Nocturnal blood pressure fall on ambulatory monitoring in a large international database
1997
A wide range of definitions is used to distinguish subjects in whom blood pressure (BP) falls at night (dippers) from their counterparts (nondippers). In an attempt to standardize the definition of nondipping, we determined the nocturnal BP fall and night-day BP ratio by 24-hour ambulatory monitoring in 4765 normotensive and 2555 hypertensive subjects from 10 to 99 years old. In all subjects combined, the systolicldiastolic nocturnal fall and corresponding ratio averaged ('SD)-16.7t 11.01-13.628.1 mm Hg and 87.258.0%183.1f 9.6%, respectively. In normotensive subjects, the 95th percentiles were-0.31-1.1 mm Hg for the nocturnal fall and 99.7%198.3% for the night-day ratio. Both the fall and ratio showed a curvilinear correlation with age. The smallest fall and largest ratio were observed in older (2 7 0 years) subjects. A higher BP on conventional sphygmomanometry was associated with a larger systolic (partial r=.l l) and diastolic (r=.12) nocturnal BP fall. The diastolic (r=.O8) but not the systolic night-day ratio increased with higher conventional BP. The nocturnal BP fall was larger and the corresponding night-day ratio smaller in oscillometric (n=5884) than in auscultatory (n=1436) recordings, in males (n=3730) than in females (n=3590), and in Europe (n=4556) than in the other continents (n=2764). The distributions of the nocturnal BP fall and night
Journal of Hypertension, 2004
Objectives To assess quantitatively the relationship between nocturnal blood pressure (BP) fall and 24-h BP variability; to propose a new method for computing 24-h BP variability, devoid of the contribution from nocturnal BP fall; and to verify the clinical value of this method. Methods and results We analysed 3863 ambulatory BP recordings, and computed: (1) the standard deviation (SD) of 24-h BP directly from all individual readings and as a weighted mean of daytime and night-time SD (wSD); and (2) the size of nocturnal BP fall. Left ventricular mass index (LVMI) was assessed by echocardiography in 339 of the patients. The 24-h SD of BP was significantly greater than the 24-h wSD. Nocturnal BP fall was strongly and directly related to 24-h SD, the relationship with 24-h wSD being much weaker and inverse. The difference between SD and wSD was almost exclusively determined by the size of nocturnal BP fall. wSD of systolic BP was significantly related to LVMI, while 24-h SD was not. Conclusion Conventional 24-h SD of BP is markedly influenced by nocturnal BP fall. The weighted 24-h SD of BP removes the mathematical interference from night-time BP fall and correlates better with end-organ damage, therefore it may be considered as a simple index of 24-h BP variability superior to conventional 24-h SD.
Limited Reproducibility of Circadian Variation in Blood Pressure Dippers and Nondippers
American Journal of Hypertension, 1998
The relation between blood pressure (BP) variation and hypertensive organ damage is controversial. The reproducibility of the circadian variation pattern acceptable as the standard for discriminating between ''dippers'' and ''nondippers'' has not yet been evaluated. We evaluated the reproducibility of ''dipper'' and ''nondipper'' patterns in essential hypertensives by monitoring BP for 48 h. Noninvasive ambulatory BP and heart rate (HR) monitoring for 48 h every 30 min were performed in 253 untreated patients with mild-to-moderate essential hypertension. Mean daytime (awake) and nighttime (sleeping) systolic BP, diastolic BP, and HR values were analyzed by reviewing the patients' diaries. Patients were divided into two groups by presence (dippers) and absence (nondippers) of a reduction of both systolic and diastolic BP during the night of > 10% of the daytime pressure. A subject who was a dipper on day 1 remained a dipper on day 2 in 41% (n ؍ 103, DD group) and changed to nondipper in 16% (n ؍ 41, DN group). A subject who was a nondipper on day 1 remained a nondipper on day 2 in 30% (n ؍ 75, NN group) and changed to a dipper in 13% (n ؍ 34, ND group). Our findings indicate that there is a high risk of false-positive or false-negative results when 24-h recordings are used to identify dipper and nondipper profiles.
Repeated Assessment of the Endogenous 24-HOUR Profile of Blood Pressure Under Constant ROUTINE1*
Chronobiology International, 2001
The impact of environmental and behavioral factors on the 24-h profile of blood pressure (BP) has been well established. Various attempts have been made to control these exogenous factors, in order to investigate a possible endogenous circadian variation of BP. Recently, we reported the results of the first environmentally and behaviorally controlled laboratory study with 24-h recordings of BP and heart rate (HR) during maintained wakefulness. In this constant-routine study, a pronounced endogenous circadian rhythm of HR was found, but circadian variation of BP was absent. This result suggested that the circadian rhythm of BP observed in earlier controlled studies, with sleep allowed, was evoked by the sleep-wake cycle as opposed to the endogenous circadian pacemaker. In order to verify our previous finding during maintained wakefulness, we repeated the experiment five times with six normotensive, healthy young subjects. Statistical analyses of the hourly measurements of BP and HR confirmed the replicable presence of an endogenous circadian rhythm * We dedicate this paper to the memory of Dr. Dolf Bobbert.
Circadian Blood Pressure Profile and Associated Cardiovascular Risk Factors in Non-Dippers
2020
Introduction: Ambulatory blood pressure accurately reflects a patient's actual blood pressure than casual or office blood pressure. This study aims to describe the circadian blood pressure profile of hypertensive patients and to identify the associated cardiovascular risk factors in non-dippers. Methods: A cross-sectional study was conducted from 1st January 2008 to 30th June 2008 among hypertensive patients attending Family Medicine Clinic HUSM. Schiller BR-102 plus was used to get 24 hours blood pressure (BP) reading. Mean of two offices BP were also taken. Non-dippers are defined as a systolic or diastolic nocturnal drop of less than 10%. Analysis was done using SPSS Version 12. Results: 105 patients were recruited with mean (SD) age of 51.8 (9.34) year old. The mean (SD) 24-hour systolic and diastolic BP was 128.4 (12.7) mmHg and 79.7 (8.74) mmHg respectively. Mean (SD) daytime systolic and diastolic BP was 132.1 (11.72) mmHg and 82.4 (9.41) mmHg while for the night time were 123.3 (12.78) mmHg and 76.2 (9.01) mmHg. Mean (SD) systolic and diastolic office BP was 144.2(15.16) mmHg and 90.2(9.71) mmHg. Percentage of non dippers were 68.6% for systolic and 61.9% for diastolic. Conclusion: Mean 24 hours and daytime ambulatory BP was normal but the mean night time diastolic and office BP was above-normal value. Majority of the patients were categorized as non dippers. Therefore, using ambulatory BP is clinically important to get a better understanding of blood pressure fluctuations over 24-hour periods compared to simple clinical measurements.
Prevalence and Factors Associated With Circadian Blood Pressure Patterns in Hypertensive Patients
Hypertension, 2009
Ambulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In addition to 24-hour values, the circadian variation of BP adds prognostic significance in predicting cardiovascular outcome. However, the magnitude of circadian BP patterns in large studies has hardly been noticed. Our aims were to determine the prevalence of circadian BP patterns and to assess clinical conditions associated with the nondipping status in groups of both treated and untreated hypertensive subjects, studied separately. Clinical data and 24-hour ambulatory BP monitoring were obtained from 42 947 hypertensive patients included in the Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry. They were 8384 previously untreated and 34 563 treated hypertensives. Twenty-four-hour ambulatory BP monitoring was performed with an oscillometric device (SpaceLabs 90207). A nondipping pattern was defined when nocturnal systolic BP dip was Ͻ10% of daytime systolic BP. The prevalence of nondipping was 41% in the untreated group and 53% in treated patients. In both groups, advanced age, obesity, diabetes mellitus, and overt cardiovascular or renal disease were associated with a blunted nocturnal BP decline (PϽ0.001). In treated patients, nondipping was associated with the use of a higher number of antihypertensive drugs but not with the time of the day at which antihypertensive drugs were administered. In conclusion, a blunted nocturnal BP dip (the nondipping pattern) is common in hypertensive patients. A clinical pattern of high cardiovascular risk is associated with nondipping, suggesting that the blunted nocturnal BP dip may be merely a marker of high cardiovascular risk. (Hypertension. 2009;53:466-472.) Key Words: circadian blood pressure pattern Ⅲ nocturnal blood pressure dip Ⅲ cardiovascular risk factors Ⅲ ambulatory blood pressure monitoring Ⅲ hypertension Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz.
Diurnal blood pressure variation, risk categories and antihypertensive treatment
Hypertension Research, 2010
Ambulatory blood pressure (BP) monitoring is a useful tool aiding diagnostic and management decisions in patients with hypertension. Diurnal BP variation or circadian rhythm adds prognostic value to the absolute BP elevation. The Spanish ABPM Registry has collected information from 430 000 treated hypertensive patients attended by either primary care physicians or referral specialists. The analysis of BP diurnal variation has allowed the conclusion that nocturnal BP decline is related to the level of risk. Patients with blunted nocturnal dip frequently belong to high-or very high-risk categories and specifically are often older, obese, diabetics or with overt cardiovascular or renal disease. With respect to treatment, the non-dipper profile is more often observed in patients receiving several antihypertensive drug agents, but it does not correlate with the time of drug administration. Among patients receiving only one drug, non-dihydropyridine calcium channel blockers and a-blockers are associated with less nocturnal BP decline than other antihypertensive drug classes, even after adjusting for the level of risk.
Circadian variability and nocturnal dipping pattern in blood pressure in young normotensive subjects
Biological Rhythm Research, 2012
Blood pressure variability (BPV) is one of the recognized risk factors for different types of cardiovascular diseases (CVDs). Several physiological, behavioral and ethnic factors are known to modulate blood pressure (BP). Such studies on the population of southeast India are altogether absent. It is worthwhile, therefore, to examine the circadian variability in systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) and nocturnal dipping pattern in BP in apparently healthy human subjects as a function of gender. Sixty females and 40 males voluntarily participated in the study. All subjects wore an Ambulatory Blood Pressure Monitor (ABPM, TM 2430) for two to four consecutive days. SBP, DBP and HR was measured every 15 and 30 minutes between 07:00-22:00 and 22:00-07:00 hrs, respectively. In addition, double product (DP) and mean arterial pressure (MAP) were also computed. Data were analyzed using A&D, Cosinor and Spectre software. Prevalence of extreme dipper, dipper and nondipper was 13%, 63% and 24%, respectively. A statistically significant circadian rhythm was validated in all studied variables, irrespective of gender and dipping pattern in BP. However, the rhythm detection ratio was low among non-dippers. Chi-square test revealed a statistically significant association of the frequency of prominent periods of SBP and MAP with nocturnal dipping categories. Further, significant differences for the circadian Mesors of SBP, DBP, HR, DP and MAP and acrophase of DBP and MAP were noticed between males and females. Dipping pattern produced a significant effect on the rhythm characteristics of all the studied variables. On the basis of our findings we can conclude that variability in BP may be associated with factor gender to some extent, whereas nocturnal dipping in BP is independent of gender. Interestingly in the present study about 24% subjects are non-dippers, which may be an indication of higher risk of CVDs among individuals belonging to younger generation of this region. However, further extensive study is desirable to strengthen the above conjecture.