Diurnal rhythm of blood pressure among Nigerians with hypertension using 24-hour ambulatory blood pressure monitoring (original) (raw)
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Journal of the Postgraduate Institute of Medicine, 2017
Background and Objectives Ambulatory blood pressure monitoring (ABPM) is more reflective of an individual's blood pressure (BP) profile and its control, eliminating several confounding and contributory factors. This study looked at the circadian pattern of BP variation with respect to nocturnal BP fluctuations and compared clinic BP measurements with ambulatory readings in patients on treatment for essential hypertension Methods A prospective study was conducted at Teaching Hospital, Kandy from August to October 2015. The study participants were 100 patients, above 18 years of age, with stage I to III essential hypertension with normal renal functions and having no history of coronary or cerebro-vascular events. All patients underwent electrocardiography, 2D echocardiography, manual BP measurement and 24-hour ambulatory blood pressure monitoring. Results There was a female preponderance 72(72%) and the mean age was 61 ± 9 years. One third had uncontrolled BP, according to clinic BP readings, whereas 60% had uncontrolled BP according to ambulatory blood pressure monitoring. The agreement between the office BP and ABPM in diagnosing controlled or uncontrolled BP was low (58%, Kappa = 0.23). A significant statistical difference (p<0.001) was observed between day and night time measurements, irrespective of BP control. In the sample, 70% had abnormal dipping patterns including non-dipping (45%), reverse dipping (25%) and extreme dipping (5%). Conclusions and Recommendations ABPM is more reflective of an individual's naïve BP pattern. It captures the different types of diurnal variation of BP thus guiding the physician to treat the patient optimally. Moreover, its noninvasive and portable nature allows it to be used with ease. It is likely that ABPM will gather widespread recognition and acceptance as a more reliable diagnostic and prognostic tool in the future
Nocturnal blood pressure patterns in essential hypertensives: an over-looked cardiovascular burden
Ceylon Medical Journal, 2018
Introduction Understanding the diurnal variation of blood pressure (BP) is important in the management of hypertension. Objectives Primary objectives of the study were to analyse the pattern of nocturnal BP in patients with essential hypertension who are already on treatment. Methodology Cross-sectional descriptive study was conducted at cardiology unit Teaching Hospital Kandy, in 2015, in patients referred from the hypertensive clinic at Teaching Hospital Peradeniya. A consecutive sample of 100 essential hypertensives aged >18 years with stage I to III hypertension were included. Patients with a history of previous ischemic heart disease or cerebro-vascular events were excluded. Twenty-four-hour ambulatory blood pressure monitoring was performed in all patients after complete clinical evaluation. Results Sample size was 100. Mean age was 60.86 ± 8.73 years. Twenty eight were male. In the sample 32 had normal dipping patterns. Out of the 68 with abnormal dipping, 45 had sub-optimal dipping, 19 had reverse dipping and 4 had extreme dipping. There were 72 patients with nocturnal hypertension, of them 29 (39.7%) had isolated nocturnal hypertension. Conclusion A high prevalence of abnormal dipping, nocturnal hypertension and isolated nocturnal hypertension among our sample of patients with essential hypertension. Therefore, it is important to increase awareness and to consider ambulatory blood pressure monitoring to detect these abnormal nocturnal blood pressure variations.
Ethnicity & disease, 2013
Blood pressure variation throughout the day is known to have cardiovascular consequences. Left ventricular (LV) mass is more closely related to 24-hour blood pressure than casual blood pressure. Daytime blood pressure expectedly is higher than that of nighttime under normal circumstances. The effect of 24-hour blood pressure pattern on the left ventricular structure and function has not been examined in hypertensive Nigerians. The aim of our study was to assess the 24-hour blood pressure pattern and its relationship to the LV structure and function in newly diagnosed hypertensives in Nigeria. We hypothesized that 24-hour blood pressure was more related to left ventricular structure than casual blood pressure in hypertensive Nigerians. Cross-sectional study. The study was carried out at the Cardiology Unit of the Department of Medicine, University College Hospital, Ibadan, South West Nigeria. Three casual blood pressure measurements were taken, while the participants were resting, us...
Pakistan Heart Journal
Hypertension, a disease of epidemic proportion, is assessed by measuring blood pressure (BP). Various methods are employed, the most common being “clinic blood pressure measurement (CBPM).” However, environment and technical errors can confound it. Other methods include home blood pressure measurement (HBPM), which shows readings of awake time only, and 24-hour ambulatory blood pressure monitoring (ABPM). A recent technique that causes less sleep disturbance is “timed HBPM.” Blood pressure is a 24-hour phenomenon, and prognostically night time blood pressure, being more important, must be assessed properly. Besides providing the precise mean of 24-hour blood pressure, it extends knowledge regarding many other parameters of clinical importance like dipping pattern and morning surge etc. For nocturnal BP assessment, 24-hour ABPM and time-triggered HBPM are utilized. The importance of nocturnal blood pressure assessment for diagnostic and prognostic evaluation of various cardiovascular...
The Role of Nocturnal Blood Pressure and Sleep Quality in Hypertension Management
European Cardiology Review, 2020
The accurate measurement, prediction and treatment of high blood pressure (BP) are essential to the management of hypertension and the prevention of its associated cardiovascular (CV) risks. However, even if BP is optimally controlled during the day, nocturnal high blood pressure may still increase the risk of CV events. The pattern of circadian rhythm of BP can be evaluated by ambulatory BP monitoring (ABPM). Night-time ABPM is more closely associated with fatal and nonfatal CV events than daytime ambulatory BP. However, the use of ABPM is limited by low availability and the fact that it can cause sleep disturbance, therefore may not provide realistic nocturnal measurements. Home blood pressure monitoring (HBPM) offers an inexpensive alternative to ABPM, is preferred by patients and provides a more realistic assessment of BP during an individual’s daily life. However, until recently, HBPM did not offer the possibility to measure nocturnal (sleep time) BP. The development and valida...
Clinical Significance of the Blood Pressure Changes from Day to Night
Blood pressure (BP) decreases by 10% to 20% from day to night. However, in 25% to 35% of hypertensive subjects there is some reduction in the day-night BP decline. In 3% to 5% of uncomplicated hypertensive subjects there is actually an increase, not a decrease, in BP from day to night. Many studies from independent centers showed that not only left ventricular hypertrophy, but also ventricular arrhythmias, silent cerebrovascular disease, microalbuminuria and progression of renal damage are more advanced in subjects with blunted or abolished fall in BP from day to night than in those with normal day-night BP difference. There is also evidence from longitudinal studies that a blunted, abolished or even reversed BP drop from day to night is associated with an increase in the risk of serious cardiovascular complications. However, if the quantity or quality of sleep is poor during overnight BP monitoring, night-time BP rises and its prognostic significance is no longer reliable. Studies which compared the prognostic value of daytime BP with that of night-time BP inevitably found the superiority of the latter for predicting prognosis. The exciting potential therapeutic implication that the control of night-time BP could be more rewarding, in terms of prevention of cardiovascular disease, than that of daytime BP has yet to be addressed in appropriately designed intervention trials. Of note, 24-hour ABP monitoring is the only practical way to assess the day-night rhythm of BP.
Journal of Xiangya Medicine
Background: Hypertension is the most frequent cardiovascular risk factor worldwide, with the greatest burden in low-income settings. We sought to know if the serial blood pressure (BP) readings measured in a single encounter, alongside other cardiovascular risk factors could reliably make the diagnosis of hypertension in a group of sub-Saharan Africans. Methods: Between October and November 2016, we carried-out a cross-sectional descriptive and analytic study in Yaoundé, Cameroon. Adults of both sexes, aged ≥18 years were screened for cardiovascular risk factors using the WHO STEPwise approach. Participants with de novo elevated office BP underwent an ambulatory blood pressure measurement (ABPM) to ascertain hypertension. We then studied the determinants of ABPM diagnosed hypertension. Results: Of the 26 participants who had an ABPM, 23 (88.5%) had hypertension, and 3 (11.5%) had white coat hypertension (WCH). Of those with hypertension (n=22), 6 (27.3%) were dippers, 2 (9.1%) were extreme dippers, 9 (40.9%) were non-dippers, and 5 (22.7%) were reverse dippers. The three participants with White coat effect were non-dippers. The determinants of de novo hypertension on ABPM were:
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.
Journal of Hypertension, 2010
,g , on behalf of the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators M Background We and other investigators previously reported that isolated nocturnal hypertension on ambulatory measurement (INH) clustered with cardiovascular risk factors and was associated with intermediate target organ damage. We investigated whether INH might also predict hard cardiovascular endpoints. Methods and results We monitored blood pressure (BP) throughout the day and followed health outcomes in 8711 individuals randomly recruited from 10 populations (mean age 54.8 years, 47.0% women). Of these, 577 untreated individuals had INH (daytime BP <135/85 mmHg and night-time BP >-120/70 mmHg) and 994 untreated individuals had isolated daytime hypertension on ambulatory measurement (IDH; daytime BP >-135/ 85 mmHg and night-time BP <120/70 mmHg). During follow-up (median 10.7 years), 1284 deaths (501 cardiovascular) occurred and 1109 participants experienced a fatal or nonfatal cardiovascular event. In multivariable-adjusted analyses, compared with normotension (n U 3837), INH was associated with a higher risk of total mortality (hazard ratio 1.29, P U 0.045) and all cardiovascular events (hazard ratio 1.38, P U 0.037). IDH was associated with increases in all cardiovascular events (hazard ratio 1.46, P U 0.0019) and cardiac endpoints (hazard ratio 1.53, P U 0.0061). Of 577 patients with INH, 457 were normotensive (<140/90 mmHg) on office BP measurement. Hazard ratios associated with INH with additional adjustment for office BP were 1.31 (P U 0.039) and 1.38 (P U 0.044) for total mortality and all cardiovascular events, respectively. After exclusion of patients with office hypertension, these hazard ratios were 1.17 (P U 0.31) and 1.48 (P U 0.034). Conclusion INH predicts cardiovascular outcome in patients who are normotensive on office or on ambulatory daytime BP measurement.