Reproducibility of Nocturnal Blood Pressure Reduction Rate and the Prevalence of "Non-Dippers" Using 48-Hour Ambulatory Blood Pressure Monitoring in Patients with Essential Hypertension (original) (raw)
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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.
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.
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.
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.
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...
Circadian variations in blood pressure in health and disease: implications for patient management
ChronoPhysiology and Therapy, 2011
Traditionally, blood pressure measurements have been performed in office settings and have provided the basis for all diagnostic and therapeutic decisions. However, the development of a clinically relevant 24-hour blood pressure monitoring system has added greatly to the ability of blood pressure values to confer additional clinical information, including prognostic value. Mechanistically, the circadian rhythm of blood pressure is mediated by a complex process as a part of the neurohormonal cascade. Pattern recognition of blood pressure peaks and troughs over a 24-hour period has led to categorization into specific subsets namely, ie, dippers, nondippers, extreme dippers, and reverse dippers. Cardiovascular risk is associated with certain pattern types, as has been demonstrated in large observational and prospective studies. The development of therapies for the purpose of restoring more pathological patterns to normal ones continues to grow. These include both pharmaceutical and device therapy. This article describes the development of 24-hour blood pressure monitoring systems, the identification of circadian blood pressure patterns, and the treatment strategies studied thus far which affect these newer blood pressure parameters.
The Diurnal Blood Pressure Profile: A Population Study
American Journal of Hypertension, 1992
This population study included 399 subjects, of whom 370 (93%) showed a significant diurnal blood pressure (BP) rhythm. The nocturnal BP fall was normally distributed and averaged 16 ± 9 mm Hg systolic and 14 ± 7 mm Hg diastolic (mean ± SD). The amplitude of the diurnal BP curve followed a positively skewed distribution, with a mean of 16 ± 5 mm Hg for systolic BP and 14 ± 4 mm Hg for diastolic BP. The daily BP maximum occurred at 15:54 ± 4:47 for systolic BP and at 15:11 ± 4:20 for diastolic BP. Thirty-four subjects were reexamined after a median interval of 350 days. The test for the presence of a significant diurnal rhythm was discordant in only two subjects. Repeatability (twice the standard deviation of the differences between paired recordings expressed as a percentage of the mean) varied from 11 to 25% for the 24 h, daytime, and overnight BP, and from 76 to 138% for the parameters describing the diurnal BP rhythm. In nine subjects with an initial night/day ratio of mean BP < 0.78, the nighttime BP was significantly increased at the repeat examination, whereas the opposite tendency was observed in nine subjects with an initial ratio > 0.87. In conclusion, the distribution of the nocturnal BP fall is unimodal. The reproducibility of the ambulatory BP is satisfactory for the level of BP and for the presence of a diurnal BP rhythm, but not for the parameters of the diurnal BP curve. Thus, one 24 h recording is insufficient to fully characterize an individual's diurnal BP profile. Am J Hypertens 1992;5:386-392 KEY WORDS: Ambulatory blood pressure, diurnal blood pressure profile, nocturnal blood pressure fall.
Journal of Human Hypertension, 2004
while 59 (21.3%) showed a nondipping pattern. Among 37 dipper patients with 420% of nocturnal systolic BP decrease (extreme dippers), only 16 (43.2%) had this marked fall in BP on the second ABPM. Of the 136 patients who had a nondipping pattern on the first ABPM, 92 (67.6%) confirmed their initial profile on the second ABPM, while 44 (32.4%) did not. Patients with reproducible nondipping profile were older (48712 years) than those with reproducible dipping profile (44712 years, Po0.05). These findings indicate that: (1) short-term reproducibility of nocturnal fall in BP in untreated middleaged hypertensives is rather limited: overall, one-fourth of patients changed their initial dipping patterns when they were studied again after a few weeks; (2) this was particularly true for extreme dipping and nondipping patterns; (3) abnormalities in nocturnal BP fall, assessed by a single ABPM, cannot be taken as independent predictors of increased cardiovascular risk.
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.