Short- and Long-Term Reproducibility of Nighttime Blood Pressure Phenotypes and Nocturnal Blood Pressure Reduction.
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ABSTRACT:
SUBMITTER: Mancia G
PROVIDER: S-EPMC9634725 | biostudies-literature | 2021 May
REPOSITORIES: biostudies-literature
Publications
Short- and Long-Term Reproducibility of Nighttime Blood Pressure Phenotypes and Nocturnal Blood Pressure Reduction.
Mancia Giuseppe G Facchetti Rita R Bombelli Michele M Quarti-Trevano Fosca F Cuspidi Cesare C Grassi Guido G
Hypertension (Dallas, Tex. : 1979) 20210322 5
[Figure: see text]. ...[more]
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Project description:[Figure: see text].
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Project description:We investigated the optimal nighttime home blood pressure (BP) measurement schedule for wrist BP monitoring. Fifty hypertensive patients (mean age 68.9 ± 11.3 years) self-measured their nighttime BP hourly using a wrist-type nocturnal home BP monitoring device at home on two consecutive nights. Using the average 7.2 ± 1.5 measurements per night, we compared the clock-based index (average of three measurements at 2:00, 3:00, and 4:00 a.m.) and the bedtime-based index (average of three measurements at 2, 3, and 4 h after bedtime). The clock-based average was significantly higher than the bedtime-based average for both systolic BP (2.7 ± 8.2 mmHg, P = .002) and diastolic BP (1.9 ± 5.1 mmHg, P < .001). Compared to the average of all measurements throughout a night (the same definition of ambulatory BP monitoring, ie, from the time point of going to bed to awakening), the clock-based average was comparable (systolic/diastolic BP: -0.5 ± 5.5/-0.2 ± 3.7), whereas the bedtime-based average was significantly lower (-3.3 ± 5.0/-2.1 ± 3.6). Thus, the repeated measurement of wrist-measured nighttime BP at three clock-based time points per night provided reliable values. Further prospective studies of larger populations are required to confirm the optimal nighttime BP measurement schedule for wrist BP monitoring for the prediction of cardiovascular events.
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Project description:BackgroundElevated blood pressure (BP) is closely related to stroke and its subtypes. However, different time periods changes in BP may result in differential risk of stroke.HypothesisShort-term blood pressure changes have a more strong impact on stroke and its subtypes than long-term blood pressure changes.MethodsWe designed the study on the effects of short- (2008-2010) and long-term (2004-2010) BP changes on stroke events (2011-2017), including 22 842 and 28 456 subjects, respectively. The difference in β coefficients between short- and long-term BP changes on the effects of stroke were examined using the Fisher Z test.ResultsDuring a median 12.5-year follow-up period, 1014 and 1505 strokes occurred in short- and long-term groups. In short-term group, going from prehypertension to hypertension, the risk of stroke events increased (stroke: hazard ratio [HR] = 1.537 [1.248-1.894], ischemic stroke: 1.456 [1.134-1.870] and hemorrhagic stroke: 1.630 [1.099-2.415]); going from hypertension to prehypertension, the risk of stroke events decreased (stroke:0.757 [0.619-0.927] and hemorrhagic stroke:0.569 [0.388-0.835]). Similarly, in long-term group, going from prehypertension to hypertension, individuals had an increased risk of stroke (1.291, 1.062-1.569) and hemorrhagic stroke (1.818, 1.261-2.623); going from hypertension to prehypertension, participants had a decreased risk of stroke (0.825, 0.707-0.963) and hemorrhagic stroke (0.777, 0.575-0.949). Furthermore, the effects of BP changes during short-term period on stroke events were greater than that in long-term period.ConclusionsShort- and long-terms BP changes were both associated with the risk of stroke events. Furthermore, short-term BP changes had a stronger impact than did long-term changes on risk of stroke events.
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Project description:BackgroundNon-dipping or reverse dipping patterns are known to be associated with adverse cardiovascular prognosis among the general population and clinical cohort. Few large sized studies have explored factors including sleep duration and sleep quality related to nighttime blood pressure (BP) and nocturnal dipping patterns.MethodsAmong 5,360 patients enrolled in Korean multicenter nationwide prospective Registry of ambulatory BP monitoring (KORABP), 981 subjects with complete data on sleep duration, sleep quality assessed using a 4-point Likert scale, and clinical variables were included in the analysis. Phenotypes of nighttime BP pattern were categorized as extreme dipper, dipper, non-dipper, and reverse dipper. Hypertension was defined as a 24-h ambulatory BPs were 130/80 mmHg or higher.ResultsAmong 981 subjects, 221 were normotensive, 359 were untreated hypertensive, and 401 were treated hypertensive. Age of the participants were 53.87 ± 14.02 years and 47.1% were female. In overall patients, sleep duration was 431.99 ± 107.61 min, and one to four points of sleep quality were observed in 15.5%, 30.0%, 30.4%, and 24.2%, respectively. Of the 760 hypertensive patients, extreme dipper, dipper, non-dipper, and reverse dipper were observed in 58 (7.63%), 277 (36.45%), 325 (42.76%), and 100 (13.16%), respectively. In multiple linear regression analysis, sleep duration (β = 0.0105, p < 0.001) and sleep quality (β = -0.8093, p < 0.001) were associated with nighttime systolic BP and sleep quality was associated with extent of nighttime systolic BP dipping (β = 0.7622, p < 0.001) in hypertensive patients. In addition, sleep quality showed positive association with dipper pattern (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 1.03-1.30) and showed negative association with reverse dipper pattern (OR = 0.73, 95% CI = 0.62-0.86) in multiple logistic regression analyses.ConclusionWhen adjusted covariates, less sleep duration and poor sleep quality were positively associated with nighttime systolic BP. Additionally, sleep quality was the independent associated factor for dipper and reverse dipper phenotypes. The study also found that male sex, low estimated glomerular filtration rate, high ambulatory BP, low office BP, and poor sleep quality were associated with blunted nighttime SBP dipping.
| S-EPMC10391961 | biostudies-literature
Project description:BackgroundWe examined the reproducibility of differences in ambulatory blood pressure (BP) monitoring (ABPM) phenotypes and other parameters (sustained hypertension, masked hypertension, nocturnal hypertension, and nondipping) between African Americans and Whites.MethodsA total of 420 participants untreated for hypertension attended 2 research visits 1 week apart during which traditional office BP averages and ABPM session averages were determined. We computed percent agreement in ABPM phenotypes across the 2 visits stratified by race and associated kappa statistics with 95% confidence intervals.ResultsWhites on average were older, more likely to be male, and had a higher body mass index. There was no significant difference in sleep quality as defined by sleep diary between the 2 races. There were also no significant differences between races in the proportions of participants with sustained hypertension, sustained normotension, or masked hypertension at either testing session. The prevalence of nocturnal hypertension was 59% vs. 75% (P = 0.012) at session 1 and 59% vs. 73% (P = 0.024) at session 2 for Whites and African Americans, respectively, with moderate reproducibility for both (kappas 0.45 and 0.44). Nocturnal BP nondipping had a prevalence 29% vs. 53% (P < 0.001) at session 1 and 29% vs. 47% (P = 0.004) at session 2 for Whites and African Americans, respectively, with fair reproducibility (kappas 0.28 and 0.29).ConclusionsOur findings support that African Americans indeed exhibit a greater preponderance of abnormal nocturnal BP patterns than Whites. Our work is some of the first to demonstrate that these abnormal patterns are modestly reproducible.
| S-EPMC5861555 | biostudies-literature