Published online before print January 26, 2009, doi: 10.1161/HYPERTENSIONAHA.108.124008
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(Hypertension. 2009;53:466.)
© 2009 American Heart Association, Inc.
Original Articles |
Prevalence and Factors Associated With Circadian Blood Pressure Patterns in Hypertensive Patients
From the Hypertension Unit (A.d.l.S.), Hospital Clínic, University of Barcelona, Barcelona, Spain; Hypertension Unit, Hospital Clínico (J.R.), University of Valencia and Centro de Investigación Biomédica au Red (CIBER) of Obesity and Nutritional Disorders, Valencia, Spain; Department of Preventive Medicine and Public Health (J.R.B., J.J.d.l.C.), Autonomous University and CIBER of Epidemiology and Public Health, Madrid, Spain; Hypertension Unit (J.Segura, L.M.R.), Hospital 12 de Octubre, Madrid, Spain; Instituto Auxológico (G.P.), Hospital San Genaro, Milan, Italy; Department of Nephrology (M.G.), Hospital San Agustín, Avilés, Spain; Department of Medicine (J.Sobrino), Hospital de L’Espirit Sant, Santa Coloma de Gramanet, Spain; Centro de Salud Ingeniero Benlloch (J.L.L.), Valencia, Spain; Centro de Salud Sillería (J.A.), Toledo, Spain; Centre d’Atenció Primaria La Mina (E.V.), Barcelona, Spain; Unidad de Vigilancia de la Salud (V.P.), Unión de Mutuas, Castellón, Spain; Instituto de Salud Carlos III (A.S.), Madrid, Spain; and Hypertension Unit (P.A.), Hospital Carlos Haya, Málaga, Spain.
Correspondence to Alejandro de la Sierra, Hypertension Unit, Department of Internal Medicine, Hospital Clínic, Villarroel 170, E-08036 Barcelona, Spain. E-mail asierra{at}clinic.ub.es
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 <10% 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 (P<0.001). 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.
Key Words: circadian blood pressure pattern • nocturnal blood pressure dip • cardiovascular risk factors • ambulatory blood pressure monitoring • hypertension
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