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Sutherland K, Dissanayake HU, Trzepizur W, Gagnadoux F, Cistulli PA. Circadian blood pressure profile and blood pressure changes following oral appliance therapy for obstructive sleep apnoea. J Hypertens 2021; 39:2272-2280. [PMID: 34149014 DOI: 10.1097/hjh.0000000000002914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Oral appliance therapy for obstructive sleep apnoea (OSA) reduces blood pressure (BP) but there is little information on relationship to circadian BP pattern (nocturnal BP dipping or non-dipping). The aims of this study were to determine whether nocturnal dipping pattern influences BP changes following oral appliance therapy, and to determine the effect of oral appliance therapy on circadian BP pattern. METHODS Participants in two randomized trials of oral appliance therapy (1-2 months) with 24-h ambulatory BP monitoring (ABPM) data were included (N = 152). Nocturnal BP Dippers (nocturnal/diurnal SBP ratio <0.9) and non-dippers were compared for BP changes following oral appliance therapy and the effect of oral appliance therapy on nocturnal BP dipping was assessed. RESULTS Of 152 participants, 64.5% were dippers. Dippers were on average younger and less likely to be hypertensive (42 vs. 82.7%, P < 0.001). Nondippers showed greater reduction in nocturnal BP measures, related to higher BP measures at baseline. There was no difference in the relationship between treatment effectiveness and BP changes between groups. Oral appliance therapy converted only 23% of baseline non-dippers to a nocturnal dipping profile. CONCLUSION Baseline circadian BP profile influenced the BP response to oral appliance therapy, largely because of higher baseline BP in the non-dipper subgroup. Oral appliance therapy did not convert OSA patients to a more favourable circadian BP profile. Further work is required to understand the effect of oral appliance therapy on circadian BP profile and of the individuals who will receive cardiovascular benefit from oral appliance therapy.
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Affiliation(s)
- Kate Sutherland
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Wojciech Trzepizur
- University of Angers, INSERM UMR 1063 'SOPAM'
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
| | - Frederic Gagnadoux
- University of Angers, INSERM UMR 1063 'SOPAM'
- Department of Respiratory and Sleep Medicine, University Hospital of Angers, Angers, France
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Burgos-Alonso N, Ruiz Arzalluz MV, Garcia-Alvarez A, Fernandez-Fernandez de Quincoces D, Grandes G. Reproducibility study of nocturnal blood pressure dipping in patients with high cardiovascular risk. J Clin Hypertens (Greenwich) 2021; 23:1041-1050. [PMID: 33591600 PMCID: PMC8678773 DOI: 10.1111/jch.14222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/09/2021] [Accepted: 01/25/2021] [Indexed: 12/31/2022]
Abstract
It has been shown that in most people there is a physiological reduction in blood pressure during nighttime sleep, it falling by approximately 10% compared to daytime values (dippers). On the other hand, in some people, there is no nighttime reduction (non‐dippers). Various studies have found an association between being a non‐dipper and a higher risk of cardiovascular disease, but few have assessed whether the nocturnal pattern is maintained over time. From the database of the TAHPS study, data were available on 225 patients, each of whom underwent 24‐hour ambulatory blood pressure monitoring (ABPM) on four occasions over a period of 5 months. We studied the reproducibility of the nocturnal BP dipping pattern with mixed linear analysis and also calculated the concordance in the classification of patients as dippers or non‐dippers. The intraclass correlation coefficients between the different ABPM recordings were 0.482 and 0.467 for systolic and diastolic blood pressure, respectively. Two‐thirds (67%) and 70% of the patients classified, respectively, as dippers or non‐dippers based on systolic and diastolic blood pressure readings in the first ABPM recording were found to have the same classification based on the subsequent recordings. We conclude that the reproducibility of nocturnal dipping patterns and concordance of dipper vs non‐dipper status in individual patients is modest and therefore that we should be cautious about recommending treatments or interventions based on these patterns.
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Affiliation(s)
- Natalia Burgos-Alonso
- Primary Care Research Unit of Bizkaia, BioCruces Bizkaia Health Research Institute, Bilbao, Spain.,Preventive Medicine and Public Health Department, Faculty of Medicine and Nursery. University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Maria Victoria Ruiz Arzalluz
- Primary Care Research Unit of Bizkaia, BioCruces Bizkaia Health Research Institute, Bilbao, Spain.,Tolosaldea Health Region, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Arturo Garcia-Alvarez
- Primary Care Research Unit of Bizkaia, BioCruces Bizkaia Health Research Institute, Bilbao, Spain
| | | | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, BioCruces Bizkaia Health Research Institute, Bilbao, Spain
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Bursztyn M. Daytime napping and ambulatory blood pressure monitoring: Relevancy in Asian populations. J Clin Hypertens (Greenwich) 2017; 19:1246-1248. [PMID: 28942606 DOI: 10.1111/jch.13080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Michael Bursztyn
- Hypertension Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel
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Zhang J, Wang C, Gong W, Ye Z, Tang Y, Zhao W, Peng H, Lou T. Poor sleep quality is responsible for the nondipper pattern in hypertensive but not in normotensive chronic kidney disease patients. Nephrology (Carlton) 2016; 22:690-698. [PMID: 27283003 DOI: 10.1111/nep.12839] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 11/27/2022]
Abstract
AIM This study was designed to evaluate the relationship between sleep quality and hypertension and to determine if there was an association between nondipper blood pressure (BP) and sleep quality in chronic kidney disease (CKD) patients. METHODS A total of 775 pre-dialysis CKD patients (314 normal BP patients, 461 hypertension patients) defined as dippers or nondippers by ambulatory BP monitoring were recruited for this study. Demographics and clinical correlates were collected, including body mass index, estimated glomerular filtration rate (eGFR) and other measures. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). RESULTS A total of 185 (58.9%) patients with normal BP and 341 (74.0%) hypertensive patients had a nondipper BP pattern. The hypertension group had a higher prevalence of the nondipper BP pattern, smoking, alcohol intake and diabetes mellitus (DM) and lower eGFR levels and poorer sleep quality than the normal BP group. Patients with the nondipper BP pattern had lower haemoglobin, worse renal function and poorer sleep quality when compared with hypertensive CKD patients with the dipping BP pattern. PSQI scores were significantly associated with the rate of nocturnal BP decline (P < 0.05) in the hypertension group but not in the normal BP group. Poor sleep quality was an independent factor affecting BP pattern in hypertensive CKD patients using multivariate linear and logistic regression analyses. There was no association between sleep quality and hypertension in CKD patients after multivariate logistic regression analyses. CONCLUSION Poor sleep quality, which is commonly observed in pre-dialysis CKD patients, is an independent associated factor of the nondipper BP pattern in hypertensive CKD patients. No association was found between poor sleep and nondipper BP in normotensive patients.
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Affiliation(s)
- Jun Zhang
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Cheng Wang
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenyu Gong
- Division of Nephrology, Department of medicine, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Zengchun Ye
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ying Tang
- Division of Nephrology, Department of medicine, Second Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wenbo Zhao
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Hui Peng
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Tanqi Lou
- Division of Nephrology, Department of medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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Bursztyn M. Left Ventricular Hypertrophy in Hypertension and Nocturnal Blood Pressure. J Clin Hypertens (Greenwich) 2015; 17:914-5. [PMID: 26176341 PMCID: PMC8031968 DOI: 10.1111/jch.12602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michael Bursztyn
- Hypertension UnitDepartment of MedicineHadassah‐Hebrew University Medical CenterJerusalemIsrael
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Johnson JA, Key BL, Routledge FS, Gerin W, Campbell TS. High trait rumination is associated with blunted nighttime diastolic blood pressure dipping. Ann Behav Med 2015; 48:384-91. [PMID: 24706074 PMCID: PMC4223575 DOI: 10.1007/s12160-014-9617-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Blunted blood pressure (BP) dipping during nighttime sleep has been associated with an increased risk of cardiovascular events. Psychological traits have been associated with prolonged cardiovascular activation and a lack of cardiovascular recovery. This activation may extend into nighttime sleep and reduce BP dipping. Purpose This study aims to evaluate the association between trait rumination and nighttime BP dipping. Methods Sixty women scoring either high or low on trait rumination underwent one 24-h ambulatory BP monitoring session. Self-reported wake and sleep times were used to calculate nighttime BP. Results High trait rumination was associated with less diastolic blood pressure (DBP) dipping relative to low trait rumination. Awake ambulatory BP, asleep systolic blood pressure (SBP) and DBP, and asleep SBP dipping were not associated with trait rumination. Conclusions In a sample of young women, high trait rumination was associated with less DBP dipping, suggesting that it may be associated with prolonged cardiovascular activation that extends into nighttime sleep, blunting BP dipping.
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Affiliation(s)
- Jillian A Johnson
- Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, Alberta, T2N 1N4, Canada
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Cuspidi C, Giudici V, Negri F, Sala C. Nocturnal nondipping and left ventricular hypertrophy in hypertension: an updated review. Expert Rev Cardiovasc Ther 2014; 8:781-92. [DOI: 10.1586/erc.10.29] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Kontaraki JE, Marketou ME, Zacharis EA, Parthenakis FI, Vardas PE. Differential expression of vascular smooth muscle-modulating microRNAs in human peripheral blood mononuclear cells: novel targets in essential hypertension. J Hum Hypertens 2013; 28:510-6. [PMID: 24284386 DOI: 10.1038/jhh.2013.117] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/18/2013] [Accepted: 10/10/2013] [Indexed: 12/11/2022]
Abstract
Vascular smooth muscle cell (VSMC) phenotypic plasticity has a critical role in the pathophysiology of arterial remodeling in essential hypertension. MicroRNAs are emerging as potential biomarkers and therapeutic targets in cardiovascular disease. We assessed the expression levels of the microRNAs miR-143, miR-145, miR-21, miR-133 and miR-1, which are implicated in VSMC phenotypic modulation, in 60 patients with essential hypertension and 29 healthy individuals. All patients underwent 24-h ambulatory blood pressure (BP) monitoring. MicroRNA levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. Hypertensive patients showed lower miR-143 (2.20±0.25 versus 4.19±0.57, P<0.001), miR-145 (13.51±1.73 versus 22.38±3.31, P=0.010) and miR-133 (8.15±1.32 versus 37.03±8.18, P<0.001) and higher miR-21 (3.08±0.32 versus 2.06±0.31, P=0.048) and miR-1 (33.94±5.19 versus 12.35±2.13 P=0.006) expression levels compared with controls. In hypertensive patients, we observed correlations of miR-143 (r = -0.380, P=0.003), miR-145 (r=-0.405, P=0.001), miR-21 (r=-0.486, P<0.001) and miR-133 (r=0.479, P<0.001) expression levels with 24-h diastolic BP. Furthermore, we observed correlations of miR-21 (r=-0.291, P=0.024), miR-1 (r=-0.312, P=0.015) and miR-133 (r=0.310, P=0.016) levels with the dipping status. Associations of miR-143 (r=-0.292, P=0.025), miR-145 (r=-0.399, P=0.002), miR-21 (r=-0.343, P=0.008) and miR-133 (r=0.370, P=0.004) levels with 24-h mean pulse pressure were also found. Our data provide important evidence that VSMC-modulating microRNAs are closely related to essential hypertension in humans and they may represent potential therapeutic targets in essential hypertension.
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Affiliation(s)
- J E Kontaraki
- Molecular Cardiology Laboratory, School of Medicine, University of Crete, Heraklion, Greece
| | - M E Marketou
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | - E A Zacharis
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | - F I Parthenakis
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | - P E Vardas
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
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Hinderliter AL, Routledge FS, Blumenthal JA, Koch G, Hussey MA, Wohlgemuth WK, Sherwood A. Reproducibility of blood pressure dipping: relation to day-to-day variability in sleep quality. ACTA ACUST UNITED AC 2013; 7:432-9. [PMID: 23850195 DOI: 10.1016/j.jash.2013.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/04/2013] [Accepted: 06/08/2013] [Indexed: 01/19/2023]
Abstract
Previous studies of the reproducibility of blood pressure (BP) dipping have yielded inconsistent results. Few have examined factors that may influence day-to-day differences in dipping. Ambulatory BP monitoring was performed on three occasions, approximately 1 week apart, in 115 untreated adult subjects with elevated clinic BPs. The mean ± standard deviation BP dip was 18 ± 7/15 ± 5 mm Hg (sleep/awake BP ratio = 0.87 ± 0.05/0.82 ± 0.06), with a median (interquartile range) day-to-day variation of 5.2 (3.1-8.1)/4.3 (2.8-5.6) mm Hg. There was no decrease in variability with successive measurements. The reproducibility coefficient (5.6 [95% confidence interval, 5.1-6.1] mm Hg) was greater and the intraclass correlation coefficient (0.53 [95% confidence interval, 0.42-0.63]) was smaller for the systolic dip than for 24-hour or awake systolic BPs, suggesting greater day-to-day variability in dipping. Variability in systolic dipping was greater in subjects with higher awake BP, but was not related to age, gender, race, or body mass index. Within individuals, day-to-day variations in dipping were related to variations in the fragmentation index (P < .001), a measure of sleep quality. Although mean 24-hour and awake BPs were relatively stable over repeated monitoring days, our study confirms substantial variability in BP dipping. Day-to-day differences in dipping are related to sleep quality.
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Affiliation(s)
| | - Faye S Routledge
- Duke University Medical Center, Durham, NC; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | | | - Gary Koch
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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Wuerzner G, Bochud M, Zweiacker C, Tremblay S, Pruijm M, Burnier M. Step count is associated with lower nighttime systolic blood pressure and increased dipping. Am J Hypertens 2013; 26:527-34. [PMID: 23467208 DOI: 10.1093/ajh/hps094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Higher nighttime blood pressure (BP) and the loss of nocturnal dipping of BP are associated with an increased risk for cardiovascular events. However, the determinants of the loss of nocturnal BP dipping are only beginning to be understood. We investigated whether different indicators of physical activity were associated with the loss of nocturnal dipping of BP. METHODS We conducted a cross-sectional study of 103 patients referred for 24-hour ambulatory monitoring of BP. We measured these patients' step count (SC), active energy expenditure (AEE), and total energy expenditure simultaneously, using actigraphs. RESULTS In our study population of 103 patients, most of whom were hypertensive, SC and AEE were associated with nighttime systolic BP in univariate (SC, r = -0.28, P < 0.01; AEE, r = -0.20, P = 0.046) and multivariate linear regression analyses (SC, coefficient beta = -5.37, P < 0.001; AEE, coefficient beta = -0.24, P < 0.01). Step count was associated with both systolic (r = 0.23, P = 0.018) and diastolic (r = 0.20, P = 0.045) BP dipping. Nighttime systolic BP decreased progressively across the categories of sedentary, moderately active, and active participants (125mm Hg, 116mm Hg, 112mm Hg, respectively; P = 0.002). The degree of BP dipping of BP increased progressively across the same three categories of activity (respectively 8.9%, 14.6%, and 18.6%, P = 0.002, for systolic BP and respectively 12.8%, 18.1%, and 22.2%, P = 0.006, for diastolic BP). CONCLUSIONS Step count is continuously associated with nighttime systolic BP and with the degree of BP dipping independently of 24-hour mean BP. The combined use of an actigraph for measuring indicators of physical activity and a device for 24-hour measurement of ambulatory BP may help identify patients at increased risk for cardiovascular events in whom increased physical activity toward higher target levels may be recommended.
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Affiliation(s)
- Gregoire Wuerzner
- Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland.
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Short-term reproducibility of ambulatory blood pressure monitoring in autosomal dominant polycystic kidney disease. Blood Press Monit 2011; 16:47-54. [PMID: 21415814 DOI: 10.1097/mbp.0b013e328344c6f3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Nondipping, defined as a less than 10% decline in Night:Day (N:D) ratio of blood pressure using 24 h ambulatory blood pressure monitoring, is associated with poor cardiovascular outcomes. However, its reproducibility has been questioned in autosomal dominant polycystic kidney disease. MATERIALS AND METHODS Twenty-five of 29 recruited hypertensive or prehypertensive patients with autosomal dominant polycystic kidney disease completed ambulatory blood pressure monitoring on two occasions, 7-15 days apart, on a stable antihypertensive regimen. Daytime and night-time were defined as 6:00-21:59 h and 22:00-5:59 h, respectively. Correlation and concordance coefficients for systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate were determined based on N:D and Asleep:Awake (A:A) ratios. Consistency of dipping was assessed by using Cohen's Kappa statistics. RESULTS Mean (±standard deviation) for age, estimated glomerular filtration rate, differences in daytime and night-time SBP and DBP were 43.12 years (8.55 years), 63.1 ml/min (20.5 ml/min), 11.74 mmHg (8.2 mmHg), and 10.82 mmHg (6.4 mmHg), respectively. Seventeen of 25 (68%) and 18 of 25 (72%) participants maintained the same dipping category based on D:N or A:A separation. Cohen's Kappa was 0.34 for D:N ratio and 0.38 for A:A ratio. Correlation and concordance coefficients were 0.89 and 0.88 for daytime SBP, 0.91 and 0.91 for daytime DBP, 0.79 and 0.78 for night-time SBP, 0.81 and 0.80 for night-time DBP, 0.58 and 0.56 for N:D ratio of SBP, and 0.56 and 0.53 for N:D ratio of DBP. Coefficients for A:A ratio were almost identical to N:D values except for A:A ratios of SBP (0.69 and 0.67) and DBP (0.48 and 0.45). CONCLUSION Repeated measures of SBP and DBP, 7-15 days apart, are highly correlative and concordant in the studied population, but nondipping, even though predominant, was found to be modestly reproducible.
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O'Brien E. Twenty-four-hour ambulatory blood pressure measurement in clinical practice and research: a critical review of a technique in need of implementation. J Intern Med 2011; 269:478-95. [PMID: 21281363 DOI: 10.1111/j.1365-2796.2011.02356.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This review presents evidence that ambulatory blood pressure measurement (ABPM) should be used more widely in clinical practice and hypertension research. The technique, which should be mandatory in trials of antihypertensive drugs, is not being used in all studies of antihypertensive drug efficacy. ABPM is also being under-used in outcome studies. The failure to implement ABPM in primary care and hypertension research is impeding patient management and scientific advancement. ABPM offers so many advantages in assessing the efficacy of blood pressure (BP)-lowering drugs that it should be mandatory in pharmacological trials. Likewise, the technique provides a means of achieving BP control in clinical practice, which is essential if we are to halt the epidemic of the cardiovascular consequences of hypertension. However, if ABPM is to be implemented for these purposes, certain requirements will need to be fulfilled. These include the availability of accurate, patient-friendly and inexpensive devices; standardization of the presentation and plotting of data with summary statistics for day-to-day practice; provision of comprehensive data analysis for research; an interpretative report to facilitate use in busy clinical practice; a trend report to demonstrate efficacy or otherwise of treatment in clinical practice and online transmission of data to provide immediate real-time data analysis. The reasons why ABPM is not being implemented are reviewed, and proposals are made to make the technique more acceptable.
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Affiliation(s)
- E O'Brien
- Department of Molecular Pharmacology, The Conway Institute, University College Dublin, Dublin, Ireland
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Sturgeon KM, Fenty-Stewart NM, Diaz KM, Brinkley TE, Dowling TC, Brown MD. The relationship of oxidative stress and cholesterol with dipping status before and after aerobic exercise training. Blood Press 2010; 18:171-9. [PMID: 19544106 DOI: 10.1080/08037050903047160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the effects of aerobic exercise training (AEXT) on dipping status in pre-hypertensive and stage-1 hypertensive individuals. A secondary purpose was to evaluate whether AEXT alters oxidative stress and endothelial biomarkers correlated to dipping status. METHODS Twenty-three subjects underwent 24-h ambulatory blood pressure monitoring at baseline and after 6 months of AEXT. AEXT consisted of training at 70% VO(2max) 3 days/week for 6 months. Total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein (LDL)-cholesterol, oxidized LDL (ox-LDL), triglycerides, urinary and plasma nitric oxide end-products, superoxide dismutase and 8-iso-PGF(2alpha) were measured before and after AEXT. Statistically, ANOVA and linear regression were used. RESULTS Before and after AEXT, there were no significant differences between dippers and non-dippers in any of the biomarkers except for total cholesterol following AEXT. In a sub-analysis following AEXT, 14 subjects retained their original dipping status, five subjects changed from dippers to non-dippers and four subjects changed from non-dippers to dippers. Significant differences existed between these groups in changes in total and LDL-cholesterol, ox-LDL, 8-iso-PGF(2alpha) and % Dip. CONCLUSIONS Changes in cholesterol levels but not oxidative stress or endothelial biomarkers were related to changes in BP variables following AEXT in dippers and non-dippers.
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Affiliation(s)
- Kathleen M Sturgeon
- Hypertension, Molecular and Applied Physiology Laboratory, Department of Kinesiology, Temple University, Philadelphia, Pennsylvania 19122, USA
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Van Berge-Landry HM, Bovbjerg DH, James GD. The reproducibility of ethnic differences in the proportional awake-sleep blood pressure decline among women. Am J Hum Biol 2010; 22:325-9. [PMID: 19844896 DOI: 10.1002/ajhb.20993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A growing body of evidence indicates that African Americans (AA), on average, have a smaller proportional decline in blood pressure (BP) from waking to sleep than European Americans (EA), but this difference is largely based on correlational data from a single assessment day. The persistence of this difference over repeated sampling is not well established. The purpose of this study was to evaluate whether ethnic differences in the awake-sleep BP decline between AA and EA persisted over three monthly assessments. The subjects were 47 AA (age = 39.7 +/- 8.7) and 92 EA (age = 37.4 +/- 9.2) normotensive women. Subjects had 24-h ambulatory BP monitoring done on midweek workdays at 1-month intervals for three consecutive months. The proportional decline in BP was calculated as follows: (average awake - average sleep)/average sleep. The persistence of ethnic differences was evaluated using repeated-measures ANCOVA and by examining Bland-Altman plots. The ANCOVA results revealed that overall, the proportional decline of AA women was less than that of EA women for both SBP (P < 0.038) and DBP (P < 0.083), consistent with previous research, and that there were also no significant ethnic differences by monthly assessment. Bland-Altman plots revealed that overall and by ethnicity, the proportional decline in BP among individual subjects over the 3 months was also reproducible. These results suggest that the ethnic difference in awake-sleep BP between AA and EA women persists over time and that the awake-sleep decline in BP among individuals, whether AA or EA, is also reproducible.
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Affiliation(s)
- Helene M Van Berge-Landry
- Institute for Primary and Preventative Health Care, Department of Anthropology, Binghamton University, PO Box 6000, Binghamton, NY 13902-6000, USA.
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Abstract
OBJECTIVE To investigate whether an association exists between experiences of everyday discrimination and blood pressure (BP) dipping in a biracial sample of black and white adults. Attenuated nocturnal BP dipping is closely linked to cardiovascular morbidity and mortality. Self-reported experiences of everyday discrimination have also been associated with negative cardiovascular health outcomes. METHODS Seventy-eight hypertensive and normotensive women and men (n = 30 black and 48 white) reported on their experiences of everyday discrimination (Everyday Discrimination Scale) and underwent two separate 24-hour ambulatory BP monitoring (ABPM) sessions approximately 1 week apart. RESULTS Correlation analysis revealed that higher endorsement of everyday discrimination was significantly associated with less diastolic BP (DBP) and systolic BP (SBP) dipping (p < .05). Subsequent hierarchical regression analyses indicated that everyday discrimination explained 8% to 11% of the variance in SBP and DBP dipping above and beyond other demographic and life-style-related factors, including race, age, 24-hour BP, body mass index, and current socioeconomic status. The relationship between discrimination and dipping was significantly stronger on the second night of monitoring. Finally, analyses revealed that everyday discrimination mediated the relationship between race and BP dipping. CONCLUSIONS These findings suggest that experiences of everyday discrimination are associated with less nocturnal SBP and DBP dipping above and beyond the effect of known covariates. The use of multiple ABPM sessions may facilitate the detection of relationships between psychological variables and BP dipping.
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Yilmaz MB, Yalta K, Turgut OO, Yilmaz A, Yucel O, Bektasoglu G, Tandogan I. Sleep quality among relatively younger patients with initial diagnosis of hypertension: Dippers versus non‐dippers. Blood Press 2009; 16:101-5. [PMID: 17612908 DOI: 10.1080/08037050701343225] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sleep is a basic physiological process. Normal sleep yields decrease in sympathetic activity, blood pressure (BP) and heart rate. Those, who do not have expected decrease in their BP are considered "non-dippers". We aimed to determine if there was any association between the non-dipping status and sleep quality, designed a cross-sectional study, and enrolled and evaluated the sleep quality of relatively young patients with an initial diagnosis of hypertension. METHODS Seventy-five consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients had newly diagnosed with stage 1 hypertension. Patients with a prior use of any anti-hypertensive medication were not included. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI), which has an established role in evaluating sleep disturbances. All patients underwent ambulatory BP monitoring. RESULTS There were 42 non-dipper patients (mean age = 47.5+/-11.9 years, 24 male/18 female), as a definition, 31 dipper hypertensive patients (mean age = 48.5+/-12.8 years, 21 male/10 female) and two with white coat hypertension. Daytime systolic and diastolic mean BPs were not significantly different between the two groups. Night-time mean systolic and diastolic BPs were significantly higher in non-dippers compared with dippers. PSQI scores, globally, were significantly higher in non-dippers compared with dippers. Total PSQI score was not correlated with body mass index. It was noticed that, individually, sleep quality, sleep efficiency and sleep disturbance scores were significantly higher in non-dippers. Being a poor sleeper in terms of high PSQI score (total score>5) was associated with 2.955-fold increased risk of being a non-dipper (95% confidence interval 1.127-7.747). CONCLUSION We showed that the risk of having non-dipping hypertension, a risk factor for poor cardiovascular outcomes among hypertensive individuals, was tripled (odds ratios) among poor sleepers. We think that evaluating sleeping status and sleep quality among the hypertensive population may help unmask non-dipper hypertension, enabling physicians to treat appropriately.
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Affiliation(s)
- Mehmet Birhan Yilmaz
- Cumhuriyet University, Faculty of Medicine, Department of Cardiology, Sivas, Turkey.
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Spruill TM, Gerin W, Ogedegbe G, Burg M, Schwartz JE, Pickering TG. Socioeconomic and psychosocial factors mediate race differences in nocturnal blood pressure dipping. Am J Hypertens 2009; 22:637-42. [PMID: 19325537 DOI: 10.1038/ajh.2009.58] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Reduced nocturnal blood pressure (BP) dipping is more prevalent among blacks living in the United States than whites and is associated with increased target organ damage and cardiovascular risk. The primary aim of this study was to determine whether socioeconomic and psychosocial factors help to explain racial differences in dipping. In order to address the limited reproducibility of dipping measures, we investigated this question in a sample of participants who underwent multiple ambulatory BP monitoring (ABPM) sessions. METHODS The study sample included 171 black and white normotensive and mildly hypertensive participants who underwent three ABPM sessions, each 1 month apart, and completed a battery of questionnaires to assess socioeconomic and psychosocial factors. RESULTS As expected, blacks showed less dipping than whites, after adjusting for age, sex, body mass index (BMI), and mean 24-h BP level (mean difference = 3.3%, P = 0.002). Dipping was related to several of the socioeconomic and psychosocial factors examined, with higher education and income, being married, and higher perceived social support, each associated with a larger dipping percentage. Of these, marital status and education were independently associated with dipping and together accounted for 36% of the effect of race on dipping. CONCLUSIONS We identified a number of socioeconomic and psychosocial correlates of BP dipping and found that reduced dipping among blacks vs. whites is partially explained by marital status (being unmarried) and lower education among blacks. We also present results suggesting that repeated ABPM may facilitate the detection of associations between dipping and other variables.
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Yontar OC, Erdem A, Yilmaz MB. Sleep quality in patients with hypertension: additional negative effect of drug therapy. Sleep Med 2009; 10:1168; author reply 1168-9. [PMID: 19467925 DOI: 10.1016/j.sleep.2009.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Accepted: 04/16/2009] [Indexed: 10/20/2022]
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Different classifications of nocturnal blood pressure dipping affect the prevalence of dippers and nondippers and the relation with target-organ damage. J Hypertens 2008; 26:691-8. [PMID: 18327078 DOI: 10.1097/hjh.0b013e3282f4225f] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We assessed how different definitions of the awake and asleep periods and use of various blood pressure (BP) indices affect the extent of the nocturnal BP dip, the prevalence of dippers and nondippers, their respective reproducibilities and the relation of nondipping with target-organ damage. METHODS We performed 24-h ambulatory BP monitoring twice and determined the left ventricular mass index and urinary albumin excretion as indices of target-organ damage in 150 hypertensive patients (off-medication). Awake and asleep periods were assessed using fixed and diary time methods, covering all readings available (wide) or excluding morning and evening transition hours (narrow). Nondipping (BP dip < 10%) was established for systolic BP and diastolic BP, their combinations (and/or), and mean arterial pressure. RESULTS The different awake-asleep definitions caused significant variation in both the extent of the BP dip and the number of dippers and nondippers in comparison with the wide diary definition (i.e. use of actual awake and sleep periods). The prevalences of dippers and nondippers also varied significantly with the BP index. Reproducibility analyses of the BP dip and the dipping status yielded repeatability coefficients (expressed as percentages of nearly maximal variation) between 42.39 and 48.71%, and kappa values between 0.323 and 0.459, respectively. Some classifications, but not all, discriminated significantly between consistent dippers and nondippers in terms of left ventricular mass index or urinary albumin excretion. CONCLUSIONS Use of different definitions of awake-asleep and BP indices affects significantly the classification of nocturnal BP dipping and its relation with hypertensive target-organ damage.
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Pulse pressure or dipping pattern: which one is a better cardiovascular risk marker in resistant hypertension? J Hypertens 2008; 26:878-84. [PMID: 18398329 DOI: 10.1097/hjh.0b013e3282f55021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Nocturnal blood pressure (BP) reduction and ambulatory pulse pressure (PP) are well known prognostic markers obtained from ambulatory BP monitoring (ABPM). The aim of this study is to investigate which one of these ABPM parameters is related to high cardiovascular risk profile in resistant hypertension, based on their associations with target organ damage (TOD). METHODS Clinical-demographic, laboratory and ABPM variables were recorded in a cross-sectional study involving 907 resistant hypertensive patients. Nocturnal systolic BP reduction and 24-h PP were assessed both as continuous and dichotomized variables (PP at the upper tertile value: 63 mmHg). Statistical analyses included bivariate tests and multivariate logistic regression with each TOD as the dependent variable. RESULTS Patients with the nondipping pattern and high 24-h PP shared some characteristics: they were older, had higher prevalence of cerebrovascular disease and nephropathy, higher office and 24-h BP levels, increased serum creatinine and microalbuminuria, and higher left ventricular mass index than their counterparts. Additionally, patients with high PP had a greater prevalence of diabetes and other TOD. In multivariate logistic regression, high PP was independently associated with all TODs even after adjustment for sex, age, BMI, cardiovascular risk factors, 24-h mean arterial pressure and antihypertensive treatment, whereas nondipping pattern was only associated with hypertensive nephropathy. Furthermore, PP was more strongly associated with the number of TOD than the nocturnal systolic blood pressure (SBP) fall. CONCLUSIONS In a large group of resistant hypertensive patients, an increased 24-h PP shows a closer correlation with high cardiovascular risk profile than the nocturnal BP reduction.
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Abstract
OBJECTIVE To examine the prognostic significance of early socioeconomic status (SES) on 24-hour blood pressure (BP) during early adulthood. Low SES has been related to poor health outcomes, in particular, cardiovascular morbidity and mortality. Recent cross-sectional research has also linked low levels of SES with several cardiovascular risk factors including poor nighttime BP dipping. METHODS A total of 174 undergraduate university students whose childhood SES was assessed by highest level of education completed by their parents underwent 24-hour ambulatory BP monitoring. RESULTS Initial correlation analyses revealed positive associations between childhood SES and BP dipping, indicating that lower levels of childhood SES were associated with less systolic BP (SBP) (r = .29, p < .01) and diastolic BP (DBP) dipping (r = .38, p < .01). A stepwise multiple regression analyses indicated that childhood SES explained 6.9% of the variance in SBP dipping and 11.5% of the variance in DBP dipping above and beyond other lifestyle-related factors including daytime BP, body mass index, alcohol use, smoking, and current SES. CONCLUSIONS These findings suggest that irrespective of adult achievement, childhood SES may have lasting health implications.
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Linear relationship between systolic and diastolic blood pressure monitored over 24 h: assessment and correlates. J Hypertens 2008; 26:199-209. [DOI: 10.1097/hjh.0b013e3282f25b5a] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Day-night blood pressure variations: mechanisms, reproducibility and clinical relevance. J Hypertens 2008; 25:2377-80. [PMID: 17984656 DOI: 10.1097/hjh.0b013e3282f2d116] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ben-Dov IZ, Kark JD, Ben-Ishay D, Mekler J, Ben-Arie L, Bursztyn M. Predictors of All-Cause Mortality in Clinical Ambulatory Monitoring. Hypertension 2007; 49:1235-41. [PMID: 17389258 DOI: 10.1161/hypertensionaha.107.087262] [Citation(s) in RCA: 293] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prognostic value of sleep blood pressure reported by recent studies is variable. Our aim was to examine the relationship of sleep blood pressure, measured by 24-hour ambulatory blood pressure monitoring, with all-cause mortality. We studied a cohort of 3957 patients aged 55+/-16 (58% treated) referred for ambulatory monitoring (1991-2005). Sleep, including daytime sleep, was recorded by diary. Linkage with the national population register identified 303 deaths during 27 750 person-years of follow-up. Hazard ratios (HRs) for mortality in Cox proportional hazards models that included age, sex, hypertension, and diabetes treatment were 1.32 (95% CI: 0.99 to 1.76) for awake hypertension (>or=135/85 mm Hg), and 1.67 (95% CI: 1.25 to 2.23) for sleep hypertension (>or=120/70 mm Hg). By quintile analysis, the upper fifths of systolic and diastolic dipping during sleep were associated with adjusted HRs of 0.58 (95% CI: 0.41 to 0.82) and 0.68 (95% CI: 0.48 to 0.96), respectively. In a model controlling for awake systolic blood pressure, hazards associated with reduced systolic dipping increased from dippers (>10%; HR: 1.0), through nondippers (0% to 9.9%; HR: 1.30; 95% CI: 1.00 to 1.69) to risers (<0%; HR: 1.96; 95% CI: 1.43 to 2.96). Thus, in practice, ambulatory blood pressure predicts mortality significantly better than clinic blood pressure. The availability of blood pressure measures during sleep and, in particular, the pattern of dipping add clinically predictive information and provide further justification for the use of ambulatory monitoring in patient management.
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Affiliation(s)
- Iddo Z Ben-Dov
- Nephrology and Hypertension Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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O'Brien E. The circadian nuances of hypertension: a reappraisal of 24-h ambulatory blood pressure measurement in clinical practice. Ir J Med Sci 2007; 176:55-63; discussion 65-6. [PMID: 17453322 DOI: 10.1007/s11845-007-0022-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 02/14/2007] [Indexed: 10/23/2022]
Abstract
Ambulatory blood pressure measurement has been in use in clinical practice for nearly half a century. However, despite the benefits the technique brings to managing patients with hypertension it is much under-used in practice. The purpose of this review is to examine critically the information that can be derived from the technique and to highlight the application of this evidence in clinical practice.
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Affiliation(s)
- E O'Brien
- Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.
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Ben-Dov IZ, Ben-Arie L, Mekler J, Bursztyn M. How should patients treated with alpha-blockers be followed? Insights from an ambulatory blood pressure monitoring database. J Hypertens 2006; 24:861-5. [PMID: 16612247 DOI: 10.1097/01.hjh.0000222755.69358.72] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Adrenergic alpha-antagonists have been suggested to confer lesser protection, compared to diuretics, when used as first agents for hypertension. While differences in clinic blood pressure may be partly responsible, this inferiority is unexpected in light of the metabolic advantages of alpha-blockade. The aim of this study was to evaluate the relationship between use of alpha-blockers and blood pressure dipping. METHODS A database of a 24-h ambulatory monitoring service was cross-sectionally evaluated for associations between antihypertensives and dipping. There were 681 treated subjects during a 3-year period (age 63 +/- 14, 57% female). RESULTS Overall, 78 of 681 treated hypertensive subjects used alpha-blockers (11%). Nine per cent of dippers and 16% of nondippers were treated with alpha-blockade, odds ratio 2.0. Whereas clinic, 24-h, and awake blood pressures were similar in alpha-blocker users and nonusers, sleep blood pressure was significantly higher in the former group. Furthermore, significantly fewer subjects given alpha-blockers had a controlled sleep blood pressure. Among alpha-blocker nonusers sleep blood pressure was the best controlled category, whereas in alpha-blocker users manual blood pressure had the highest rate of control. Generally, accounting for covariates of alpha-blockade (age, gender, diabetes, total number of medications) did not influence the above-mentioned trends. Finally, a limited negative dose-response relationship between alpha-blockade and dipping magnitude was also noticed. CONCLUSIONS We found a significant negative association between adrenergic alpha-blockade and the magnitude of sleep-related blood pressure decline. Awaiting results from interventional studies, this may suggest a need to perform ambulatory monitoring in patients given alpha-blocking agents (or at least supine and standing measurements), and may partially clarify the inferiority of doxazosin in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
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Affiliation(s)
- Iddo Z Ben-Dov
- Department of Internal Medicine, Hadassah - Hebrew University Medical Center, Mount-Scopus Campus, Jerusalem 91240, Israel.
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Ben-Dov IZ, Bursztyn M. Daytime sleeping and night-time urinating obscure normal dipping. Nephrol Dial Transplant 2005; 21:226-7. [PMID: 16204295 DOI: 10.1093/ndt/gfi139] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Iddo Z Ben-Dov
- Hadassah-Hebrew University Medical Center, Department of Internal Medicine, P.O.Box 24035, Jerusalem, Israel, 91240.
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