The relationship between serum albumin levels and 24-h ambulatory blood pressure monitoring recordings in non-diabetic essential hypertensive patients

Abstract

OBJECTIVES:The goal of this study was to evaluate the relationship between serum albumin levels and 24-hour ambulatory blood pressure monitoring (24-h ABPM) recordings in non-diabetic essential hypertensive patients.METHODS:A total of 354 patients (mean [SD] age: 55.5 [14.3] years, 50% females) with essential hypertension and 24-h ABPM recordings were included. Patient 24-h nighttime and daytime ABPM values, systolic and diastolic dipping status and average nocturnal dipping were recorded. The correlations between serum albumin levels and nocturnal systolic and diastolic dipping were evaluated, and correlates of average nocturnal systolic dipping were determined via a linear regression model.RESULTS:Overall, 73.2% of patients were determined to be non-dippers. The mean (SD) levels of serum albumin (4.2 [0.3] g/dL vs. 4.4 [0.4] g/dL, p<0.001) and the average nocturnal systolic (15.2 [4.8] mmHg vs. 0.3 [6.6] mmHg, p<0.001) and diastolic dipping (4.2 [8.6] mmHgvs. 18.9 [7.0] mmHg, p<0.001) were significantly lower in non-dippers than in dippers. A significant positive correlation was noted between serum albumin levels and both systolic (r=0.297, p<0.001) and diastolic dipping (r=0.265, p<0.001). The linear regression analysis revealed that for each one-unit increase in serum albumin, the average nocturnal dip in systolic BP increased by 0.17 mmHg (p=0.033).CONCLUSION:Our findings indicate an association between serum albumin levels and the deterioration of circadian BP rhythm among essential hypertensive patients along with the identification of a non-dipper pattern in more than two-thirds of patients. Our findings emphasize the importance of serum albumin levels, rather than urinary albumin excretion, as an independent predictor of nocturnal systolic dipping, at least in non-diabetic essential hypertensive patients with moderate proteinuria.

Circadian Rhythms, Exercise, and Cardiovascular Health

“…If circadian misalignment becomes chronic, ongoing elevation of blood pressure poses a risk factor for the development of CVD [2334]. During the regular day/night pattern that follows a circadian rhythmicity, blood pressure drops during nocturnal sleep compared to diurnal wakefulness, which contributes to decreased stress to the cardiovascular system [353637]. The nocturnal decrease in blood pressure compared to diurnal blood pressure is called “dipping” [353637].…”

“…During the regular day/night pattern that follows a circadian rhythmicity, blood pressure drops during nocturnal sleep compared to diurnal wakefulness, which contributes to decreased stress to the cardiovascular system [353637]. The nocturnal decrease in blood pressure compared to diurnal blood pressure is called “dipping” [353637]. Nocturnal blood pressure that decreases by 10% to 20% of diurnal blood pressure levels is indicative of the dipping response [3637].…”

“…Nocturnal blood pressure that decreases by 10% to 20% of diurnal blood pressure levels is indicative of the dipping response [3637]. Non-dippers, or those who do not exhibit the dipping response, are defined as having nocturnal blood pressure that decreases by less than 10% compared to diurnal blood pressure [35363839]. …”

“…Compared to dippers, non-dippers have increased cardiovascular risk, including complications such as CVD and higher mortality [353637] as well as greater complications for individuals already diagnosed with hypertension [3538]. In individuals 60 years and older, increased systolic blood pressure accompanied by decreased diastolic blood pressure leads to increased pulse pressure and decreased dipping response at night [40].…”

“…These circadian variations of blood pressure in the elderly population lead to an increased risk of developing CVD [4142]. Consequently, ambulatory blood pressure monitoring (ABPM) that tracks changes in blood pressure both diurnally and nocturnally can improve prediction of cardiovascular morbidity and mortality [354344]. …”