High prevalence of non-dipping patterns among black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

Abstract

Background Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of anti-hypertensive therapy, and intensifying salt restriction. Objectives To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of three 6-months anti-hypertensive regimens on the dipping pattern among Black African hypertensive patients. Methods This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-hour ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures. Results The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium >140mmol/l (OR=1.72, 95% CI: 1.17–2.51, p-value 0.005), a higher office systolic BP (OR=1.03, 95% CI: 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR=0.97, 95% CI: 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar's χ2 0.71, p-value 0.40). Conclusion There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Fogarty International Center and the National Institutes of Health of the United States of America Figure 1

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…In an analysis from the CREOLE study, which included 721 Black people from sub-Saharan Africa between 30 and 79 years of age with uncontrolled hypertension and a baseline 24-h ambulatory BP monitoring, the prevalence of nondipping pattern was 78%. 117…”

Effect of 3, 2-Drug Combinations of Antihypertensive Therapies on Blood Pressure Variability in Black African Patients: Secondary Analyses of the CREOLE Trial

“…While nocturnal BP dipping may impact on 24-hour BP variability, 26 it is reassuring that 78% of CREOLE participants were classified as nondippers 27 and similar low degrees of dipping occurred across all 3 groups of patients. Consequently, we did not apply a weighted SD to adjust for night-time falls.…”

Effects of a high salt diet on blood pressure dipping and the implications on hypertension

“…These individuals are forced to consume a high salt diet due to their inability to access healthy, natural food options. A study by Ingabire et al further examined the rates of non-dipping patterns across ethnicities, and found that non-dippers were more likely to be African American, specifically, those with uncontrolled hypertension (Ingabire et al, 2021). Furthermore, African Americans were found to have a higher percentage of patients expressing a non-dipping pattern (Muntner et al, 2015).…”