Prevalence and clinical correlates of ambulatory blood pressure phenotypes in a Saudi hypertensive population

Abstract

International Guidelines recommend ambulatory blood pressure monitoring (ABPM) for the management of hypertension. ABPM phenotypes predict outcomes independent of office blood pressure (BP). The authors explored the prevalence and clinical correlates of ABPM phenotypes and relationship with office BP in Saudi patients (n = 428, mean age 53.5 ± 14.6, 55% male) referred to a Specialist Hypertension clinic in Riyadh, Saudi Arabia. ABPM phenotypes included sustained normotension (27%), masked hypertension, MHT(32%), sustained hypertension, SHT(52%), and white coat hypertension(2.6%). MHT was more prevalent using asleep than 24-hours (26.4% vs 12.9%, P < .01) or awake BP (26.4% vs 8.5%, P < .001) and observed in 85% of prehypertensive patients. Isolated nocturnal hypertension was more prevalent in MHT vs SHT (70% vs 30%, P < .001). Office BP overestimated control rates compared with ABPM (48% vs 12.9%, P < .001). Our study shows that one in three Saudi patients will be managed inappropriately if office BP alone was relied upon for management of hypertension.

Isolated nocturnal hypertension in relation to host and environmental factors and clock genes

“… 6 In 428 Saudi patients who were referred to a hypertension clinic, INH was observed in 21%, and was more prevalent in masked hypertension versus sustained hypertension (70% vs 30%, P < .001) and in untreated versus treated patients (29% vs 18.7%, P < .05). 5 In a recent report from a Korean general population including 823 participants, INH was observed in 22.8% of patients, among whom 92.6% had normal office BP. 3 Compared to normotensive participants, the INH patients had an older age, greater body mass index, and higher levels of serum cholesterol and plasma glucose, and serum creatinine.…”

“…Patients with INH had a significantly higher neck circumference than normotensive persons 6 . In 428 Saudi patients who were referred to a hypertension clinic, INH was observed in 21%, and was more prevalent in masked hypertension versus sustained hypertension (70% vs 30%, P < .001) and in untreated versus treated patients (29% vs 18.7%, P < .05) 5 . In a recent report from a Korean general population including 823 participants, INH was observed in 22.8% of patients, among whom 92.6% had normal office BP 3 .…”

“…Although the pathophysiological pathways of INH remain incompletely understood, it is generally accepted that several mechanisms related to nocturnal hypertension might be involved, including activated sympathetic and renin‐angiotensin systems, disturbed water and sodium metabolism, decreased baroreflex sensitivity, and insulin resistance. 15 These mechanisms, at least in part, explain why the prevalence of INH varied between populations of different characteristics, 1 , 3 , 4 , 5 , 6 and was common in patients complicated with sleep‐related disorders, chronic kidney disease, diabetes mellitus, and metabolic syndrome. 2 , 8 , 9 , 22 …”

Comparison of ambulatory blood pressure monitoring and office blood pressure in primary health care of populations at a high risk of hypertension

“…Previous studies on ABPM have mainly focused on outpatients or inpatients ( 16 – 18 ), and the number of studies on the population receiving primary health care is very limited. ABPM is not routinely used in primary health care due to its high cost and limited resources ( 10 ).…”

“…Current studies have found that the incidence of masked hypertension, morning hypertension and nocturnal hypertension in Asian countries is higher than that in Western countries ( 7 – 9 ). However, the use of ABPM in Asian countries, including China, is very limited, especially in primary health care ( 10 ). The purpose of this study was to compare OBP with ABPM in high hypertension-risk Asian individuals in primary care.…”