Prevalence and Factors Associated With Circadian Blood Pressure Patterns in Hypertensive Patients

Sierra, Alejandro de la; Redón, Josep; Banegas, José R.; Segura, Julián; Parati, Gianfranco; Gorostidi, Manuel; Cruz, Juan; Sobrino, Javier; Llisterri, J.L.; Alonso, J. Jimenez; Vinyoles, Ernest; Pallarés, Vicente; Sarrı́a, Antonio; Aranda, Pedro J.; Ruilope, Luís M.

doi:10.1161/hypertensionaha.108.124008

Cited by 318 publications

(168 citation statements)

References 30 publications

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“…In our experience, the burden of cardiovascular risk was the main determinant for a blunted nocturnal BP decrease. 24,25 The contribution of the absence of a nocturnal BP fall is controversial in patients with diabetes. Absolute BP levels, particularly at night, probably have a higher predictive value for vascular damage than the BP dipper/nondipper status.…”

Section: Discussionmentioning

confidence: 99%

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

et al. 2011

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on behalf of the Spanish Society of Hypertension ABPM Registry investigators 9Our aim was to assess the ambulatory blood pressure monitoring (ABPM) characteristics or patterns in hypertensive patients with diabetes compared with non-diabetic hypertensives. We performed a cross-sectional analysis of a 68 045 patient database from the Spanish Society of Hypertension ABPM Registry, a nation-wide network of 41200 primary-care physicians performing ABPM under standardized conditions in daily practice. We identified 12 600 (18.5%) hypertensive patients with diabetes. When compared with patients without diabetes, diabetic hypertensives exhibited higher systolic blood pressure (BP) levels in every ABPM period (daytime 135.4 vs. 131.8, and nighttime 126.0 vs. 121.0 mm Hg, Po0.001 for both) despite they were receiving more antihypertensive drugs (mean number 1.71 vs. 1.23, Po0.001). Consequently, diabetic patients suffered from lack of control of BP more frequently than non-diabetic subjects particularly during the night (65.5% vs. 57.4%, Po0.001).Prevalence of a non-dipping BP profile (64.2% vs. 51.6%, Po0.001) was higher in diabetic patients. In the other hand, prevalence of 'white-coat' hypertension in diabetic patients was 33.0%. We conclude that there was a remarkably high prevalence of alterations in ABPM in patients with diabetes. Abnormalities in systolic BP, particularly during the night, and in circadian BP pattern could be linked with the excess of BP-related cardiovascular risk of diabetes. A wider use of ABPM in diabetic patients should be considered. Hypertension Research (2011) 34, 1185-1189; doi:10.1038/hr.2011.100; published online 11 August 2011Keywords: ambulatory blood pressure monitoring; circadian profile; diabetes; hypertension control INTRODUCTION Hypertension affects the majority of patients with diabetes and constitutes a major risk factor for vascular complications. 1 Ambulatory blood pressure monitoring (ABPM) provides a high-quality approach in estimating the true levels of blood pressure (BP). 2 Several population-and patient-based studies have showed the benefits of ABPM in exploring the relationship between BP and cardiovascular events. 2,3 A series of reports dealing with diabetic patients have also shown a close correlation between ambulatory BP and diabetic complications. 4,5 Evidences are available for the entire cardiorenal continuum of diabetic damage from the prediction of microalbuminuria by early changes in nocturnal BP in type 1 patients 6 to the effect of a riser pattern on mortality in patients with type 2 diabetes. 7 Nevertheless, information about the ABPM characteristics of large cohorts of diabetic hypertensives attending primary care centers is scarce. We aimed to assess such characteristics in comparison with non-diabetic hypertensives by using the Spanish Society of Hypertension ABPM Registry.

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Section: Discussionmentioning

confidence: 99%

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

et al. 2011

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“…Individuals with a non-dipper pattern (reduction in nighttime SBP o10%) are at increased risk for cerebrovascular and cardiovascular complications Nocturnal dipping and endothelial function in resistant hypertension T Quinaglia et al when compared with individuals with a normal dipper profile. 16,[21][22][23][24][25][26] Previous studies have shown that patients with UCRH and CRH both have blunted nocturnal drops in SBP and DBP. 3,27 In these earlier publications, patients with RHTN have a high prevalence of nondipper pattern which contributes to an increased risk of cardiovascular events, 18 as well as a high prevalence of target organ damage at cardiac, macroand microvascular levels.…”

Section: Discussionmentioning

confidence: 99%

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

et al. 2011

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Resistant hypertension (RHTN) includes both patients whose blood pressure (BP) is uncontrolled on three or more medications (uncontrolled RHTN (UCRH)) and patients whose BP is controlled with use of four or more drugs (controlled RHTN (CRH)). It is unknown whether endothelial function and nocturnal drop demonstrate a similar pattern in patients with CRH and UCRH. We examined circadian BP patterns and vascular function in these patients. In all, 40 CRH and 26 UCRH patients, and 25 normotensives underwent biochemical testing, ambulatory BP monitoring, determination of brachial artery responses to endothelial-dependent (flow-mediated; dilation (FMD)) and independent (nitroglycerin mediated) stimuli. The nighttime drop in systolic BP (SBP) and diastolic BP (DBP) was less pronounced in UCRH than in CRH (SBP, 1.9±1.6 versus 4.9 ± 1.7%; DBP, 7.5 ± 1.8 versus 10.9 ± 1.8%, UCRH and CRH, respectively; Po0.05). FMD was greater in control group compared with RHTN patients. Patients with UCRH had significantly impaired FMD compared with CRH (5.9 ± 2.3% versus 7.1 ± 5.1%; Po0.0001). Therefore, UCRH patients have less nocturnal dipping and a more impaired endothelial response compared with CRH patients. These findings suggest that important differences among patients with RHTN may allow identify subgroups with increased cardiovascular risk.

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“…Details of physician recruitment and characteristics of the registry have been reported elsewhere 11, 12. Briefly, physicians and nurses received specific training in the technique of ABPM and used the internet‐based platform that receives ABPM records, together with their corresponding medical charts.…”

Section: Methodsmentioning

confidence: 99%

“…The methodology of office BP measurements and 24‐hour ABPM has been previously described by our group 2, 4, 11, 12. Briefly, BP was measured at the office with a calibrated mercury sphygmomanometer or a validated oscillometric device, after 5 minutes rest in a sitting position.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and Clinical Characteristics of Refractory Hypertension

Armario

Calhoun

Oliveras

et al. 2017

JAHA

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BackgroundWe aimed to estimate the prevalence of refractory hypertension (RfH) and to determine the clinical differences between these patients and resistant hypertensives (RH). Secondly, we assessed the prevalence of white‐coat RfH and clinical differences between true‐ and white‐coat RfH patients.Methods and ResultsThe present analysis was conducted on the Spanish Ambulatory Blood Pressure Monitoring Registry database containing 70 997 treated hypertensive patients. RH and RfH were defined by the presence of elevated office blood pressure (≥140 and/or 90 mm Hg) in patients treated with at least 3 (RH) and 5 (RfH) antihypertensive drugs. White‐coat RfH was defined by RfH with normal (<130/80 mm Hg) 24‐hour blood pressure. A total of 11.972 (16.9%) patients fulfilled the standard criteria of RH, and 955 (1.4%) were considered as having RfH. Compared with RH patients, those with RfH were younger, more frequently male, and after adjusting for age and sex, had increased prevalence of target organ damage, and previous cardiovascular disease. The prevalence of white coat RfH was lower than white‐coat RH (26.7% versus 37.1%, P<0.001). White‐coat RfH, in comparison with those with true RfH, showed a lower prevalence of both left ventricular hypertrophy (22% versus 29.7%; P=0.018) and microalbuminuria (28.3% versus 42.9%; P=0.047).ConclusionsThe prevalence of RfH was low and these patients had a greater cardiovascular risk profile compared with RH. One out of 4 patients with RfH have normal 24‐hour blood pressure and less target organ damage, thus indicating the important role of ambulatory blood pressure monitoring in guiding antihypertensive therapy in difficult‐to‐treat patients.

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Prevalence and Factors Associated With Circadian Blood Pressure Patterns in Hypertensive Patients

Cited by 318 publications

References 30 publications

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

Prevalence and Clinical Characteristics of Refractory Hypertension

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