The reproducibility of dipping status: beyond the cutoff points

Chaves, Hilton; Souza, Fernando Menezes Campello de; Krieger, Eduardo Moacyr

doi:10.1097/01.mbp.0000172709.05158.59

Cited by 26 publications

(21 citation statements)

References 25 publications

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“…On repeated ABPM, expressing the decline in BP during sleep as a continuous variable (eg, percentage fall in nocturnal BP) was shown to be far more reproducible than its expression as a categorical variable (ie,using the traditionally adopted 10% cut-off), given a loss of information. 10 This is particularly an issue for defining abnormalities of dipping status as definitions rest on a difference score of individual daytime and night-time BP levels. [10][11][12][13] In a study of repeated ABPM, agreement in diagnosing nocturnal hypertension on the basis of two measurements was greater using an absolute nocturnal BP threshold value (Cohen's kappa = 0.485 systolic BP) rather than the percentage nocturnal BP fall (Cohen's kappa = 0.378 systolic BP).…”

Section: Diagnostic Limitationsmentioning

confidence: 99%

Can nocturnal hypertension predict cardiovascular risk?

Friedman

Logan²

2009

IBPC

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Nocturnal hypertension and non-dipping of blood pressure during sleep are distinct entities that often occur together and are regarded as important harbingers of poor cardiovascular prognosis. This review addresses several aspects related to these blood pressure abnormalities including definitions, diagnostic limitations, pathogenesis and associated patient profiles, prognostic significance, and therapeutic strategies. Taken together, persistent nocturnal hypertension and non-dipping blood pressure pattern, perhaps secondary to abnormal renal sodium handling and/or altered nocturnal sympathovagal balance, are strongly associated with deaths, cardiovascular events, and progressive loss of renal function, independent of daytime and 24-hour blood pressure. Several pharmacological and non-pharmacological approaches may restore nocturnal blood pressure and circadian blood pressure rhythm to normal; however, whether this translates to a clinically meaningful reduction in unfavorable cardiovascular and renal consequences remains to be seen.

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Section: Diagnostic Limitationsmentioning

confidence: 99%

Can nocturnal hypertension predict cardiovascular risk?

Friedman

Logan²

2009

IBPC

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“…Considering that the short-term reproducibility of the non-dipping pattern in DM patients is better than in non-DM hypertensive patient [49], BP monitoring may provide an opportunity for a better risk assessment in DM patients. However, consideration of a cut-point rather than using a continuous value in the BP dipping definition is criticized by some authors [22].…”

Section: Discussionmentioning

confidence: 99%

“…Although HSM did not include sleeping BP, the average of two evening BP measurements in the period of monitoring was used as a surrogate for nighttime BP in the group A, because European Society of Hypertension clearly suggested that nocturnal hypertension may be suspected on the basis of increased evening home blood pressure [3]. Nocturnal dipping was calculated as [(mean daytime BP -mean nighttime BP)/ mean daytime BP] and patients with less than 10% SBP dipping were identified as non-dippers [3,22]. Also the absolute white coat effect and nighttime BP reduction were considered in the analysis.…”

Section: Measurementsmentioning

confidence: 99%

Clinical Application of a Complex of Blood Pressure Profile, Arterial Stiffness and Albuminuria for Cardiorenal Risk Assessment in Diabetic Patients

Khoshdel¹,

Bowen²,

Carney³

et al. 2011

TOHYPERJ

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Abstract:Background: In modern epidemiology, risk assessment is a crucial step in diabetes care. Clinic blood pressure reading though is not a good measurement for this purpose since both uncontrolled hypertension and white coat hypertension (WCH) are frequent among patients with diabetes mellitus (DM). Given the problems with clinical application of ambulatory blood pressure monitoring (ABPM), in this study we evaluated clinical utility of home self measurement (HSM) with a wrist-cuff device in DM patients with hypertension to make a BP profile. Also, the clinical application of a complex of arterial study, albuminuria and blood pressure profile, in DM risk assessment was investigated. Methods and Materials: Seventy-eight adult DM patients with labile or uncontrolled hypertension were randomly assigned to 24 hour ABPM or HSM for 4 consecutive days and their BP profiles were evaluated in conjunction with an assessment of arterial stiffness and renal function as well as lipid profile. Results: The two groups were of comparable age, gender, BP, DM duration and control, smoking, lipids, renal function, arterial compliance and antihypertensive medication use. ABPM detected 33% WCH and 17.6% evening/night-time dipping, compared to 32% and 16% respectively for HSM, with overlapping 95% confidence intervals for day versus night BP regression coefficients. WCH patients had more compliant arteries as well as less albuminuria compared to the sustained hypertensive group. Conclusion: A complex of BP profile (by either ABPM or HSM), arterial compliance and albuminuria is a reliable and economical alternative to current methods for risk assessment in hypertensive diabetic patients.

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“…However, our operating definition was applied throughout the study and all definitions appear to be adequately reliable (51). Third, because dipping is defined by a difference score, its reproducibility falls short of the individual daytime and nighttime BP levels (29,52,53); on repeated ABPM, agreement in diagnosing nocturnal hypertension on the basis of the two measurements was greater using an absolute nocturnal BP cut-off rather than the percentage nocturnal BP fall (54). Also, one would anticipate a regression to the mean effect had we repeated measurements.…”

Section: Discussionmentioning

confidence: 99%

Nocturnal blood pressure profiles among normotensive, controlled hypertensive and refractory hypertensive subjects

Friedman

Logan

2009

Canadian Journal of Cardiology

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R efractory hypertension (RH) is emerging as a significant and growing problem in managing hypertension. In a previous study (1), 11% of patients referred for uncontrolled hypertension were found to meet the criteria for RH. Not surprisingly, RH is associated with an increased risk of hypertensive target organ damage (2). Experts recommend 24 h ambulatory blood pressure monitoring (ABPM) to differentiate true RH from white-coat resistant hypertension (3). The test also provides information on nocturnal blood pressure (BP) and the means to assess its relationship with survival and the occurrence of cardiovascular and renal events, adjusted for daytime or 24 h BP (4-12). Several sleep BP pattern disturbances in normotensive (NT) and hypertensive subjects have been identified. A Japanese study (6) found a 20% increase in cardiovascular mortality for every 5% attenuation in nocturnal BP fall, independent of overall 24 h BP. In another study (13), a J-shaped curve of stroke incidence was found among extreme dippers (subjects with a 20% or greater fall in nocturnal BP) and nondippers, albeit from different causes, with risers (subjects with a paradoxical increase in nocturnal BP) having the worst cardiovascular prognosis. Recently, nighttime BP, independent of daytime level, was found to be a predictor of death and cardiovascular disease (12). Surprisingly, to date, little attention has been given to sleep BP patterns in subjects with RH, and the results in the existing literature conflict, at least in part, with the use of different definitions of the condition itself and methods to define the nighttime period (14-17).The present study was undertaken to determine whether sleep BP pattern disturbances are related to the presence or severity of hypertension. We used a widely accepted definition of RH and diaries BACKGROUND: Nocturnal blood pressure abnormalities are independently associated with an increased risk of death and cardiovascular disease. It is unclear, however, whether they are related to the presence or severity of hypertension. OBJECTIVES: To determine and compare the prevalence of sleep pattern disturbances in normotensive (NT) and hypertensive patients. METHODS:The present cross-sectional study assessed the nocturnal blood pressure profiles from 24 h ambulatory blood pressure monitoring of refractory hypertensive (RH) (n=26), controlled hypertensive (CH) (n=52) and NT (n=52) subjects who were matched for age, sex and body mass index. Results are expressed as mean ± SD or proportion, as appropriate. RESULTS: During sleep, the percentage fall in mean arterial pressure was 15.1±6.1% in the NT group, 11.5±7.0% in the CH group and 7.7±7.7% in the RH group (P<0.0001). The corresponding proportions of nondipping were 25.0%, 42.3% and 61.5%, respectively (P=0.006), and those of nocturnal hypertension were 9.6%, 23.1% and 84.6%, respectively (P<0.0001). All pairwise comparisons of nocturnal blood pressure fall were significant. The proportion of subjects in the RH group who experienced a rise in nocturnal blood ...

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The reproducibility of dipping status: beyond the cutoff points

Cited by 26 publications

References 25 publications

Can nocturnal hypertension predict cardiovascular risk?

Can nocturnal hypertension predict cardiovascular risk?

Clinical Application of a Complex of Blood Pressure Profile, Arterial Stiffness and Albuminuria for Cardiorenal Risk Assessment in Diabetic Patients

Nocturnal blood pressure profiles among normotensive, controlled hypertensive and refractory hypertensive subjects

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