Variability of diurnal changes in ambulatory blood pressure and nocturnal dipping status in untreated hypertensive and normotensive subjects

Manning, Gillian; Rushton, Lesley; Donnelly, Richard; Millar-Craig, Michael W

doi:10.1016/s0895-7061(00)00261-2

Cited by 124 publications

(79 citation statements)

References 9 publications

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“…These findings are in close agreement with those reported by Manning et al 27 in a smaller study carried out in 79 untreated hypertensive subjects who underwent 24-hour ABP monitoring and filled a questionnaire about the perceived quality of sleep during overnight BP recording. In that study, nighttime BP was significantly higher in the subjects who reported that "recording caused significant disruption to normal sleep" as compared with those in whom recording "did not interrupt sleep," whereas daytime ABP did not any significant difference between the 2 groups.…”

Section: The Present Studysupporting

confidence: 93%

“…In that study, nighttime BP was significantly higher in the subjects who reported that "recording caused significant disruption to normal sleep" as compared with those in whom recording "did not interrupt sleep," whereas daytime ABP did not any significant difference between the 2 groups. 27 Beyond the close agreement, our study and that by Manning et al 27 support the reliability of questionnaires for assessing the perceived sleep disturbances during noninvasive ABP monitoring.…”

Section: The Present Studysupporting

confidence: 86%

See 1 more Smart Citation

Ambulatory Blood Pressure and Cardiovascular Outcome in Relation to Perceived Sleep Deprivation

Verdecchia¹,

Borgioni²,

Gattobigio³

et al. 2007

Hypertension

116

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Abstract-Sleep deprivation induced by cuff inflations during overnight blood pressure (BP) monitoring might interfere with the prognostic significance of nighttime BP. In 2934 initially untreated hypertensive subjects, we assessed the perceived quantity of sleep during overnight BP monitoring. Overall, 58.7%, 27.7%, 9.7%, and 4.0% of subjects reported a sleep duration perceived as usual (group A), Ͻ2 hours less than usual (group B), 2 to 4 hours less than usual (group C), and Ͼ4 hours less than usual (group D). Daytime BP did not differ across the groups (all Ps not significant). Nighttime BP increased from group A to D (124/75, 126/76, 128/77, and 129/79 mm Hg, respectively; all Ps for trend Ͻ0.01). Over a median follow-up period of 7 years there were 356 major cardiovascular events and 176 all-cause deaths. Incidence of total cardiovascular events and deaths was higher in the subjects with a night/day ratio in systolic BP Ͼ10% compared with those with a greater day-night BP drop in the group with perceived sleep duration as usual or Ͻ2 hours less than usual (both PϽ0.01), not in the group with duration of sleep Ն2 hours less than usual (all Ps not significant). In a Cox model, the independent prognostic value of nighttime BP for total cardiovascular end points and all-cause mortality disappeared in the subjects with perceived sleep deprivation Ն2 hours. In conclusion, nighttime BP rises and loses its prognostic significance in the hypertensive subjects who perceive a sleep deprivation by Ն2 hours during overnight monitoring. Key Words: hypertension Ⅲ dippers Ⅲ nondippers Ⅲ blood pressure monitoring Ⅲ sleep Ⅲ stroke Ⅲ myocardial infarction Ⅲ epidemiology D espite the growing body of evidence supporting the prognostic value of nighttime blood pressure (BP), 1-6 it is unclear to what extent the compressive, tactile, and sonorous stimuli produced by repeated cuff inflations during 24-hour ambulatory BP (ABP) monitoring interfere with nighttime BP measurements, possibly through sleep disturbance or deprivation. In a study, intra-arterial ABP did not differ during day and night in the presence versus absence of concomitant noninvasive ABP monitoring. 7 Studies carried out in sleep laboratories produced conflicting results in showing no changes 8 and an increase 9,10 in the number of nocturnal awakenings during overnight monitoring. The picture is complicated by the finding that hypertensive subjects with a blunted day-night fall in BP ("non-dippers") 11 present more frequent microarousals 12 and apneic snoring 13 as compared with subjects with normal day-night BP fall, but evidence is controversial. 14 Overall, available studies suggest that nighttime BP could be altered by the sleep noise induced by repeated cuff inflations but do not clarify the prevalence of this phenomenon or, more importantly, its prognostic significance. The clinical impact of this issue is relevant because of the growing reliance on nighttime BP when interpreting results of ABP monitoring. Thus, the aim of the present study was to determine t...

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Section: The Present Studysupporting

confidence: 93%

Section: The Present Studysupporting

confidence: 86%

Ambulatory Blood Pressure and Cardiovascular Outcome in Relation to Perceived Sleep Deprivation

Verdecchia¹,

Borgioni²,

Gattobigio³

et al. 2007

Hypertension

116

View full text Add to dashboard Cite

show abstract

“…This was to ensure the consistency of our findings and address the potential lack of reproducibility of non-dipper status. 18,19 Values were expressed as percentage (number of subjects), mean (s.d.) or odds ratio (confident interval at 95%).…”

Section: Discussionmentioning

confidence: 99%

“…The findings presented did not include the possible confounding effect of physical activity, which has been shown to have a significant impact on ANS activity indices. 28 The results were adjusted for neither alcohol consumption nor quality of nighttime sleep; 19 however, no difference in the autonomic sleep fragmentation index was observed between dipper and non-dipper status.…”

Section: Non-dipper Blood Pressure Pattern V Dauphinot Et Almentioning

confidence: 99%

Autonomic nervous system activity is independently associated with the risk of shift in the non-dipper blood pressure pattern

et al. 2010

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An insufficient decrease in nocturnal blood pressure (BP) is a known factor in cardiovascular mortality. We aimed to determine whether autonomic nervous system (ANS) activity and its change over 2 years were associated with a shift to non-dipper status, independently of initial BP, in a general elderly population. From participants in the PROOF study, 600 subjects untreated for hypertension were selected (age at baseline: 65 years, men: 41.5%). Dipper/non-dipper status was defined using repeated measures of 24-h ambulatory BP at baseline and 2 years later. ANS activity was evaluated on the basis of 24-h heart rate variability at both examinations. Among the 454 dipper subjects at baseline, 26.2% became non-dippers. Multivariate analysis showed that a +1 between-subject s.d. increase in the very low frequency at baseline was associated with a decreased odds ratio for the shift to non-dipper status 2 years later (OR¼0.61 [0.41-0.91], P¼0.02). The within-subject change between the two measurements of day and night systolic BP and day diastolic BP also contributed significantly to the risk of shift to non-dipper status. Our results suggest that impaired ANS activity precedes an insufficient decrease in nocturnal BP independent of hypertension status. Keywords: ambulatory blood pressure; heart rate variability; non-dipper; sympathetic nervous activity INTRODUCTION An insufficient decrease in nocturnal blood pressure (BP) (nondipping) is recognized as a marker of end-organ damage and a predictor of cardiovascular and all-cause mortality, independently of hypertension status. 1-3 Our understanding of the pathophysiologic factors that may be involved in the mechanisms of the circadian variation of BP and the non-dipping pattern remains incomplete. Among the suspected determinants, autonomic nervous system (ANS) activity is shown to be associated with arterial BP level and involved in the control of the circadian variation of BP. 4,5 Previous cross-sectional studies have shown that ANS activity, evaluated by heart rate variability (HRV), was reduced in non-dipper, untreated hypertensive subjects. 6,7 A possible explanation of the nocturnal decrease in BP is that it results from a reduction of sympathetic nervous activity and impaired circadian rhythm in sympatho-vagal balance during sleep. 8,9 We aimed to assess whether ANS activity indices and their changes over 2 years, as evaluated by 24-h HRV, were associated with a shift to non-dipper status among subjects identified as dippers at study entry in a general elderly population not treated for hypertension.

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“…[22][23][24] On the other hand, as ABP is affected by various internal and external environmental factors on a particular day, the reproducibility of its mean value is inferior to that of home BP, [23][24][25] and the reproducibility of circadian BP variations based on ABPM is not enough. [26][27][28][29] Table 1 summarizes the characteristics of home BP compared with clinic BP and ABP. 30 …”

Section: Introductionmentioning

confidence: 99%

The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)

et al. 2012

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INTRODUCTIONSince Riva-Rocci invented indirect brachial cuff sphygmomanometry in 1896 1 and Korotkoff proposed the auscultatory method in 1905, 2 the method for blood pressure (BP) measurements has remained essentially unchanged for the past 100 years.In 1969, Posey et al. 3 identified mean BP on the basis of the cuff-oscillometric method. With subsequent theoretical and technical improvements, the method to determine systolic and diastolic BP (S and D, respectively) was introduced to the cuff-oscillometric method. As a result, many of the automatic electronic sphygmomanometers available today have adopted this method, and those different from the auscultatory method have begun to be used in general clinical practice. Since the advent of indirect methods for sphygmomanometry, the past century has developed the practical and clinical sciences of hypertension. However, BP information necessary for the diagnosis and treatment of hypertension is still obtained essentially on the basis of casual measurements at the outpatient clinic (clinic BP). However, the reliability of clinic BP was called into question 40 years after the advent of indirect sphygmomanometry. In 1940, Ayman and Goldshine 4 widely adopted the concept of self-BP measurements in the field of clinic BP measurements and demonstrated discrepancies between clinic BP and self-BP measurements. Bevan, 5 in the United Kingdom, first reported the results of ambulatory BP (ABP) monitoring (ABPM) using a direct arterial BP measurement method in 1969, and showed that human BP changes markedly with time. The quantity and quality of BP information vary greatly according to different methods, and the problem of interpreting clinic BP, which is obtained specifically in a medical environment, has been an issue in the clinical practice of hypertension during the past 50 years.However, the practice and epidemiology of hypertension still depend entirely on BP information obtained in a medical environment (clinic BP/BP at a health examination), resulting in the

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Variability of diurnal changes in ambulatory blood pressure and nocturnal dipping status in untreated hypertensive and normotensive subjects

Cited by 124 publications

References 9 publications

Ambulatory Blood Pressure and Cardiovascular Outcome in Relation to Perceived Sleep Deprivation

Ambulatory Blood Pressure and Cardiovascular Outcome in Relation to Perceived Sleep Deprivation

Autonomic nervous system activity is independently associated with the risk of shift in the non-dipper blood pressure pattern

The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)

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