Journal of Diagnostics Concepts & Practice >

2019 , Vol. 18 >Issue 03: 313 - 318

DOI: https://doi.org/10.16150/j.1671-2870.2019.03.013

Original articles

Study on circadian blood pressure rhythmandrelated influencing factors in outpatients

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  • Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2019-04-25

  Online published: 2019-06-25

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Abstract

Objective: Based on an electronic reporting system of ambulatory blood pressure monitoring (ABPM), the circadian blood pressure rhythm and related influencing factors in outpatients were analyzed. Methods: From February 2017 to February 2018, 5 545 outpatients with eligible ABPM data in the Shuoyun electronic reporting system were recruited. Of them there were 2 524 males and 3 021 females, with an average age of (53±14.3) years. The rate of nocturnal systolic blood pressure(SBP) decrease was calculated, according to which the circadian rhythm was categorized into four types:reverse-dipper, non-dipper, dipper and extreme-dipper. Results: The number of dippers was the most (2 323, 41.9%), followed by non-dippers (2 318, 41.8%), and the reverse-dippers (532, 9.6%) and extreme-dippers (372, 6.7%) were much less. The reverse-dippers were the oldest [average age, (60.2±13.3) years], and the dippers were the youngest [(50.9±14.1) years]. The nighttime SBP, ambulatory arterial stiffness index (AASI), the proportion of concomitant diseases (diabetes, stroke, myocardial infarction) and the prevalence of hypertension of the reverse-dippers were higher than the others (P<0.05); the prevalence of hypertension in dippers was lower than the others.The average daytime SBP of the extreme-dippers was higher (P<0.05) than the others, while the nighttime SBP, AASI were lower(P<0.05) than the others. There were no significant differences in body mass index, proportion of taking antihypertensive drugs and hyperlipidemia among the groups (P>0.05). Logistic regression analysis showed that women, aging, diabetes mellitus and hypertension were risk factors for abnormal circadian rhythm, and patients taking antihypertensive drugs and smokers tended to be dippers (P<0.05). Conclusions: In outpatients of the Hypertension Clinic, around half have abnormal circadian blood pressure rhythm. Female, aging, the presence of diabetes and hypertension were risk factors, while patients on antihypertensive medication and smokers were more likely to be dippers.

Key words： Ambulatory blood pressure monitoring; Reverse-dipper; Non-dipper; Dipper; Extreme-dipper; Circadian rhythm

Cite this article

HUANG Jianfeng, SHENG Changsheng, HUANG Qifang, CHENG Yibang, GUO Qianhui, ZHANG Dongyan, WANG Jiguang, LI Yan . Study on circadian blood pressure rhythmandrelated influencing factors in outpatients[J]. Journal of Diagnostics Concepts & Practice, 2019 , 18(03) : 313 -318 . DOI: 10.16150/j.1671-2870.2019.03.013

References

[1] Richardson DW, Honour AJ, Fenton GW, et al. Variationin arterial pressure throughout the day and night[J]. Clin Sci, 1964, 26:445-460.
[2] O'Brien E, Sheridan J, O'Malley K. Dippers and non-dippers[J]. Lancet, 1988, 2(8607):397.
[3] Mancia G, Facchetti R, Bombelli M, et al. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure[J]. Hypertension, 2006, 47(5):846-853.
[4] Dolan E, Stanton A, Thijs L, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study[J]. Hypertension, 2005, 46(1):156-161.
[5] 中国高血压联盟, 中国医师协会高血压专业委员会血压测量与监测工作委员会,《中华高血压杂志编委会》. 2015动态血压监测临床应用中国专家共识[J]. 中华高血压杂志, 2015, 23(8):727-730.
[6] Li Y, Wang JG, Dolan E, et al. Ambulatory arterial stiffness index derived from 24-hour ambulatory blood pressure monitoring[J]. Hypertension, 2006, 47(3):359-364.
[7] Kario K, Pickering TG, Matsuo T, et al. Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives[J]. Hypertension, 2001, 38(4):852-857.
[8] 王继光. 24 h动态血压监测:适用人群及临床意义[J]. 中华高血压杂志, 2014, 22(7):614-615.
[9] Hansen TW, Kikuya M, Thijs L, et al. Prognostic supe-riority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7,030 individuals[J]. J Hypertens, 2007, 25(8):1554-1564.
[10] ABC-H Investigators, Roush GC, Fagard RH, et al. Prognostic impact from clinic, daytime, and night-time systolic blood pressure in nine cohorts of 13,844 patients with hypertension[J]. J Hypertens, 2014, 32(12):2332-2340.
[11] Kario K, Shimada K, Pickering TG. Abnormal nocturnal blood pressure falls in elderly hypertension: clinical significance and determinants[J]. J Cardiovasc Pharmacol, 2003, 41(Suppl 1):S61-S66.
[12] Degaute JP, van de Borne P, Linkowski P, et al. Quantitative analysis of the 24-hour blood pressure and heart rate patterns in young men[J]. Hypertension, 1991, 18(2):199-210.
[13] Routledge F, McFetridge-Durdle J. Nondipping blood pressure patterns among individuals with essential hypertension: a review of the literature[J]. Eur J Cardiovasc Nurs, 2007, 6(1):9-26.
[14] Anan F, Takahashi N, Ooie T, et al. Role of insulin resistance in nondipper essential hypertensive patients[J]. Hypertens Res, 2003, 26(9):669-676.
[15] Ozdemir E, Yildirimturk O, Cengiz B, et al. Evaluation of carotid intima-media thickness and aortic elasticity in patients with nondipper hypertension[J]. Echocardiography, 2014, 31(5):663-668.
[16] Gao Y, Guo Q, Zhang J, et al. The underlying risks of circadian blood pressure variation for carotid plaque in treated hypertensive patients with normal blood pressure[J]. Blood Press Monit, 2017, 22(4):191-195.
[17] Mergeani AC, Antochi F, Rusu O, et al. Correlations of Cognitive Impairment with Circadian Blood Pressure Pattern and Intima-Media Thickness in Hypertensive Patients[J]. Maedica (Buchar), 2015, 10(4):325-330.
[18] Karadag B, Ozyigit T, Serindag Z, et al. Blood pressure profile is associated with microalbuminuria and retinopathy in hypertensive nondiabetic patients[J]. Wien Klin Wochenschr, 2018, 130(5-6):204-210.
[19] Mann SJ, James GD, Wang RS, et al. Elevation of ambulatory systolic blood pressure in hypertensive smokers. A case-control study[J]. JAMA, 1991, 265(17):2226-2228.
[20] Kario K, Schwartz JE. Disruption of diurnal rhythm in the elderly[J]. Lancet, 1999, 354(9175):339.
[21] Cui HW, Zhang ZX, Gao MT, et al. Circadian rhythm of melatonin and blood pressure changes in patients with essential hypertension[J]. Zhonghua Xin Xue Guan Bing Za Zhi, 2008, 36(1):20-23.
[22] Wang C, Ye Y, Liu C, et al. Evening versus morning dosing regimen drug therapy for chronic kidney disease patients with hypertension in blood pressure patterns: a systematic review and meta-analysis[J]. Intern Med J, 2017, 47(8):900-906.
[23] Hermida RC, Ayala DE, Mojón A, et al. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study[J]. Chronobiol Int, 2010, 27(8):1629-1651.
[24] Rahman A, Hitomi H, Nishiyama A. Cardioprotective effects of SGLT2 inhibitors are possibly associated with normalization of the circadian rhythm of blood pressure[J]. Hypertens Res, 2017, 40(6):535-540.
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