Clinical risk factors and predictive score for the non-dipper profile in hypertensive patients: a case-control study
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Night-time BP, especially non-dipper, is a stronger predictor of adverse cardiovascular outcomes. Ambulatory blood pressure monitoring (ABPM) is a gold standard for the detection of non-dippers but it often is unavailable and expensive. This study aims to determine clinical risk factors that predict non-dipper.An exploratory traditional case-control study, exclusive sampling of control was conducted from January 2013 to September 2018 to explore clinical risk factors associated with non-dippers in hypertensive patients. Subgroup analysis was performed in each treated and untreated hypertensive patient. The parsimonious predictive score for non-dippers was constructed. The study included 208 hypertensive patients receiving 24 h ABPM. There were 104 dippers and 104 non-dippers. Significant clinical risk factors associated with non-dippers were the age of > 65 years, average office diastolic blood pressure (DBP), and fasting plasma glucose of > 5.6 mmol/L. Results of subgroup analysis showed that dyslipidemia, history of coronary artery disease, use of angiotensin-converting enzyme inhibitors (ACEIs) and direct vasodilators, average office DBP, and serum uric acid were associated with non-dippers in treated hypertensive patients, however, there were no risk factors associated with non-dippers in the untreated group. The predictive score for non-dippers in treated group included average office DBP, dyslipidemia, serum uric acid, male, calcium channel blockers and ACEIs use. The area under Receiver Operating Characteristic (AuROC) was 0.723. A cut-off point which was > 0.0701 and prevalence of non-dippers of 46%, this score had a sensitivity of 77.4%, specificity of 65.6%, positive predictive value (PPV) of 66.1%, and negative predictive value (NPV) of 79.6%. For untreated group, age, hemoglobin and body mass index were included in the predictive model. AuROC was 0.74. There was a sensitivity of 51.9%, specificity of 91.2%, PPV of 82.4%, and NPV of 70.5% at the cut-off point of > 0.357, and prevalence of 44%. There were several significant clinical risk factors associated with non-dippers in treated hypertensive patients. The predictive score might be useful for the detection of non-dippers; however, it cannot replace ABPM.
Abstract
Night-time BP, especially non-dipper, is a stronger predictor of adverse cardiovascular outcomes. Ambulatory blood pressure monitoring (ABPM) is a gold standard for the detection of non-dippers but it often is unavailable and expensive. This study aims to determine clinical risk factors that predict non-dipper.An exploratory traditional case-control study, exclusive sampling of control was conducted from January 2013 to September 2018 to explore clinical risk factors associated with non-dippers in hypertensive patients. Subgroup analysis was performed in each treated and untreated hypertensive patient. The parsimonious predictive score for non-dippers was constructed. The study included 208 hypertensive patients receiving 24 h ABPM. There were 104 dippers and 104 non-dippers. Significant clinical risk factors associated with non-dippers were the age of > 65 years, average office diastolic blood pressure (DBP), and fasting plasma glucose of > 5.6 mmol/L. Results of subgroup analysis showed that dyslipidemia, history of coronary artery disease, use of angiotensin-converting enzyme inhibitors (ACEIs) and direct vasodilators, average office DBP, and serum uric acid were associated with non-dippers in treated hypertensive patients, however, there were no risk factors associated with non-dippers in the untreated group. The predictive score for non-dippers in treated group included average office DBP, dyslipidemia, serum uric acid, male, calcium channel blockers and ACEIs use. The area under Receiver Operating Characteristic (AuROC) was 0.723. A cut-off point which was > 0.0701 and prevalence of non-dippers of 46%, this score had a sensitivity of 77.4%, specificity of 65.6%, positive predictive value (PPV) of 66.1%, and negative predictive value (NPV) of 79.6%. For untreated group, age, hemoglobin and body mass index were included in the predictive model. AuROC was 0.74. There was a sensitivity of 51.9%, specificity of 91.2%, PPV of 82.4%, and NPV of 70.5% at the cut-off point of > 0.357, and prevalence of 44%. There were several significant clinical risk factors associated with non-dippers in treated hypertensive patients. The predictive score might be useful for the detection of non-dippers; however, it cannot replace ABPM.
참고문헌 (35)
- Stanaway G, "Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017 : a systematic analysis for the global burden of disease study 2017", Lancet, 392(10159), pp.1923~1994 (2018)
- Lewington S, "Age-specific relevance of usual blood pressure to vascular mortality : a meta-analysis of individual data for one million adults in 61 prospective studies", Lancet, 360, pp.1903~1913 (2002)
- Rapsomaniki E, "Blood pressure and incidence of twelve cardiovascular diseases : lifetime risks, healthy life-years lost, and agespecific associations in 1·25 million people", Lancet, 383, pp.1899~1911 (2014)
- O'Brien E, "European Society of Hypertension position paper on ambulatory blood pressure monitoring", J Hypertens, 31, pp.1731~1768 (2013)
- Hermida RC, "Ambulatory blood pressure monitoring(ABPM)as the reference standard for diagnosis of hypertension and assessment of vascular risk in adults", Chronobiol Int, 32, pp.1329~1342 (2015)
- Mancia G, "2013 ESH", ESC guidelines for the management of arterial hypertension : the task force for the management of arterial hypertension of the European Society of Hypertension(ESH)and of the European Society of Cardiology(ESC), 2013, pp.31, 1281~1357
- Williams B, "2018 ESC", ESH guidelines for the management of arterial hypertension : the task force for the management of arterial hypertension of the European Society of Cardiology(ESC)and the European Society of Hypertension(ESH), 2018, pp.39, 3021~3104
- Parati G, "European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring", J Hypertens, 32, pp.1359~1366 (2014)
- Tilea I, "Clinical conditions and predictive markers of non-dipper profile in hypertensive patients", Acta Marisiensis Seria Medica, 64, pp.10~16 (2018)
- Gunebakmaz O, "Red blood cell distribution width in ‘non-dippers’ versus ‘dippers’", Cardiology, 123, pp.154~159 (2012)
- Sunbul M, "Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension", Clin Exp Hypertens, 36, pp.217~221 (2014)
- de la Sierra A, "Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients", Hypertension, 53, pp.466~472 (2009)
- Kanbay M, "Causes and mechanisms of nondipping hypertension", Clin Exp Hypertens, 30, pp.585~597 (2008)
- Kaya MG, "Platelet activation and inflammatory response in patients with non-dipper hypertension", Atherosclerosis, 209, pp.278~282 (2010)
- Fan HQ, "Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10populations", J Hypertens, 28, pp.2036~2045 (2010)
- Dai S, "Associations of dipping and non-dipping hypertension with cardiovascular diseases in patients with dyslipidemia", Arch Med Sci, 15, pp.337~342 (2019)
- Hermida RC, "Bedtime hypertension treatment improves cardiovascular risk reduction : the Hygia Chronotherapy trial", Eur Heart J, 41, pp.4565~4576 (2019)
- Giallauria F, "Serum uric acid is associated with non-dipping circadian pattern in young patients(30-40 years old)with newly diagnosed essential hypertension", Clin Exp Hypertens, 38, pp.233~237 (2016)
- Turak O, "Serum uric acid, inflammation, and nondipping circadian pattern in essential hypertension", J Clin Hypertens, 15, pp.7~13 (2013)
- Matsumura K, "Effect of losartan on serum uric acid in hypertension treated with a diuretic : the COMFORT study", Clin Exp Hypertens, 37, pp.192~196 (2015)
- Kurniadi A, "Losartan effect decreased uric acid Serum and Urine Levelin Hyperuricemia Hypertensivepatients", J Hypertens, 33, pp.e14~ (2015)
- Rayner BL, "Effect of losartan versus candesartan on uric acid, renal function, and fibrinogen in patients with hypertension and Hyperuricemia associated with diuretics", Am J Hypertens, 19, pp.208~213 (2006)
- Kario K, "Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives", Hypertension, 38, pp.852~857 (2001)
- O'Brien E, "Dippers and non-dippers", Lancet, 2, pp.397~ (1988)
- Shimada K, "Silent cerebrovascular disease in the elderly. Correlation with ambulatory pressure", Hypertension, 16, pp.692~699 (1990)
- Hoshide S, "Associations between nondipping of nocturnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives", Am J Hypertens, 16, pp.434~438 (2003)
- Kario K, "Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives : a prospective study", Circulation, 107, pp.1401~1406 (2003)
- Pierdomenico SD, "Circadian blood pressure changes and myocardial ischemia in hypertensive patients with coronary artery disease", J Am Coll Cardiol, 31, pp.1627~1634 (1998)
- Hermida RC, "Chronotherapy with the angiotensin-converting enzyme inhibitor ramipril in essential hypertension : improved blood pressure control with bedtime dosing", Hypertension, 54, pp.40~46 (2009)
- Ragot S, "Autonomic nervous system activity in dipper and non-dipper essential hypertensive patients. What about sex differences?", J Hypertens, 17, pp.1805~1811 (1999)
- Osanai T, "Salt-induced exacerbation of morning surge in blood pressure in patients with essential hypertension", J Hum Hypertens, 14, pp.57~64 (2000)
- Tadic M, "Isolated nocturnal hypertension:what do we know and what can we do?", Integr Blood Press Contr, 13, pp.63~69 (2020)
- Chu CS, "Morning versus evening administration of a calcium channel blocker in combination therapy for essential hypertension by ambulatory blood pressure monitoring analysis", Int Heart J, 46, pp.433~442 (2005)
- White WB, "Differential effects of morning and evening dosing of nisoldipine ER on circadian blood pressure and heart rate", Am J Hypertens, 12, pp.806~814 (1999)
- Yifan Luo LR, "Anti-hypertensive efficacy of amlodipine dosing during morning versus evening : a meta-analysis", Rev Cardiovasc Med, 20, pp.91~98 (2019)