title: Does nocturnal blood pressure fall in people of African and South Asian descent differ from that in European white populations? A systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess whether nocturnal blood pressure fall in people of African (Black) and South Asian descent differs from that of the European origin white populations (White).
  
  
  METHODS
  A systematic literature review was carried out using Medline 1966-2003 and Embase 1980-2003, and citations from references. The meta-analysis was performed using Cochrane review manager software (RevMan version 4.2; The Cochrane Collaboration, Oxford, UK).
  
  
  RESULTS
  Seventeen studies were identified; 11 studies from the USA, one from the USA and Canada, and six studies from the United Kingdom. The mean percentage systolic blood pressure (SBP) nocturnal fall was below 10% (non-dipping) in 10 of 17 studies (59%) and the diastolic blood pressure (DBP) nocturnal fall was below 10% in four of 16 studies (25%) in Blacks compared with four of 17 studies (24%) in SBP and none in DBP nocturnal falls in Whites. Compared with Whites, Blacks had a significantly lower mean percentage nocturnal fall; the overall weighted mean difference in SBP was -3.07 (95% confidence interval, -3.81, -2.33; P < 0.00001) and in DBP was -2.98 (95% confidence interval, -3.97, -2.00; P < 0.00001). Two studies on South Asians showed a higher SBP but a similar mean DBP nocturnal fall compared with Whites.
  
  
  CONCLUSIONS
  Smaller nocturnal blood pressure falls and a higher prevalence of non-dipping may contribute to the higher levels of hypertension complications seen in Black people. No such phenomenon was seen in South Asians but more research is needed to explore their higher stroke mortality.
authors.affiliation: Institute of Health Policy and Management, Erasmus Medical Center, Rotterdam, The Netherlands. Agyemang@bmg.eur.nl
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
authors.forename: Raj
authors.initials: R
authors.lastname: Bhopal
authors.forename: Marc
authors.initials: M
authors.lastname: Bruijnzeels
authors.forename: W Ken
authors.initials: WK
authors.lastname: Redekop
mesh_terms: D044466:Asian People; D044383:Black People; D001794:Blood Pressure; D002940:Circadian Rhythm; D006801:Humans; D013997:Time Factors; D044465:White People