Reproducibility of the circadian blood pressure pattern in 24-h versus 48-h recordings: the Spanish Ambulatory Blood Pressure Monitoring Registry.
OBJECTIVE
To assess the reproducibility of the circadian blood pressure (BP) pattern over a 48-h period by comparing the first 24 h of ambulatory blood pressure monitoring (ABPM) with the following 24 h and with the mean over 48 h.


METHODS
Patients undergoing 48-h ABPM within the National ABPM Registry of the Spanish Society of Hypertension, based on 800 Spacelabs 90207 monitors distributed throughout Spain in hypertension units and primary healthcare centres, were included. Between June 2004 and September 2005, 611 valid 48-h ABPM recordings were obtained, 235 corresponded to patients without antihypertensive treatment.


RESULTS
The percentages of patients classified as non-dipper for the first 24 h, the second 24 h and the 48-h average were 47, 50 and 48%, respectively. When the first and second 24-h periods were compared, 147 (24%) subjects switched from dipper (D) to non-dipper (ND) or vice-versa. When the first 24-h period was compared to the 48-h average, 66 (11%) subjects switched patterns. The proportions were similar separately for systolic blood pressure (SBP) and diastolic blood pressure (DBP) and between treated and untreated patients. In subjects with poor ABPM reproducibility, night-to-day ratios were of an intermediate value between those of subjects always classified as D or ND.


CONCLUSIONS
Categorization of D or ND based on a single 24-h ABPM is moderately reproducible, since one out of every five patients change profile over the following 24 h. Nevertheless, the use of 48-h ABPM in clinical practice should be assessed according to cost-effectiveness criteria. Night-to-day ratios may be helpful in identifying patients with a stable profile.
Hernández-del Rey
Raquel
R
Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital General de L'Hospitalet, University of Barcelona, Spain. raquel.hernandez@sanitatintegral.org
Martin-Baranera
Montserrat
M
Sobrino
Javier
J
Gorostidi
Manuel
M
Vinyoles
Ernest
E
Sierra
Cristina
C
Segura
Julian
J
Coca
Antonio
A
Ruilope
Luis Miguel
LM
D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods* / Q000706:statistics & numerical data; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012042:Registries; D015203:Reproducibility of Results; D013030:Spain; D013997:Time Factors