title: Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients.
abstract: Ambulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In addition to 24-hour values, the circadian variation of BP adds prognostic significance in predicting cardiovascular outcome. However, the magnitude of circadian BP patterns in large studies has hardly been noticed. Our aims were to determine the prevalence of circadian BP patterns and to assess clinical conditions associated with the nondipping status in groups of both treated and untreated hypertensive subjects, studied separately. Clinical data and 24-hour ambulatory BP monitoring were obtained from 42,947 hypertensive patients included in the Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry. They were 8384 previously untreated and 34,563 treated hypertensives. Twenty-four-hour ambulatory BP monitoring was performed with an oscillometric device (SpaceLabs 90207). A nondipping pattern was defined when nocturnal systolic BP dip was <10% of daytime systolic BP. The prevalence of nondipping was 41% in the untreated group and 53% in treated patients. In both groups, advanced age, obesity, diabetes mellitus, and overt cardiovascular or renal disease were associated with a blunted nocturnal BP decline (P<0.001). In treated patients, nondipping was associated with the use of a higher number of antihypertensive drugs but not with the time of the day at which antihypertensive drugs were administered. In conclusion, a blunted nocturnal BP dip (the nondipping pattern) is common in hypertensive patients. A clinical pattern of high cardiovascular risk is associated with nondipping, suggesting that the blunted nocturnal BP dip may be merely a marker of high cardiovascular risk.
authors.affiliation: Hypertension Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Villarroel 170, E-08036 Barcelona, Spain. asierra@clinic.ub.es
authors.forename: Alejandro
authors.initials: A
authors.lastname: de la Sierra
authors.forename: Josep
authors.initials: J
authors.lastname: Redon
authors.forename: José R
authors.initials: JR
authors.lastname: Banegas
authors.forename: Julián
authors.initials: J
authors.lastname: Segura
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.forename: Manuel
authors.initials: M
authors.lastname: Gorostidi
authors.forename: Juan J
authors.initials: JJ
authors.lastname: de la Cruz
authors.forename: Javier
authors.initials: J
authors.lastname: Sobrino
authors.forename: José L
authors.initials: JL
authors.lastname: Llisterri
authors.forename: Javier
authors.initials: J
authors.lastname: Alonso
authors.forename: Ernest
authors.initials: E
authors.lastname: Vinyoles
authors.forename: Vicente
authors.initials: V
authors.lastname: Pallarés
authors.forename: Antonio
authors.initials: A
authors.lastname: Sarría
authors.forename: Pedro
authors.initials: P
authors.lastname: Aranda
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D013030:Spain / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents