Circadian rhythm of blood pressure and its related factors in patients with hypertension
Abstract
Introduction. Hypertension is a common, almost asymptomatic, detectable and treatable disease. Abnormal circadian rhythm of blood pressure is associated with increased risk of disorders such as sleep problems, metabolic syndrome, cardiovascular disease and cancer. On the other hand, 24-hour blood pressure monitoring, a method for detecting the abnormal pattern of blood pressure decrease over night, gets less clinicians’ attention. This study aims to determine the circadian rhythm of blood pressure and its related factors in hypertensive patients.
Material and methods. This analytical cross-sectional study was done in 2015. The study population was patients referred to the offices and clinics in the city of Qom and 183 of them were selected based on convenience sampling. Data were collected by use of demographic checklist and the results of 24-hour monitoring of blood pressure.
Results. The mean age of patients was 52.08 ± 14.16 years, and 57.9% were female. The mean duration of hyper- tension history was 4.32 ± 4.96 years. 77% of the patients had non-dipper blood pressure pattern. In terms of age (p = 0.31) and duration of hypertension (p = 0.93), gender (p = 0.55) and type of hypertension treatment (p = 0.96), there was no significant difference between the two groups of dippers and non-dippers.
Conclusions. In this study, the frequency of non-dipper pattern in patients with hypertension was higher than in similar studies. Since the importance of 24-hour blood pressure monitoring for proper evaluation and management, it is recommended that hypertensive patients undergo 24-hour blood pressure monitoring.
Keywords: hypertensioncircadian BP rhythmambulatory blood pressure monitoringnon-dipperdipper
References
- Fauci AS. Harrison's principles of internal medicine: McGraw-Hill. Medical Publishing Division New York, New York 2008.
- Braunwald E, Bonow RO. Braunwald's heart disease. Elsevier Saunders 2012.
- Kearney PM, Whelton M, Reynolds K, et al. Worldwide prevalence of hypertension: a systematic review. J Hypertens. 2004; 22(1): 11–19.
- Haghdoost AA, Sadeghirad B, Rezazadehkermani M. Epidemiology and heterogeneity of hypertension in Iran: a systematic review. Arch Iran Med. 2008; 11(4): 444–452.
- Anigbogu CN, Williams DT, Brown DR, et al. Circadian Variations in Blood Pressure, Heart Rate, and HR-BP Cross-Correlation Coefficient during Progression of Diabetes Mellitus in Rat. Int J Hypertens. 2011; 2011: 738689.
- Leão R, Florêncio AF, Calaça J, et al. Management of hypertension in a tertiary hospital. Eur J Intern Med. 2013; 24: e35.
- Matsumura R, Node K, Akashi M. Estimation methods for human circadian phase by use of peripheral tissues. Hypertens Res. 2016; 39(9): 623–627.
- Leão RN, Florêncio AF, Cruz J, et al. Non-dipping blood pressure profile in treated hypertensive patients. European Journal of Internal Medicine. 2013; 24: e35.
- Hassler C, Burnier M. Circadian variations in blood pressure : implications for chronotherapeutics. Am J Cardiovasc Drugs. 2005; 5(1): 7–15.
- Hooman N, Nakhaei S, Saiedi M, et al. Update on usefulness of 24-hour ambulatory blood pressure monitoring in children. Razi J Med Sci. 2014; 21(122): 68–79.
- Staessen JA, Byttebier G, Buntinx F, et al. Antihypertensive treatment based on conventional or ambulatory blood pressure measurement. A randomized controlled trial. Ambulatory Blood Pressure Monitoring and Treatment of Hypertension Investigators. JAMA. 1997; 278(13): 1065–1072.
- Kario K, Pickering TG, Matsuo T, et al. Stroke prognosis and abnormal nocturnal blood pressure falls in older hypertensives. Hypertension. 2001; 38(4): 852–857.
- Krakoff LR. Cost-effectiveness of ambulatory blood pressure: a reanalysis. Hypertension. 2006; 47(1): 29–34.
- Lovibond K, Jowett S, Barton P, et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. Lancet. 2011; 378(9798): 1219–1230.
- Kario K. Essential manual of 24 hour blood pressure management: from morning to nocturnal hypertension. John Wiley & Sons 2015.
- Boggia J, Li Y, Thijs L, et al. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet. 2007; 370(9594): 1219–1229.
- Kabutoya T, Hoshide S, Ishikawa J, et al. The effect of pulse rate and blood pressure dipping status on the risk of stroke and cardiovascular disease in Japanese hypertensive patients. Am J Hypertens. 2010; 23(7): 749–755.
- Soergel M, Kirschstein M, Busch C, et al. Oscillometric twenty-four-hour ambulatory blood pressure values in healthy children and adolescents: a multicenter trial including 1141 subjects. J Pediatr. 1997; 130(2): 178–184.
- Hodgkinson JA, Sheppard JP, Heneghan C, et al. Accuracy of ambulatory blood pressure monitors: a systematic review of validation studies. J Hypertens. 2013; 31(2): 239–250.
- Omboni S, Palatini P, Parati G. Standards for ambulatory blood pressure monitoring clinical reporting in daily practice. Blood Press Monit. 2015; 20(5): 241–244.
- Kawamura H, Ozawa Y, Izumi Y, et al. Non-dipping blood pressure variations in adult Kazakhs are derived from decreased daytime physical activity and increased nighttime sympathetic activity. Clin Exp Hypertens. 2016; 38(2): 194–202.
- Kario K. Perfect 24-h management of hypertension: clinical relevance and perspectives. J Hum Hypertens. 2017; 31(4): 231–243.
- Ssinabulya I, Nabunnya Y, Kiggundu B, et al. Hypertension control and care at Mulago Hospital ambulatory clinic, Kampala-Uganda. BMC Res Notes. 2016; 9(1): 487.
- Furberg CD, Psaty BM, Pahor M, et al. Clinical Implications of Recent Findings from the Antihypertensive and Lipid-Lowering Treatment To Prevent Heart Attack Trial (ALLHAT) and Other Studies of Hypertension. Ann Intern Med. 2001; 135(12): 1074–1078.
- Katakam R, Brukamp K, Townsend RR. What is the proper workup of a patient with hypertension? Cleve Clin J Med. 2008; 75(9): 663–672.
- Hermida R, Smolensky M, Ayala D, et al. 2013 Ambulatory Blood Pressure Monitoring Recommendations for the Diagnosis of Adult Hypertension, Assessment of Cardiovascular and other Hypertension-associated Risk, and Attainment of Therapeutic Goals. Chronobiol Int. 2013; 30(3): 355–410.
- Kario K. Hypertension: Benefits of strict blood-pressure lowering in hypertension. Nat Rev Cardiol. 2016; 13(3): 125–126.