Original Article
Ambulatory blood pressure monitoring profiles in a cross-sectional analysis of a large database of normotensive and true or suspected hypertensive patients
Perfis ambulatoriais de monitoramento da pressão arterial em uma análise transversal de um grande banco de dados de pacientes hipertensos normotensos e verdadeiros ou suspeitos
Sara Araújoa, Ana Rouxinol-Diasa, José Mesquita-Bastosc, José Silvab, Loide Barbosaa, Jorge Polóniaa,b,,
a Department of Medicine, Center for Research in Health Technologies and Services (Cintesis), Faculty of Medicine of Porto, Porto, Portugal
b Unidade de Hipertensao, Hospital Pedro Hispano, ULS Matosinhos, Matosinhos, Portugal
c Escola Superior de Saúde da Universidade de Aveiro, Aveiro, Portugal
Recebido 12 Fevereiro 2017, Aceitaram 24 Julho 2017
Abstract
Objective

To assess ambulatory blood pressure monitoring (ABPM) circadian patterns and their determinants in a large sample of normotensive and hypertensive patients.

Methods

A total of 26170 individual ABPM recordings from 1995 to 2015 were analyzed. Mean office blood pressure (OBP), 24-hour blood pressure (BP), daytime BP and nocturnal BP were measured. Circadian patterns were classified by nocturnal systolic BP fall as extreme dipper (ED, ≥20%), dipper (D, 10%-19.9%), non-dipper (ND, 0%-9.9%), and reverse dipper (RD, <0%).

Results

The population were 52% female, aged 58±15 years, mean body mass index (BMI) 27±5 kg/m2. Using ABPM criteria of normalcy, 22.8% were normotensives (NT), 19.1% were untreated hypertensives, 29.7% were controlled hypertensives and 28.4% were treated but uncontrolled hypertensives. Among NT, 60.7% were white-coat hypertensive. In controlled hypertensives 62.4% had OBP ≥140/90 mmHg. In treated but uncontrolled hypertensives 8.2% had masked uncontrolled hypertension. ABPM values were lower than OBP in all cases. In all subgroups the most common pattern was D (42-50%), followed by ND (35-41%), ED (7-11%) and RD (4-11%). Age and BMI were determinants of attenuation of nocturnal BP fall and ND+RD. The proportion of ND+RD was higher in patients with BMI >30 kg/m2 vs. others (46.5 vs. 42.9%, p<0.01) and in those aged ≥65 vs. <65 years (54.9. vs. 33.1%, p<0.00). Nocturnal BP fall was greater in NT than in hypertensives (11.3±6.7 vs. 9.9±7.9%, p<0.000).

Conclusions

There was a marked discrepancy between office and ABPM values. The rates of control on ABPM were more than double those on OBP. Non-dipping occurred in >43%, including in NT. Age and BMI predicted non-dipping.

Resumo
Objetivo

Avaliar os perfis circadiários da pressurometria ambulatória 24 h (ABPM) numa vasta população de normotensos e hipertensos.

Métodos

Analisaram-se 26 170 registos de ABPM (1995-2015). Avaliou-se a pressão arterial (BP) de consultório (cBP), diurna (dayBP), noturna (nightBP) e de 24-horas (24hBP). Perfis circadiários definidos pela queda percentual noturna (Nqueda %) da pressão sistólica (SBP): extreme dipper (ED>=20%), dipper (D, 10%-19,9%), non-dipper (ND 0%-9,9%) e reverted dipper (RD <0%).

Resultados

População com 52% mulheres, 58+15 anos, IMC 27+5 Kg/m2. Sob critérios de normalidade da ABPM, 22,8% eram normotensos (NT), 18,1% hipertensos não tratados (UnTxHT), 22,7% hipertensos controlados (TxcHT) e 28,4% hipertensos tratados e não controlados (TxnoncHT). Nos NT, 60,7% tinham HT da bata branca. Dos TxnoncHT 8,2% apresentaram HT mascarada. Os valores da ABPM foram sempre inferiores à cBP. O perfil mais frequente foi D (42-50%), seguido por ND (35-41%), ED (7-11%) e RD (4-11%). Idade e o IMC e determinaram o non-dippering e o conjunto ND+RD. A % de RD+ND foi superior nos obesos versus não obesos (46,5 versus 42,9%, p<0,01), e superior se >=65 versus < 65 anos (54,9 versus 33,1%, p<0,00). Nqueda % foi superior nos NT do que nos hipertensos (11,3+6,7, versus 9,9+7,9%, p<0,000).

Conclusão

Há uma marcada discrepância entre a pressão casual e ambulatória; as taxas de controlo tensional por ABPM foram mais do dobro das da pressão casual. O perfil non-dipper ocorreu em 43-49%, inclusive nos normotensos. A idade e o IMC determinaram o fenómeno non-dipper.

Keywords
Circadian blood pressure rhythm, 24h ambulatory blood pressure, Non-dipping blood pressure
Palavras-chave
Perfis circadiários da pressurometria ambulatória, Pressurometria ambulatória de 24 horas, Padrão non dipping

Métricas

  • Impact Factor: 1,195(2016)
  • 5-years Impact Factor: 0,728
  • SCImago Journal Rank (SJR):0,29
  • Source Normalized Impact per Paper (SNIP):0,398