Circadian Blood Pressure Variations Computed From 1.7 Million Measurements in an Acute Hospital Setting.

Adam Mahdi,Lionel Tarassenko,Richard J Mcmanus,Peter Watkinson

doi:10.1093/ajh/hpz130

Abstract

BACKGROUNDKnowledge of the circadian blood pressure (BP) variations in the acute hospital setting is very limited.METHODSThis is a retrospective analysis of BP data for in-hospital patients stratified by age and sex. We used data collected with the help of a standardized electronic health record system between March 2014 and April 2018 on the adult general wards in 4 acute hospitals in Oxford, UK.RESULTSA total of 41,455 unique patient admissions with 1.7 million sets of vital-sign measurements have been included in the study. The typical 24-hour systolic BP profile (dipping pattern during sleep followed by a gradual increase during the day) was only seen in the younger age groups (up to 40–49 for men and 30–39 for women). For older age groups, there was a late nocturnal rise in systolic BP, the amplitude of which increased with age. The late nocturnal BP rise above the age of 50 was seen whether or not the patient was treated for or previously identified with hypertension.CONCLUSIONHospitalized patients’ circadian patterns of BP largely mirror those found in the community. High-quality hospital data may allow for the identification of patients at significant cardiovascular risk through either opportunistic screening or systematic screening.

Highlights

BackgroundIt is well known that in the community blood pressure (BP) is characterized by fluctuations occurring over different time scales.[1]
Nighttime BP profiles can be classified into 3 patterns: dippers, nondippers, and risers or reverse dippers.[6,7]
A systematic review by Taylor et al.[4] found nighttime dipping was associated with a lower risk of cardiovascular events while rising BP at night compared with daytime values was associated with increased risk

Summary

Introduction

BackgroundIt is well known that in the community blood pressure (BP) is characterized by fluctuations occurring over different time scales.[1]. Recent analysis[5] of data from a registry-based, multicenter, national cohort that included 63,910 adults recruited over a decade showed that measurements made over 24 hours with ambulatory BP monitoring (ABPM) were a stronger predictor of all-cause and cardiovascular mortality than clinic BP measurements. Nighttime BP profiles can be classified into 3 patterns: dippers (subjects in whom BP falls at night), nondippers (subjects in whom BP does not fall at night), and risers or reverse dippers (subjects in whom BP rises at night).[6,7] These categories have been observed from studies using ABPM,[8,9] home BP monitoring,[10,11] and a small-sample study in elderly hospitalized patients.[12] The riser or reverse dipping pattern has been found to be more common in older patients.[13,14,15] A systematic review by Taylor et al.[4] found nighttime dipping was associated with a lower risk of cardiovascular events while rising BP at night compared with daytime values was associated with increased risk. Knowledge of the circadian blood pressure (BP) variations in the acute hospital setting is very limited

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