Abstract
BackgroundNight-time BP, especially non-dipper, is a stronger predictor of adverse cardiovascular outcomes. Ambulatory blood pressure monitoring (ABPM) is a gold standard for the detection of non-dippers but it often is unavailable and expensive. This study aims to determine clinical risk factors that predict non-dipper.MethodsAn exploratory traditional case-control study, exclusive sampling of control was conducted from January 2013 to September 2018 to explore clinical risk factors associated with non-dippers in hypertensive patients. Subgroup analysis was performed in each treated and untreated hypertensive patient. The parsimonious predictive score for non-dippers was constructed.ResultsThe study included 208 hypertensive patients receiving 24 h ABPM. There were 104 dippers and 104 non-dippers. Significant clinical risk factors associated with non-dippers were the age of > 65 years, average office diastolic blood pressure (DBP), and fasting plasma glucose of > 5.6 mmol/L. Results of subgroup analysis showed that dyslipidemia, history of coronary artery disease, use of angiotensin-converting enzyme inhibitors (ACEIs) and direct vasodilators, average office DBP, and serum uric acid were associated with non-dippers in treated hypertensive patients, however, there were no risk factors associated with non-dippers in the untreated group. The predictive score for non-dippers in treated group included average office DBP, dyslipidemia, serum uric acid, male, calcium channel blockers and ACEIs use. The area under Receiver Operating Characteristic (AuROC) was 0.723. A cut-off point which was > 0.0701 and prevalence of non-dippers of 46%, this score had a sensitivity of 77.4%, specificity of 65.6%, positive predictive value (PPV) of 66.1%, and negative predictive value (NPV) of 79.6%. For untreated group, age, hemoglobin and body mass index were included in the predictive model. AuROC was 0.74. There was a sensitivity of 51.9%, specificity of 91.2%, PPV of 82.4%, and NPV of 70.5% at the cut-off point of > 0.357, and prevalence of 44%.ConclusionThere were several significant clinical risk factors associated with non-dippers in treated hypertensive patients. The predictive score might be useful for the detection of non-dippers; however, it cannot replace ABPM.
Highlights
Hypertension is a cause of death globally, accounting for 10.4 million death per year [1]
Because we mainly aimed to investigate the differences of red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR), which might be new biomarkers for non-dippers as in previous studies [10, 11], between two groups
Of the 208 adult hypertensive patients who underwent 24 h, Ambulatory blood pressure monitoring (ABPM) were enrolled in our study
Summary
Hypertension is a cause of death globally, accounting for 10.4 million death per year [1]. Uncontrolled hypertension is one of the most important risk factors for cardiovascular disease as well as increases morbidity and mortality [2, 3]. Ambulatory blood pressure monitoring (ABPM) is the best method for the detection of non-dippers and is a better predictor of hypertension-mediated organ damage (HMOD) than office BP [4, 5]. Previous studies found that night-time BP was a stronger predictor of adverse cardiovascular outcomes than daytime BP [5,6,7,8]. Night-time BP, especially non-dipper, is a stronger predictor of adverse cardiovascular outcomes. Ambulatory blood pressure monitoring (ABPM) is a gold standard for the detection of non-dippers but it often is unavailable and expensive. This study aims to determine clinical risk factors that predict non-dipper
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