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      Associations of dipping and non-dipping hypertension with cardiovascular diseases in patients with dyslipidemia

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          Abstract

          Introduction

          Dyslipidemia combined with hypertension increases the risk of cardiovascular disease (CVD). The current study aimed to investigate the association of dipping and non-dipping hypertension with CVD in patients with dyslipidemia.

          Material and methods

          A total of 243 documented dyslipidemia patients with hypertension were enrolled. Clinical characteristics and clinic and 24-hour blood pressure (BP) parameters were compared between dipping and non-dipping groups based on 24-hour ambulatory blood pressure monitoring. Logistic regression analysis was performed to evaluate the association of dipping and non-dipping hypertension with CVD.

          Results

          Compared to the dipping group, patients in the non-dipping group were older, more likely to be male and smokers, had higher serum creatinine levels, and were more likely to have chronic kidney disease and CVD ( p < 0.05 for all comparisons). No significant between-group differences in clinic systolic and diastolic BP (SBP and DBP) were observed. However, compared to the dipping group, 24-hour SBP, nighttime SBP and DBP, and night-day ratio of SBP and DBP were all significantly higher in the non-dipping group ( p < 0.05 for all comparisons). In the dipping group, only night-day ratio of SBP was significantly associated with CVD, with an odds ratio (OR) of 1.09 (95% confidence interval (CI) of 1.02–1.34). In the non-dipping group, both night-day ratio of SBP and DBP were significantly associated with CVD, with an OR of 1.72 (95% CI: 1.33–2.06) and 1.23 (95% CI: 1.05–1.66), respectively.

          Conclusions

          In patients with dyslipidemia, non-dipping hypertension is more closely related to CVD compared to dipping hypertension.

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          Most cited references14

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          Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study.

          Few studies have formally compared the predictive value of the blood pressure at night over and beyond the daytime value. We investigated the prognostic significance of the ambulatory blood pressure during night and day and of the night-to-day blood pressure ratio. We did 24-h blood pressure monitoring in 7458 people (mean age 56.8 years [SD 13.9]) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uruguay, and China. We calculated multivariate-adjusted hazard ratios for daytime and night-time blood pressure and the systolic night-to-day ratio, while adjusting for cohort and cardiovascular risk factors. Median follow-up was 9.6 years (5th to 95th percentile 2.5-13.7). Adjusted for daytime blood pressure, night-time blood pressure predicted total (n=983; p or =0.07). Adjusted for the 24-h blood pressure, night-to-day ratio predicted mortality, but not fatal combined with non-fatal events. Antihypertensive drug treatment removed the significant association between cardiovascular events and the daytime blood pressure. Participants with systolic night-to-day ratio value of 1 or more were older, at higher risk of death, and died at an older age than those whose night-to-day ratio was normal (> or =0.80 to <0.90). In contrast to commonly held views, daytime blood pressure adjusted for night-time blood pressure predicts fatal combined with non-fatal cardiovascular events, except in treated patients, in whom antihypertensive drugs might reduce blood pressure during the day, but not at night. The increased mortality in patients with higher night-time than daytime blood pressure probably indicates reverse causality. Our findings support recording the ambulatory blood pressure during the whole day.
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            Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study.

            To examine the relationship between the normal nocturnal decline in blood pressure and the risk of cardiovascular mortality in individuals with and without high 24-h blood pressure values. We obtained 24-h ambulatory blood pressure readings from 1542 residents of Ohasama, Japan, who were aged 40 years or more and were representative of the Japanese general population. We then followed up their survival for a mean of 9.2 years. The relationship was analysed using a Cox proportional hazards model adjusted for possible confounding factors. There was a linear relationship between the nocturnal decline in blood pressure and cardiovascular mortality. On average, each 5% decrease in the decline in nocturnal systolic/diastolic blood pressure was associated with an approximately 20% greater risk of cardiovascular mortality. There were no significant interactions for the risk between 24-h systolic/diastolic blood pressure values and continuous values for the nocturnal decline in blood pressure ( for interaction 0.6). Even when 24-h blood pressure values were within the normal range ( 135/80 mmHg, average 118/69 mmHg), diminished nocturnal decreases in systolic/diastolic blood pressure were associated with an increased risk of cardiovascular mortality. This is the first study to demonstrate that a diminished nocturnal decline in blood pressure is a risk factor for cardiovascular mortality, independent of the overall blood pressure load during a 24-h period, in the general population.
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              Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension in Europe Trial Investigators.

              The clinical use of ambulatory blood pressure (BP) monitoring requires further validation in prospective outcome studies. To compare the prognostic significance of conventional and ambulatory BP measurement in older patients with isolated systolic hypertension. Substudy to the double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) Trial, started in October 1988 with follow up to February 1999. The conventional BP at randomization was the mean of 6 readings (2 measurements in the sitting position at 3 visits 1 month apart). The baseline ambulatory BP was recorded with a noninvasive intermittent technique. Family practices and outpatient clinics at primary and secondary referral hospitals. A total of 808 older (aged > or =60 years) patients whose untreated BP level on conventional measurement at baseline was 160 to 219 mm Hg systolic and less than 95 mm Hg diastolic. For the overall study, patients were randomized to nitrendipine (n = 415; 10-40 mg/d) with the possible addition of enalapril (5-20 mg/d) and/or hydrochlorothiazide (12.5-25.0 mg/d) or to matching placebos (n = 393). Total and cardiovascular mortality, all cardiovascular end points, fatal and nonfatal stroke, and fatal and nonfatal cardiac end points. After adjusting for sex, age, previous cardiovascular complications, smoking, and residence in western Europe, a 10-mm Hg higher conventional systolic BP at randomization was not associated with a worse prognosis, whereas in the placebo group, a 10-mm Hg higher 24-hour BP was associated with an increased relative hazard rate (HR) of most outcome measures (eg, HR, 1.23 [95% confidence interval [CI], 1.00-1.50] for total mortality and 1.34 [95% CI, 1.03-1.75] for cardiovascular mortality). In the placebo group, the nighttime systolic BP (12 AM-6 AM) more accurately predicted end points than the daytime level. Cardiovascular risk increased with a higher night-to-day ratio of systolic BP independent of the 24-hour BP (10% increase in night-to-day ratio; HR for all cardiovascular end points, 1.41; 95% CI, 1.03-1.94). At randomization, the cardiovascular risk conferred by a conventional systolic BP of 160 mm Hg was similar to that associated with a 24-hour daytime or nighttime systolic BP of 142 mm Hg (95% CI, 128-156 mm Hg), 145 mm Hg (95% CI, 126-164 mm Hg) or 132 mm Hg (95% CI, 120-145 mm Hg), respectively. In the active treatment group, systolic BP at randomization did not significantly predict cardiovascular risk, regardless of the technique of BP measurement. In untreated older patients with isolated systolic hypertension, ambulatory systolic BP was a significant predictor of cardiovascular risk over and above conventional BP.
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                Author and article information

                Journal
                Arch Med Sci
                Arch Med Sci
                AMS
                Archives of Medical Science : AMS
                Termedia Publishing House
                1734-1922
                1896-9151
                05 January 2018
                March 2019
                : 15
                : 2
                : 337-342
                Affiliations
                Department of Emergency, The Third People’s Hospital, Huizhou, China
                Author notes
                Corresponding author: Siping Dai, Department of Emergency, The Third People’s Hospital of Huizhou, 1 Qiaodongxuebei St, 516000 Huizhou, China. Phone: +86 752 2255120. E-mail: daisiping123@ 123456gmail.com
                Article
                31447
                10.5114/aoms.2018.72609
                6425204
                30899285
                5bc3249f-c755-424a-be20-165e53b82e18
                Copyright: © 2018 Termedia & Banach

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

                History
                : 08 October 2017
                : 11 December 2017
                Categories
                Clinical Research

                Medicine
                dyslipidemia,hypertension,cardiovascular diseases
                Medicine
                dyslipidemia, hypertension, cardiovascular diseases

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