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      Nocturnal dipping of heart rate and blood pressure in people with HIV in Tanzania

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          Abstract

          People with HIV (PWH) have a >2‐fold greater risk for development of cardiovascular disease (CVD), which may be associated with abnormalities in 24‐h ambulatory blood pressure measurement (ABPM) profile. We conducted a nested case‐control study of ABPM in 137 PWH and HIV‐uninfected controls with normal and high clinic blood pressure (BP) in Tanzania. Nocturnal non‐dipping of heart rate (HR) was significantly more common among PWH than HIV‐uninfected controls ( p = .01). Nocturnal non‐dipping of BP was significantly more common in PWH with normal clinic BP ( p = .048). Clinical correlates of nocturnal non‐dipping were similar in PWH and HIV‐uninfected adults and included higher BMI, higher CD4 + cell count, and high C‐reactive protein for HR and markers of renal disease for BP. In conclusion, nocturnal non‐dipping of both BP and HR was more common in PWH but further research is needed to determine causes and consequences of this difference.

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          Most cited references15

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          2018 ESC/ESH Guidelines for the management of arterial hypertension

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            2020 International Society of Hypertension Global Hypertension Practice Guidelines

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              European Society of Hypertension position paper on ambulatory blood pressure monitoring.

              Ambulatory blood pressure monitoring (ABPM) is being used increasingly in both clinical practice and hypertension research. Although there are many guidelines that emphasize the indications for ABPM, there is no comprehensive guideline dealing with all aspects of the technique. It was agreed at a consensus meeting on ABPM in Milan in 2011 that the 34 attendees should prepare a comprehensive position paper on the scientific evidence for ABPM.This position paper considers the historical background, the advantages and limitations of ABPM, the threshold levels for practice, and the cost-effectiveness of the technique. It examines the need for selecting an appropriate device, the accuracy of devices, the additional information and indices that ABPM devices may provide, and the software requirements.At a practical level, the paper details the requirements for using ABPM in clinical practice, editing considerations, the number of measurements required, and the circumstances, such as obesity and arrhythmias, when particular care needs to be taken when using ABPM.The clinical indications for ABPM, among which white-coat phenomena, masked hypertension, and nocturnal hypertension appear to be prominent, are outlined in detail along with special considerations that apply in certain clinical circumstances, such as childhood, the elderly and pregnancy, and in cardiovascular illness, examples being stroke and chronic renal disease, and the place of home measurement of blood pressure in relation to ABPM is appraised.The role of ABPM in research circumstances, such as pharmacological trials and in the prediction of outcome in epidemiological studies is examined and finally the implementation of ABPM in practice is considered in relation to the issue of reimbursement in different countries, the provision of the technique by primary care practices, hospital clinics and pharmacies, and the growing role of registries of ABPM in many countries.
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                Author and article information

                Contributors
                rnp2002@med.cornell.edu
                Journal
                J Clin Hypertens (Greenwich)
                J Clin Hypertens (Greenwich)
                10.1111/(ISSN)1751-7176
                JCH
                The Journal of Clinical Hypertension
                John Wiley and Sons Inc. (Hoboken )
                1524-6175
                1751-7176
                02 June 2021
                July 2021
                : 23
                : 7 ( doiID: 10.1111/jch.v23.7 )
                : 1452-1456
                Affiliations
                [ 1 ] Center for Global Health Weill Cornell Medicine New York NY USA
                [ 2 ] Department of Medicine Brigham and Women's Hospital Boston MA USA
                [ 3 ] Mwanza Interventional Trials Unit (MITU) Mwanza Tanzania
                [ 4 ] Weill Bugando School of Medicine Mwanza Tanzania
                [ 5 ] KEMRI‐Wellcome Trust Research Program Kilifi Kenya
                [ 6 ] Department of Population Health Sciences Weill Cornell Medicine New York NY USA
                [ 7 ] Division of General Internal Medicine, Department of Medicine Weill Cornell Medicine New York NY USA
                Author notes
                [*] [* ] Correspondence

                Robert N. Peck, Center for Global Health, Weill Cornell Medicine, 402 East 67 th Street, New York, NY, USA.

                Email: rnp2002@ 123456med.cornell.edu

                Author information
                https://orcid.org/0000-0002-9509-4526
                Article
                JCH14300
                10.1111/jch.14300
                8678662
                34080288
                e78f841e-978b-4239-a284-fbaa51ac1bd6
                © 2021 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 26 April 2021
                : 17 March 2021
                : 15 May 2021
                Page count
                Figures: 1, Tables: 1, Pages: 5, Words: 2781
                Funding
                Funded by: NIH‐Fogarty International Center , doi 10.13039/100000061;
                Award ID: K01TW010281
                Categories
                Short Research Article
                Short Research Articles
                Custom metadata
                2.0
                July 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.7.0 mode:remove_FC converted:17.12.2021

                ambulatory blood pressure monitoring,hiv,nocturnal blood pressure,nocturnal heart rate,sub‐saharan africa

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