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Dipping is superior to cusums analysis in assessment of the risk of stroke in a case-control study
R A Phillips1, A Butkevich, K F Sheinart
1Hypertension Section, Zena and Michael A. Wiener Cardiovascular Institute, USA. robert.philips@mssm.edu
Insights
Blunted nocturnal blood pressure (BP) decline, known as nondipping, significantly increases stroke risk. Circadian alteration magnitude (CDCAM) of BP did not show a similar association in this study.
Area of Science:
- Cardiovascular Research
- Neurology
- Hypertension Studies
Background:
- Blunted nocturnal blood pressure (BP) decline is linked to higher stroke incidence.
- Diurnal BP variation is commonly assessed by mean day-night BP difference (dipping) and CDCAM.
- The clinical significance of CDCAM in predicting cardiovascular events remains unclear.
Purpose of the Study:
- To evaluate the association between BP dipping patterns and CDCAM with stroke risk.
- To compare the clinical utility of dipping versus CDCAM in stroke risk assessment.
Main Methods:
- Analysis of 24-hour ambulatory BP recordings from 110 controls and 91 stroke survivors.
- Nondipping defined as a nocturnal systolic BP drop < 10 mm Hg.
- Case-control design to calculate odds ratios for stroke associated with nondipping and CDCAM.
Main Results:
- Significantly fewer nondippers were observed in the control group compared to stroke survivors.
- Nondipping was associated with an odds ratio of 2.3 for stroke.
- No significant difference in CDCAM of systolic BP was found between control and stroke groups.
Conclusions:
- Classification of individuals as dippers or nondippers is more clinically relevant for stroke risk than CDCAM analysis.
- Further prospective studies are required to ascertain the clinical value of CDCAM in BP profiling.
Background:
Blunted nocturnal decline in blood pressure (BP) is associated with increased risk of stroke. Mean day-night BP difference (dipping) and cusums-derived circadian alteration magnitude (CDCAM) of BP are the common measures of diurnal BP variation. Although a significant number of clinical trials have demonstrated that dipping is associated with a lower risk of cardiovascular events, the clinical value of CDCAM of BP is unknown. We evaluated the association between dipping and CDCAM of BP and the risk of stroke.
Methods:
We analyzed 24-h ambulatory BP recordings of 110 control subjects and 91 stroke survivors enrolled in a case-control stroke study. Nondipping was defined as nocturnal drop of < 10 mm Hg in systolic BP. The associations between nondipping, CDCAM of BP, and risk of stroke were calculated in the same sample.
Results:
There were significantly fewer nondippers in the control group as compared with those among the stroke survivors. The odds ratio for stroke of nondippers was 2.3. By contrast, there was no significant difference in CDCAM of systolic BP between the control and stroke survivor groups. This finding could not be explained by the presence of reverse dippers in both groups.
Conclusions:
In this case-control study, classification of subjects into dippers and nondippers was found to be more clinically useful than cusums analysis of BP profile. Analysis of prospective data is needed to determine the clinical value of the cusums analysis of BP profile.
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