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The impact of work on the night blood pressure dipping profile
Britt A Sjölin-Israelsson1, Inger E Enström
1Bergnäset Health Centre, 97223 Luleå, Sweden. britt.sjolin-israelsson@nll.se
Objective:
The purpose of this study was to elucidate whether ambulatory blood pressure (ABPM) performed during a work day and a non-work day had any impact on the night dipping profile.
Study Design:
A crossover randomized ABPM study in primary healthcare was retrospectively analysed for the occurrence of non-dipping (ND), dipping (D) or extreme (XD) nightly dipping. Non-dippers were defined as subjects with less than 10% and extreme dippers as subjects with more than 20% nightly blood pressure fall measured as mean arterial pressure (MAP).
Subjects:
Forty treated hypertensives and 40 normotensives (20 men and 20 women in each group), who had performed ABPM twice in a fortnight. They had been randomly allocated to perform a work day or a non-work day as the first period.
Result:
Only one of the 16 subjects who at any time was a non-dipper remained so during both monitoring periods. Extreme dipping was more often reproduced in nine persons out of 29. Of all 80 subjects, 43.8% (35 persons) remained dippers during both periods. No one changed from a non-dipper to an extreme dipper or the reverse. The odds of being an ND were 3.8 times more common on a non-work day, p = 0.010. XDs were slightly more common (1.7 times) on a work day than on a non-work day, p = 0.040. There was no correlation as to the degree of MAP and the dipping profile, p = 0.629.
Conclusions:
More subjects were non-dippers at the end than at the beginning of the work week. It is essential to consider this when attempting to identify a non-dipper by ABPM.
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