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Clinical risk factors and predictive score for the non-dipper profile in hypertensive patients: a case-control study
Chavalit Chotruangnapa1, Titima Tansakun1, Weranuj Roubsanthisuk2
1Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Siriraj, Bangkoknoi, Bangkok, 10700, Thailand.
Insights
Night-time blood pressure (BP) non-dippers predict cardiovascular events. This study identified clinical risk factors for non-dippers in hypertensive patients, developing a predictive score for treated individuals that may aid detection but not replace monitoring.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Risk Stratification
Background:
- Night-time blood pressure (BP) is a critical predictor of cardiovascular outcomes, with non-dipper status indicating higher risk.
- Ambulatory blood pressure monitoring (ABPM) is the gold standard for identifying non-dippers but is often inaccessible and costly.
Purpose of the Study:
- To identify clinical risk factors predicting non-dipper status in hypertensive patients.
- To develop a predictive score for non-dipper status, particularly in treated hypertensive individuals.
Main Methods:
- An exploratory case-control study involving 208 hypertensive patients undergoing 24-hour ABPM.
- Subgroup analysis was conducted for treated and untreated hypertensive patient groups.
- A parsimonious predictive score for non-dippers was constructed and validated.
Main Results:
- Significant risk factors for non-dippers included age > 65 years, elevated office diastolic blood pressure (DBP), and high fasting plasma glucose.
- In treated patients, dyslipidemia, coronary artery disease history, ACEI/direct vasodilator use, office DBP, and serum uric acid were associated with non-dipper status.
- A predictive score for treated non-dippers, incorporating office DBP, dyslipidemia, serum uric acid, sex, and specific antihypertensives, showed moderate predictive accuracy (AuROC 0.723).
Conclusions:
- Several clinical factors predict non-dipper status in treated hypertensive patients.
- A developed predictive score may assist in identifying non-dippers but does not substitute for ABPM.
- Further research could refine predictive models for non-dipper status.
Background:
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.
Methods:
An 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.
Results:
The 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%.
Conclusion:
There 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.
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