June 16, 2021Journal of Clinical HypertensionOpen Access

Prognostic value of nocturnal blood pressure dipping on cardiovascular outcomes in Chinese patients with hypertension in primary care

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=1199). Intervention: Nocturnal blood pressure non-dipping vs. Normal dipping. Primary outcome: Total cardiovascular events (HR 1.166, 95% CI 0.770-1.764, p=0.469).

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Key result

Nocturnal BP non-dipping and reverse dipping show no significant association with total cardiovascular events.

HR 1.166
95% CI 0.770-1.764
P=0.469
n=1,199

Why the study?

Studies linking nocturnal blood pressure non-dipping on ABPM to adverse cardiovascular prognosis were mainly conducted in Caucasian and Japanese populations, leaving its relevance in Chinese patients uninvestigated.

Does nocturnal blood pressure non-dipping or reverse dipping increase the risk of cardiovascular events in Chinese patients with hypertension?

Population

1199 Chinese patients with hypertension undergoing ABPM from five public clinics in Hong Kong

Comparison

Different nocturnal blood pressure dipping patterns

Design

Retrospective cohort study

Follow-up

Mean 6.42 years

Authors

LLLing LoNational Yang Ming Chiao Tung University SHSandra W. S. HungHospital Authority SCSara S. W. ChanHospital Authority

Discussion

Member takes

Implication

May support ABPM for risk stratification in Chinese hypertension; leaves open whether targeting nocturnal patterns improves outcomes.

Study Design

Type

Cohort (n=1,199)

Multicenter

Yes

Structured PICO

Does nocturnal blood pressure non-dipping or reverse dipping increase the risk of cardiovascular events in Chinese patients with hypertension?

Population

1,199 Chinese patients with hypertension undergoing ambulatory blood pressure monitoring (ABPM) in primary care, mean age 64.5 years. Excluded: non-Chinese ethnicity, secondary hypertension, known sleep disorders (e.g., obstructive sleep apnea), or lower urinary tract symptoms.

Intervention

Non-dipping (SBP-NDR >0.9 to ≤1.0), reverse dipping (SBP-NDR >1.0), or extreme dipping (SBP-NDR ≤0.8) nocturnal blood pressure patterns on 24-hour ABPM

Comparator

Normal nocturnal blood pressure dipping pattern (SBP-NDR >0.8 to ≤0.9) or traditional dippers (SBP-NDR ≤0.9)

Outcome

Total cardiovascular events (composite of acute non-fatal myocardial infarction, acute non-fatal cerebral vascular accident, congestive heart failure, transient ischemic attack, re-vascularization, CV-related hospitalization, peripheral vascular disease, end-stage renal failure, CV mortality, and new diagnosis of coronary heart disease/cerebrovascular disease) at mean 6.42 years follow-upcomposite

Main Result

Effect estimate: HR 1.166 (95% CI 0.770-1.764)

p-value: p=0.469

Nocturnal blood pressure non-dipping and reverse dipping are associated with adverse cardiovascular prognosis in Chinese patients with hypertension, highlighting the value of ABPM for risk stratification.

Limitations

Inadequate sample size and follow-up duration
Study population from hypertension referral clinics may not be generalizable to average primary care patients
Sleep quality could not be incorporated due to retrospective design
Potential missing data from private hospital admissions
Low cardiovascular mortality rate in the cohort
Study population from referral clinics may not be generalizable to average primary care patients
Sleep quality not incorporated due to retrospective nature
Possible missing hospitalizations in private hospitals
Incongruent HRs on CV mortality due to low CV mortality rate

Cite This Study

Lo et al. (2021) conducted a cohort in Hypertension (n=1,199). Nocturnal blood pressure non-dipping vs. Normal dipping was evaluated on Total cardiovascular events (HR 1.166, 95% CI 0.770-1.764, p=0.469). Nocturnal blood pressure non-dipping and reverse dipping demonstrated adverse cardiovascular prognosis in Chinese patients with hypertension, with adjusted hazard ratios for total cardiovascular events of 1.166 and 1.173, respectively.

synapsesocial.com/papers/6a09e72a16dfdfe7ed3473ac https://doi.org/10.1111/jch.14304

Topics

Hypertension management

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Prognostic value of nocturnal blood pressure dipping on cardiovascular outcomes in Chinese patients with hypertension in primary care

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Prognostic value of nocturnal blood pressure dipping on cardiovascular outcomes in Chinese patients with hypertension in primary care

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider