Ambulatory blood pressure monitoring profiles in a cross-sectional analysis of a large database of normotensive and true or suspected hypertensive patients

To assess ambulatory blood pressure monitoring (ABPM) circadian patterns and their determinants in a large sample of normotensive and hypertensive patients. A total of 26 170 individual ABPM recordings from 1995 to 2015 were analyzed. Mean office blood pressure (OBP), 24-hour blood pressure (BP), daytime BP and nocturnal BP were measured. Circadian patterns were classified by nocturnal systolic BP fall as extreme dipper (ED, ≥20%), dipper (D, 10%-19.9%), non-dipper (ND, 0%-9.9%), and reverse dipper (RD, <0%). The population were 52% female, aged 58±15 years, mean body mass index (BMI) 27±5 kg/m2. Using ABPM criteria of normalcy, 22.8% were normotensives (NT), 19.1% were untreated hypertensives, 29.7% were controlled hypertensives and 28.4% were treated but uncontrolled hypertensives. Among NT, 60.7% were white-coat hypertensive. In controlled hypertensives 62.4% had OBP ≥140/90 mmHg. In treated but uncontrolled hypertensives 8.2% had masked uncontrolled hypertension. ABPM values were lower than OBP in all cases. In all subgroups the most common pattern was D (42-50%), followed by ND (35-41%), ED (7-11%) and RD (4-11%). Age and BMI were determinants of attenuation of nocturnal BP fall and ND+RD. The proportion of ND+RD was higher in patients with BMI >30 kg/m2 vs. others (46.5 vs. 42.9%, p<0.01) and in those aged ≥65 vs. <65 years (54.9. vs. 33.1%, p<0.00). Nocturnal BP fall was greater in NT than in hypertensives (11.3±6.7 vs. 9.9±7.9%, p<0.000). There was a marked discrepancy between office and ABPM values. The rates of control on ABPM were more than double those on OBP. Non-dipping occurred in >43%, including in NT. Age and BMI predicted non-dipping. Avaliar os perfis circadiários da pressurometria ambulatória 24 h (ABPM) numa vasta população de normotensos e hipertensos. Analisaram-se 26 170 registos de ABPM (1995-2015). Avaliou-se a pressão arterial (BP) de consultório (cBP), diurna (dayBP), noturna (nightBP) e de 24-horas (24hBP). Perfis circadiários definidos pela queda percentual noturna (Nqueda %) da pressão sistólica (SBP): extreme dipper (ED>=20%), dipper (D, 10%-19,9%), non-dipper (ND 0%-9,9%) e reverted dipper (RD <0%). População com 52% mulheres, 58+15 anos, IMC 27+5 Kg/m2. Sob critérios de normalidade da ABPM, 22,8% eram normotensos (NT), 18,1% hipertensos não tratados (UnTxHT), 22,7% hipertensos controlados (TxcHT) e 28,4% hipertensos tratados e não controlados (TxnoncHT). Nos NT, 60,7% tinham HT da bata branca. Dos TxnoncHT 8,2% apresentaram HT mascarada. Os valores da ABPM foram sempre inferiores à cBP. O perfil mais frequente foi D (42-50%), seguido por ND (35-41%), ED (7-11%) e RD (4-11%). Idade e o IMC e determinaram o non-dippering e o conjunto ND+RD. A % de RD+ND foi superior nos obesos versus não obesos (46,5 versus 42,9%, p<0,01), e superior se >=65 versus < 65 anos (54,9 versus 33,1%, p<0,00). Nqueda % foi superior nos NT do que nos hipertensos (11,3+6,7, versus 9,9+7,9%, p<0,000). Há uma marcada discrepância entre a pressão casual e ambulatória; as taxas de controlo tensional por ABPM foram mais do dobro das da pressão casual. O perfil non-dipper ocorreu em 43-49%, inclusive nos normotensos. A idade e o IMC determinaram o fenómeno non-dipper.