Daytime standard deviation of systolic blood pressure was a better screening tool than nocturnal nondipping status for detecting autonomic failure, yielding an AUC of 0.79 (95% CI 0.66-0.91).
Observational (n=273)
No
Does daytime SD of SBP improve the detection of autonomic failure compared to nondipping status in patients undergoing ambulatory BP monitoring?
Daytime SD of systolic blood pressure is a superior screening tool compared to nondipping status for detecting autonomic dysfunction in patients undergoing 24-hour ambulatory BP monitoring.
Effect estimate: AUC (95% CI 0.66-0.91)
Absolute Event Rate: 0.79% vs 0.73%
Background Increased blood pressure ( BP ) variability and nondipping status seen on 24‐hour ambulatory BP monitoring are often observed in autonomic failure ( ATF ). Methods and Results We assessed BP variability and nocturnal BP dipping in 273 patients undergoing ambulatory BP monitoring at Southwestern Medical Center between 2010 and 2017. SD , average real variability, and variation independent of mean were calculated from ambulatory BP monitoring. Patients were divided into a discovery cohort (n=201) and a validation cohort (n=72). ATF was confirmed by formal autonomic function test. In the discovery cohort, 24‐hour and nighttime average real variability, SD , and variation independent of mean did not differ significantly between ATF (n=25) and controls (n=176, all P >0.05). However, daytime SD, daytime coefficient of variation, and daytime variation independent of mean of systolic BP ( SBP ) were all significantly higher in patients with ATF than in controls in both discovery and validation cohorts. Nocturnal BP dipping was more blunted in ATF patients than controls in both cohorts (both P <0.01). Using the threshold of 16 mm Hg, daytime SD SBP yielded a sensitivity of 77% and specificity of 82% in detecting ATF in the validation cohort, whereas nondipping status had a sensitivity of 80% and specificity of 44%. The area under the receiver operator characteristic of daytime SD SBP was greater than the area under the receiver operator characteristic of nocturnal SBP dipping (0.79 0.66‐0.91 versus 0.73 0.58‐0.87, respectively). Conclusions Daytime SD of SBP is a better screening tool than nondipping status in detecting autonomic dysfunction.
Lodhi et al. (Sat,) conducted a observational in Autonomic failure (n=273). Daytime SD of systolic blood pressure vs. Nocturnal SBP dipping was evaluated on Detection of autonomic failure (AUC, 95% CI 0.66-0.91). Daytime standard deviation of systolic blood pressure was a better screening tool than nocturnal nondipping status for detecting autonomic failure, yielding an AUC of 0.79 (95% CI 0.66-0.91).