What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Dyslipidemia with hypertension (n=243). Intervention: Non-dipping blood pressure pattern vs. Dipping blood pressure pattern. Primary outcome: Association of night-day ratio of systolic blood pressure with prevalent cardiovascular disease in the non-dipping group (OR 1.72, 95% CI 1.33-2.06, p=<0.001).

March 8, 2018Open Access

Associations of dipping and non-dipping hypertension with cardiovascular diseases in patients with dyslipidemia

Q: What are the key findings of this study?

In patients with dyslipidemia, a non-dipping blood pressure pattern was associated with a higher prevalence of cardiovascular disease, with the night-day systolic blood pressure ratio significantly increasing CVD risk (OR 1.72).

SDSiping DaiHuizhou Central People's Hospital BHBo HuangPfizer (United States)YZYunliang ZouHuizhou Central People's Hospital

Key Result

In patients with dyslipidemia, a non-dipping blood pressure pattern was associated with a higher prevalence of cardiovascular disease, with the night-day systolic blood pressure ratio significantly increasing CVD risk (OR 1.72).

Study Design

Type

Cross-Sectional (n=243)

Multicenter

Structured PICO

Is non-dipping hypertension associated with a higher risk of cardiovascular disease compared to dipping hypertension in patients with dyslipidemia?

Population

243 patients with documented dyslipidemia and hypertension were evaluated in a cross-sectional study to assess the association between dipping and non-dipping blood pressure patterns and prevalent cardiovascular disease.

Exposure

Non-dipping hypertension (based on 24-hour ambulatory blood pressure monitoring)

Comparator

Dipping hypertension

Outcome

Cardiovascular disease (CVD)hard clinical

Non-dipping hypertension is more strongly associated with cardiovascular disease than dipping hypertension in patients with dyslipidemia.

Main Result

Odds Ratio: 1.72 (95% CI 1.33–2.06)

p-value: p=<0.001

Limitations

The cross-sectional design could not allow inference of a causal relationship between non-dipping BP pattern and prevalent CVD.
The relatively small number of ischemic stroke cases might have limited the ability to observe significant differences.
Obstructive sleep apnea (OSA), which is highly prevalent in non-dipping hypertensive patients, was not evaluated or adjusted for.
Participants had comorbidities such as CHD, IS, diabetes mellitus, and CKD, which might influence BP patterns and their association with prevalent CVD.

Abstract

Introduction: Dyslipidemia combined with hypertension increases the risk of cardiovascular disease (CVD). The current study aimed to investigate the association of dipping and non-dipping hypertension with CVD in patients with dyslipidemia. Material and methods: A total of 243 documented dyslipidemia patients with hypertension were enrolled. Clinical characteristics and clinic and 24hour blood pressure (BP) parameters were compared between dipping and non-dipping groups based on 24-hour ambulatory blood pressure monitoring. Logistic regression analysis was performed to evaluate the association of dipping and non-dipping hypertension with CVD. Results: Compared to the dipping group, patients in the non-dipping group were older, more likely to be male and smokers, had higher serum creatinine levels, and were more likely to have chronic kidney disease and CVD (p < 0.05 for all comparisons). No significant between-group differences in clinic systolic and diastolic BP (SBP and DBP) were observed. However, compared to the dipping group, 24-hour SBP, nighttime SBP and DBP, and night-day ratio of SBP and DBP were all significantly higher in the non-dipping group (p < 0.05 for all comparisons). In the dipping group, only night-day ratio of SBP was significantly associated with CVD, with an odds ratio (OR) of 1.09 (95% confidence interval (CI) of 1.02-1.34). In the non-dipping group, both night-day ratio of SBP and DBP were significantly associated with CVD, with an OR of 1.72 (95% CI: 1.33-2.06) and 1.23 (95% CI: 1.05-1.66), respectively. Conclusions: In patients with dyslipidemia, non-dipping hypertension is more closely related to CVD compared to dipping hypertension.

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