TY - JOUR
T1 - Reproducibility and clinical value of nocturnal hypotension
T2 - Prospective evidence from the SAMPLE study
AU - Omboni, Stefano
AU - Parati, Gianfranco
AU - Palatini, Paolo
AU - Vanasia, Alessandro
AU - Muiesan, Maria Lorenza
AU - Cuspidi, Cesare
AU - Mancia, Giuseppe
PY - 1998
Y1 - 1998
N2 - Objective. To assess whether modifications in the night-time blood pressure fall caused by antihypertensive treatment predict the regression of end-organ damage of hypertension. Methods. The analysis was performed in patients with essential hypertension and echocardiographically detected left ventricular hypertrophy involved in the SAMPLE study. For each patient, ambulatory blood pressure monitoring and echocardiographic determination of left ventricular mass index were performed at the end of a 4-week wash-out pretreatment period, after 3 and 12 months of treatment with lisinopril or with lisinopril plus hydrochlorothiazide and after a final 4-week placebo period. For each ambulatory blood pressure monitoring the 24 h average, daytime average (0600-2400 h), night-time average (2400-0600 h) and day-night difference was computed. The percentages of dipper and non-dipper patients (i.e. the patients with night blood pressure falls greater and less than 10% of the daytime average, respectively) were also computed. Results. The reproducibility of the day-night difference was low, both for comparison of the pretreatment and final placebo periods (n = 170) and for comparison of the third and the 12th month of treatment (n = 180). The reproducibility of the dipper-non-dipper dichotomy was also low, 35-40% of patients becoming non-dippers if they were dippers and vice versa, both with and without treatment. The changes in left ventricular mass index after 12 months of treatment were significantly (P <0.01) related to the changes in 24 h, daytime and night-time blood pressure (r always > 0.33), but this was not the case for the treatment-induced modification of the day-night difference (r = -0.03 and -0.008 for systolic and diastolic blood pressures, respectively). Conclusions. Our results show that day-night blood pressure changes and the classification of patients into dippers and non-dippers are poorly reproducible over time. It also provides the first prospective evidence that treatment-induced changes in day-night blood pressure difference are not related to treatment-induced regression of left ventricular mass index, thus having a limited clinical significance.
AB - Objective. To assess whether modifications in the night-time blood pressure fall caused by antihypertensive treatment predict the regression of end-organ damage of hypertension. Methods. The analysis was performed in patients with essential hypertension and echocardiographically detected left ventricular hypertrophy involved in the SAMPLE study. For each patient, ambulatory blood pressure monitoring and echocardiographic determination of left ventricular mass index were performed at the end of a 4-week wash-out pretreatment period, after 3 and 12 months of treatment with lisinopril or with lisinopril plus hydrochlorothiazide and after a final 4-week placebo period. For each ambulatory blood pressure monitoring the 24 h average, daytime average (0600-2400 h), night-time average (2400-0600 h) and day-night difference was computed. The percentages of dipper and non-dipper patients (i.e. the patients with night blood pressure falls greater and less than 10% of the daytime average, respectively) were also computed. Results. The reproducibility of the day-night difference was low, both for comparison of the pretreatment and final placebo periods (n = 170) and for comparison of the third and the 12th month of treatment (n = 180). The reproducibility of the dipper-non-dipper dichotomy was also low, 35-40% of patients becoming non-dippers if they were dippers and vice versa, both with and without treatment. The changes in left ventricular mass index after 12 months of treatment were significantly (P <0.01) related to the changes in 24 h, daytime and night-time blood pressure (r always > 0.33), but this was not the case for the treatment-induced modification of the day-night difference (r = -0.03 and -0.008 for systolic and diastolic blood pressures, respectively). Conclusions. Our results show that day-night blood pressure changes and the classification of patients into dippers and non-dippers are poorly reproducible over time. It also provides the first prospective evidence that treatment-induced changes in day-night blood pressure difference are not related to treatment-induced regression of left ventricular mass index, thus having a limited clinical significance.
KW - Ambulatory blood pressure monitoring
KW - Antihypertensive treatment
KW - Day-night blood pressure changes
KW - Dippers
KW - Hydrochlorothiazide
KW - Left ventricular hypertrophy
KW - Lisinopril
KW - Non-dippers
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U2 - 10.1097/00004872-199816060-00003
DO - 10.1097/00004872-199816060-00003
M3 - Article
C2 - 9663912
AN - SCOPUS:0031808364
VL - 16
SP - 733
EP - 738
JO - Journal of Hypertension
JF - Journal of Hypertension
SN - 0263-6352
IS - 6
ER -