Clinical and life style factors related to the nighttime blood pressure, nighttime dipping and their phenotypes in Korean hypertensive patients

Clinical Hypertension

Research

Sang Hyun Ihm¹  Ju Han Kim²  Wook Bum Pyun³  Wan Kim⁴  Byung Sik Kim⁵  Jeong-Hun Shin⁶  Jinho Shin⁶  Woo Shik Kim⁷  Sungha Park⁸  Jang Young Kim⁹  Sang Jae Lee^1,10  Eun Mi Lee^1,11 

[1]Division of Cardiology, Department of Internal Medicine, Catholic University School of Medicine, Seoul, South Korea

[2]Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea

[3]Division of Cardiology, Department of Internal Medicine, Ehwa Women’s University Seoul Hospital, Seoul, South Korea

[4]Division of Cardiology, Department of Internal Medicine, Gwangju Veterans Hospital, Gwangju, South Korea

[5]Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, South Korea

[6]Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, 222, Wangsimni-Ro, Sungdong-Gu, 04763, Seoul, South Korea

[7]Division of Cardiology, Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, South Korea

[8]Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, South Korea

[9]Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea

[10]Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Iksan, South Korea

[11]Division of Cardiology, Department of Internal Medicine, Wonkwang University Hospital, Sanbon, South Korea

关键词: Blood Pressure Monitoring;    Ambulatory;    Blood pressure;    Hypertension;    Sleep;    Antihypertensive Agents;    Smoking;    Aging;   

DOI  :  10.1186/s40885-023-00241-w

 received in 2023-03-14, accepted in 2023-05-25,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundNon-dipping or reverse dipping patterns are known to be associated with adverse cardiovascular prognosis among the general population and clinical cohort. Few large sized studies have explored factors including sleep duration and sleep quality related to nighttime blood pressure (BP) and nocturnal dipping patterns.MethodsAmong 5,360 patients enrolled  in Korean multicenter nationwide prospective Registry of ambulatory BP monitoring (KORABP), 981 subjects with complete data on sleep duration, sleep quality assessed using a 4-point Likert scale, and clinical variables were included in the analysis. Phenotypes of nighttime BP pattern were categorized as extreme dipper, dipper, non-dipper, and reverse dipper. Hypertension was defined as a 24-h ambulatory BPs were 130/80 mmHg or higher.ResultsAmong 981 subjects, 221 were normotensive, 359 were untreated hypertensive, and 401 were treated hypertensive. Age of the participants were 53.87 ± 14.02 years and 47.1% were female. In overall patients, sleep duration was 431.99 ± 107.61 min, and one to four points of sleep quality were observed in 15.5%, 30.0%, 30.4%, and 24.2%, respectively. Of the 760 hypertensive patients, extreme dipper, dipper, non-dipper, and reverse dipper were observed in 58 (7.63%), 277 (36.45%), 325 (42.76%), and 100 (13.16%), respectively. In multiple linear regression analysis, sleep duration (β = 0.0105, p < 0.001) and sleep quality (β = -0.8093, p < 0.001) were associated with nighttime systolic BP and sleep quality was associated with extent of nighttime systolic BP dipping (β = 0.7622, p < 0.001) in hypertensive patients. In addition, sleep quality showed positive association with dipper pattern (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 1.03–1.30) and showed negative association with reverse dipper pattern (OR = 0.73, 95% CI = 0.62–0.86) in multiple logistic regression analyses.ConclusionWhen adjusted covariates, less sleep duration and poor sleep quality were positively associated with nighttime systolic BP. Additionally, sleep quality was the independent associated factor for dipper and reverse dipper phenotypes. The study also found that male sex, low estimated glomerular filtration rate, high ambulatory BP, low office BP, and poor sleep quality were associated with blunted nighttime SBP dipping.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 4