Laboratory of Clinical Neurophysiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
J Clin Hypertens (Greenwich). 2020 Nov;22(11):1951-1959. doi: 10.1111/jch.14039. Epub 2020 Nov 8.
The objective of this systematic review and meta-analysis is to determine whether nocturnal blood pressure fall, expressed by dipping patterns according to ambulatory blood pressure monitoring (ABPM), is a risk factor for cardiovascular events (CVEs) in untreated hypertensives. Α thorough systematic literature search at MEDLINE, Embase, Cochrane Library, and gray literature was conducted through March 2020. Two reviewers screened studies and assessed dipping patterns of untreated hypertensives using ABPM with a follow-up >6 months. Newcastle-Ottawa scale was used for risk of bias assessment. We initially identified 463 reports; of which, seven cohort studies were eligible for meta-analysis enrolling 10 438 untreated hypertensives. Untreated patients classified as dippers at baseline (n = 7081) had significant lower risk of CVEs and total mortality compared to non-dippers (n = 3,357) [RR = 0.67, 95% CI (0.49, 0.92); RR = 0.71, 95% CI (0.59, 0.86)]. However, when patients were further classified into four dipping groups, only reverse dippers, yet not extreme dippers or non-dippers, were at increased risk for CVEs compared to dippers [RR = 0.47, 95% CI (0.33, 0.66)]. Likewise, only reverse dippers had a higher stroke risk than dippers [RR = 0.39, 95% CI (0.22, 0.72)]. When compared with the whole group of dippers (including extreme dippers), non-dipping alone (excluding reverse dipping) was not a significant risk factor for CVEs [RR = 0.84, 95% CI (0.61, 1.16)] or total mortality [RR = 0.84, 95% CI (0.61, 1.16); RR = 0.78, 95% CI (0.53, 1.13), respectively]. Untreated hypertensives may benefit more from the evaluation of reverse dipping rather than the non-dipping phenomenon in general.
本系统评价和荟萃分析的目的是确定根据动态血压监测（ABPM）表示的夜间血压下降（即下降模式）是否是未经治疗的高血压患者心血管事件（CVE）的危险因素。通过 MEDLINE、Embase、Cochrane 图书馆和灰色文献进行了全面的系统文献检索，截至 2020 年 3 月。两名审查员筛选了研究，并使用 ABPM 评估了未经治疗的高血压患者的下降模式，随访时间>6 个月。使用纽卡斯尔-渥太华量表评估偏倚风险。我们最初确定了 463 份报告；其中，有 7 项队列研究符合纳入标准，共纳入 10438 名未经治疗的高血压患者进行荟萃分析。与非夜间血压下降者（n=3357）相比，基线时夜间血压下降者（n=7081）发生 CVE 和总死亡率的风险显著降低[RR=0.67，95%CI（0.49，0.92）；RR=0.71，95%CI（0.59，0.86）]。然而，当患者进一步分为四个下降组时，只有反向下降者，而不是极端下降者或非下降者，与下降者相比，CVE 的风险增加[RR=0.47，95%CI（0.33，0.66）]。同样，只有反向下降者的中风风险高于下降者[RR=0.39，95%CI（0.22，0.72）]。与整个下降者组（包括极端下降者）相比，仅非夜间血压下降（不包括反向下降）不是 CVE 的显著危险因素[RR=0.84，95%CI（0.61，1.16）]或总死亡率[RR=0.84，95%CI（0.61，1.16）；RR=0.78，95%CI（0.53，1.13）]。未经治疗的高血压患者可能从评估反向下降中获益更多，而不是从一般的非夜间血压下降现象中获益。
