St. Francis Hospital, Nsambya, Kampala, Uganda.
MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda.
BMC Cardiovasc Disord. 2021 May 22;21(1):254. doi: 10.1186/s12872-021-02074-7.
Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of antihypertensive therapy, and intensifying salt restriction.
To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of 6 months of three antihypertensive regimens on the dipping pattern among Black African hypertensive patients.
This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-h ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures.
The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium > 140 mmol/l (OR = 1.72, 95% CI 1.17-2.51, p-value 0.005), a higher office systolic BP (OR = 1.03, 95% CI 1.01-1.05, p-value 0.003) and a lower office diastolic BP (OR = 0.97, 95% CI 0.95-0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar's Chi 0.71, p-value 0.40).
There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes. Trial registration ClinicalTrials.gov (NCT02742467).
夜间血压下降是一种正常的生理现象。然而，非杓型血压与高血压介导的器官损伤、继发性高血压和较差的长期预后有关。识别非杓型血压可能有助于评估风险、辅助继发性高血压的检查决策、开始治疗、辅助降压治疗选择和时机的决策，并加强盐限制。
评估非杓型血压的患病率和相关因素，并确定 6 个月 3 种降压方案对黑种非洲裔高血压患者血压杓型模式的影响。
这是 CREOLE 研究的二次分析，该研究是在撒哈拉以南 6 个非洲国家的 10 个地点进行的一项随机、单盲、三分组试验。参与者为 721 名年龄在 30 至 79 岁之间、血压控制不佳且基线 24 小时动态血压监测（ABPM）的黑种非洲裔高血压患者。通过平均日间和夜间收缩压测量值计算杓型。
非杓型血压的患病率为 78%（721 例中的 564 例）。与非杓型血压独立相关的因素包括：血清钠>140mmol/L（比值比 1.72，95%置信区间 1.17-2.51，p 值 0.005）、诊室收缩压较高（比值比 1.03，95%置信区间 1.01-1.05，p 值 0.003）和诊室舒张压较低（比值比 0.97，95%置信区间 0.95-0.99，p 值 0.03）。6 个月时治疗分配并未改变杓型状态（McNemar 卡方检验 0.71，p 值 0.40）。
在血压控制不佳的黑种非洲裔人群中，非杓型血压的患病率很高。如果资源允许，应更常规地对血压控制不佳的黑种非洲裔人群进行 ABPM，以帮助个体化治疗。需要进一步研究以了解非杓型血压的机制和原因，以及针对夜间血压是否改善临床结局。
ClinicalTrials.gov（NCT02742467）。
