Clinical risk factors and predictive score for the non-dipper profile in hypertensive patients: a case-control study

Abstract Background Night-time BP, especially non-dipper, is a stronger predictor of adverse cardiovascular outcomes. Ambulatory blood pressure monitoring (ABPM) is a gold standard for the detection of non-dippers but it often is unavailable and expensive. This study aims to determine clinical risk...

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Autores principales:	Chavalit Chotruangnapa, Titima Tansakun, Weranuj Roubsanthisuk
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Hypertension Non-dippers Risk factors Blood pressure monitoring Ambulatory Medicine R Internal medicine RC31-1245
Acceso en línea:	https://doaj.org/article/529a4f1e8bb34f72bff31b4ca90e7135
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spelling	oai:doaj.org-article:529a4f1e8bb34f72bff31b4ca90e71352021-11-21T12:33:15ZClinical risk factors and predictive score for the non-dipper profile in hypertensive patients: a case-control study10.1186/s40885-021-00180-42056-5909https://doaj.org/article/529a4f1e8bb34f72bff31b4ca90e71352021-11-01T00:00:00Zhttps://doi.org/10.1186/s40885-021-00180-4https://doaj.org/toc/2056-5909Abstract Background Night-time BP, especially non-dipper, is a stronger predictor of adverse cardiovascular outcomes. Ambulatory blood pressure monitoring (ABPM) is a gold standard for the detection of non-dippers but it often is unavailable and expensive. This study aims to determine clinical risk factors that predict non-dipper. Methods An exploratory traditional case-control study, exclusive sampling of control was conducted from January 2013 to September 2018 to explore clinical risk factors associated with non-dippers in hypertensive patients. Subgroup analysis was performed in each treated and untreated hypertensive patient. The parsimonious predictive score for non-dippers was constructed. Results The study included 208 hypertensive patients receiving 24 h ABPM. There were 104 dippers and 104 non-dippers. Significant clinical risk factors associated with non-dippers were the age of > 65 years, average office diastolic blood pressure (DBP), and fasting plasma glucose of > 5.6 mmol/L. Results of subgroup analysis showed that dyslipidemia, history of coronary artery disease, use of angiotensin-converting enzyme inhibitors (ACEIs) and direct vasodilators, average office DBP, and serum uric acid were associated with non-dippers in treated hypertensive patients, however, there were no risk factors associated with non-dippers in the untreated group. The predictive score for non-dippers in treated group included average office DBP, dyslipidemia, serum uric acid, male, calcium channel blockers and ACEIs use. The area under Receiver Operating Characteristic (AuROC) was 0.723. A cut-off point which was > 0.0701 and prevalence of non-dippers of 46%, this score had a sensitivity of 77.4%, specificity of 65.6%, positive predictive value (PPV) of 66.1%, and negative predictive value (NPV) of 79.6%. For untreated group, age, hemoglobin and body mass index were included in the predictive model. AuROC was 0.74. There was a sensitivity of 51.9%, specificity of 91.2%, PPV of 82.4%, and NPV of 70.5% at the cut-off point of > 0.357, and prevalence of 44%. Conclusion There were several significant clinical risk factors associated with non-dippers in treated hypertensive patients. The predictive score might be useful for the detection of non-dippers; however, it cannot replace ABPM.Chavalit ChotruangnapaTitima TansakunWeranuj RoubsanthisukBMCarticleHypertensionNon-dippersRisk factorsBlood pressure monitoringAmbulatoryMedicineRInternal medicineRC31-1245ENClinical Hypertension, Vol 27, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Hypertension Non-dippers Risk factors Blood pressure monitoring Ambulatory Medicine R Internal medicine RC31-1245
spellingShingle	Hypertension Non-dippers Risk factors Blood pressure monitoring Ambulatory Medicine R Internal medicine RC31-1245 Chavalit Chotruangnapa Titima Tansakun Weranuj Roubsanthisuk Clinical risk factors and predictive score for the non-dipper profile in hypertensive patients: a case-control study
description	Abstract Background Night-time BP, especially non-dipper, is a stronger predictor of adverse cardiovascular outcomes. Ambulatory blood pressure monitoring (ABPM) is a gold standard for the detection of non-dippers but it often is unavailable and expensive. This study aims to determine clinical risk factors that predict non-dipper. Methods An exploratory traditional case-control study, exclusive sampling of control was conducted from January 2013 to September 2018 to explore clinical risk factors associated with non-dippers in hypertensive patients. Subgroup analysis was performed in each treated and untreated hypertensive patient. The parsimonious predictive score for non-dippers was constructed. Results The study included 208 hypertensive patients receiving 24 h ABPM. There were 104 dippers and 104 non-dippers. Significant clinical risk factors associated with non-dippers were the age of > 65 years, average office diastolic blood pressure (DBP), and fasting plasma glucose of > 5.6 mmol/L. Results of subgroup analysis showed that dyslipidemia, history of coronary artery disease, use of angiotensin-converting enzyme inhibitors (ACEIs) and direct vasodilators, average office DBP, and serum uric acid were associated with non-dippers in treated hypertensive patients, however, there were no risk factors associated with non-dippers in the untreated group. The predictive score for non-dippers in treated group included average office DBP, dyslipidemia, serum uric acid, male, calcium channel blockers and ACEIs use. The area under Receiver Operating Characteristic (AuROC) was 0.723. A cut-off point which was > 0.0701 and prevalence of non-dippers of 46%, this score had a sensitivity of 77.4%, specificity of 65.6%, positive predictive value (PPV) of 66.1%, and negative predictive value (NPV) of 79.6%. For untreated group, age, hemoglobin and body mass index were included in the predictive model. AuROC was 0.74. There was a sensitivity of 51.9%, specificity of 91.2%, PPV of 82.4%, and NPV of 70.5% at the cut-off point of > 0.357, and prevalence of 44%. Conclusion There were several significant clinical risk factors associated with non-dippers in treated hypertensive patients. The predictive score might be useful for the detection of non-dippers; however, it cannot replace ABPM.
format	article
author	Chavalit Chotruangnapa Titima Tansakun Weranuj Roubsanthisuk
author_facet	Chavalit Chotruangnapa Titima Tansakun Weranuj Roubsanthisuk
author_sort	Chavalit Chotruangnapa
title	Clinical risk factors and predictive score for the non-dipper profile in hypertensive patients: a case-control study
title_short	Clinical risk factors and predictive score for the non-dipper profile in hypertensive patients: a case-control study
title_full	Clinical risk factors and predictive score for the non-dipper profile in hypertensive patients: a case-control study
title_fullStr	Clinical risk factors and predictive score for the non-dipper profile in hypertensive patients: a case-control study
title_full_unstemmed	Clinical risk factors and predictive score for the non-dipper profile in hypertensive patients: a case-control study
title_sort	clinical risk factors and predictive score for the non-dipper profile in hypertensive patients: a case-control study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/529a4f1e8bb34f72bff31b4ca90e7135
work_keys_str_mv	AT chavalitchotruangnapa clinicalriskfactorsandpredictivescoreforthenondipperprofileinhypertensivepatientsacasecontrolstudy AT titimatansakun clinicalriskfactorsandpredictivescoreforthenondipperprofileinhypertensivepatientsacasecontrolstudy AT weranujroubsanthisuk clinicalriskfactorsandpredictivescoreforthenondipperprofileinhypertensivepatientsacasecontrolstudy
_version_	1718418941764698112

Clinical risk factors and predictive score for the non-dipper profile in hypertensive patients: a case-control study

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