Limited Reproducibility of Circadian Variation in Blood Pressure Dippers and Nondippers

Jun 2, 1998American journal of hypertension

Inconsistent daily blood pressure patterns in dippers and nondippers

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Abstract

41% of subjects classified as 'dippers' maintained their status on a second day of monitoring.

Patients were monitored for 48 hours to evaluate blood pressure patterns in essential hypertension.
Dippers are defined as those with a nighttime reduction in blood pressure exceeding 10% of daytime levels.
Approximately 16% of dippers changed to nondippers on the second day of monitoring.
Only 30% of nondippers remained consistent in their classification on the second day.
The findings suggest a significant risk of misclassification when using 24-hour blood pressure recordings to identify dipper and nondipper statuses.

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The relation between blood pressure (BP) variation and hypertensive organ damage is controversial. The reproducibility of the circadian variation pattern acceptable as the standard for discriminating between "dippers" and "nondippers" has not yet been evaluated. We evaluated the reproducibility of "dipper" and "nondipper" patterns in essential hypertensives by monitoring BP for 48 h. Noninvasive ambulatory BP and heart rate (HR) monitoring for 48 h every 30 min were performed in 253 untreated patients with mild-to-moderate essential hypertension. Mean daytime (awake) and nighttime (sleeping) systolic BP, diastolic BP, and HR values were analyzed by reviewing the patients' diaries. Patients were divided into two groups by presence (dippers) and absence (nondippers) of a reduction of both systolic and diastolic BP during the night of > 10% of the daytime pressure. A subject who was a dipper on day 1 remained a dipper on day 2 in 41% (n = 103, DD group) and changed to nondipper in 16% (n = 41, DN group). A subject who was a nondipper on day 1 remained a nondipper on day 2 in 30% (n = 75, NN group) and changed to a dipper in 13% (n = 34, ND group). Our findings indicate that there is a high risk of false-positive or false-negative results when 24-h recordings are used to identify dipper and nondipper profiles.

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Limited Reproducibility of Circadian Variation in Blood Pressure Dippers and Nondippers

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