Musso NR, Vergassola C, Garbero G, Lotti G
Nondipper hypertensive patients and ambulatory blood
pressure reproducibility
12th Annual ASH Meeting
Am J Hypertens
(Apr) 10:74A 1997
The short and long term reproducibility of ambulatory blood pressure
in untreated hypertensive subjects is quite high and certainly exceeds
that of office blood pressure. This fact as well as the virtual lack
of a placebo effect with ambulatory monitoring allow the use of
smaller numbers of patients in clinical hypertension studies without
sacrificing statistical power. However the reproducibility of
ambulatory blood pressure in subjects on drug therapy is less well
studied. Furthermore, the longitudinal stability of the dipper status
is also not well studied.
The authors of this paper studied 540 patients with treated essential
hypertension on two occasions 8-12 weeks apart. They found that
there was a good correlation of blood pressure averages between the
two studies and that there was a small but significant decrease in
ambulatory blood pressure averages. The authors also found that
significant crossover occurred from dipper to non-dipper categories
and vice versa from the first to the second blood pressure study.
Comment: These results show that in treated
hypertensives the reproducibility of ambulatory blood pressure and the
dipper status is less than in untreated patients. Factors that may
contribute to this reduced reproducibility may include noncompliance,
differing levels of activity and sleep. The authors do not provide the
absolute changes in nocturnal BP dip to compare the two ambulatory
studies. The designation of dipper and non dipper is somewhat
arbitrary and further study is needed of its independent use as a
prognostic factor. (George Mansoor, M.D., University of
Connecticut)
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12th Annual ASH Meeting
H: Exam and lab tests :
Ambulatory monitoring