Abstract
Since the presence or absence of a nocturnal decrease in blood pressure values (BP) may suggest an increased risk of visceral complications or the existence of secondary hypertension, several methods have been described for evaluating the BP profile. Nevertheless, a universally accepted system to evaluate this item has not yet been established. Our aim in this study was to test different dispersion quotients (DQ) which estimate the differences between the mean of each hour, and the mean of all the readings in the 24 h period. These quotients may be employed regarding systolic (SBP) or diastolic (DBP) blood pressure, and may be referred to the whole period of 24 h, or to the subperiods morning (m), afternoon (a) or night (n). We have studied two non selected groups of essential (n=20) or secondary (Cushing’s syndrome, n=17) hypertensives. We observed a marked decrease in these quotients, particularly DQ-SBP and nDQ-SBP, in secondary hypertensives (respectively 10.2±2.9 vs 15.6±4.2 and 11.8±5.0 vs 20.5±6.3, p<0.0001), thus indicating, a blunted nocturnal fall of BP in these patients. Also the DQ and particularly DQ-SBP, nDQ-SBP and nDQ-DBP, showed a high positive and negative predictive value, sensitivity and specificity for pertaining to the Cushing’s syndrome group (respectively: 0.75, 0.88, 0.88, 0.75; 0.86, 0.82, 0.77 0,90; and 0.78, 0.84, 0.82, 0.80).
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References
Clark L.A., Denby L., Pregibon D., Hashfield G.A., Pickering T.G., Blank S., Laragh J.H. A quantitative analysis of the effects of activity and time of day on diurnal variations of blood pressure. J. Chron. Dis. 40: 671, 1987.
Van der Meiracker A., Man in’t Veld A., Van Eck H.J.R., Wenting G., Schalekamp M. Determinants of short-term blood pressure variability: effect of bed rest and sensory deprivation in essential hypertension. Am. J. Hypertens. 1: 22, 1988.
Chau M.P., Mallion J.M., de Gaudemaris R., Ruche E., Siche J.P., Pele O., Mathern G. Twenty-four-hour ambulatory blood pressure in shift workers. Circulation 80: 341, 1989.
Baumgart P., Walger P., Fuchs G., Dorst K.G., Vette H., Rahn K.H. Twenty-four-hour blood pressure is not dependent on endogenous circadian rhythm. J. Hypertens. 7: 331, 1989.
Littler W.A., Honour A.J., Carter R.D., Sleight P. Sleep and blood pressure. Br. Med. J. 3: 346, 1975.
Littler W.A., Honour A.J. Direct arterial pressure, heart rate and electrocardiogram in unrestricted patients before and after removal of pheochromocytoma. Q.J. Med. 43: 441, 1974.
Redman C.W.G., Beilin L.J., Bonnar J. Reversed diurnal blood pressure rhythm in hypertensive pregnancies. Clin. Sci. Mol. Med. 51: 687s, 1976.
Mann S., Alerman D.G., Raftery E.B., Bannister R. Circadian variation of blood pressure in autonomie failure. Circulation 68: 477, 1983.
Imai Y., Abe K., Sasaki S., Minami N., Nihei M., Nunakata M., Murakami O., Matsue K., Sekino H., Miura Y., Yoshinaga K. Altered circadian blood pressure rhythm in patients with Cushing’s syndrome. Hypertension 12: 11, 1988.
Imai Y., Abe K., Sasaki S., Minami N., Nunakata M., Nihei M. Exogenous glucocorticoid eliminates or reserves circadian blood pressure variations. J. Hypertens. 7: 113, 1989.
Mancia G., Parati G., Albini F., Villani A. Circadian blood pressure variations and their impact on disease. J. Cardiovasc. Pharmacol. 12(Suppl 7): S11, 1988.
Verdecchia P., Schillaci G., Guerrieri M., Gatteschi C., Benemio G, Boldrini F, Porcellati M. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 81: 528, 1990.
Stanton A., Cox J., Atkins N., O’Malley K., O’Brien E. Cumulative sums in quantifiying circadian blood pressure pattern. Hypertension 19: 93, 1992.
Alam M., Pavitt D.V., Mathias C.J. Cumulative sums analysis of twenty-four-hour blood pressure profiles in patients with sympathetic denervation. J. Hypertens. 11(Suppl 5): S286, 1993.
Van der Borne P., Gelin M., Van de Stadt J., Degaute J.P. Circadian rhythm of blood pressure after liver transplantation. Hypertension 21: 398, 1993.
Degaute J.P., van de Borne P., Linkowski P., Van Cauter E. Quantitative analysis of the 24 hour blood pressure and heart rate patterns in young men. Hypertension 18: 199, 1991.
Machning T., Engels G., Schöbel S., Gellert J., Bachmann K. A new approach for evaluating circadian blood pressure levels and variability from 24 h ambulatory blood pressure profiles. Am. J. Hypertens. 6: 248, 1993.
Verdecchia P., Schillaci G., Porcellati C. Dippers versus non-dippers. J. Hypertens. 9(Suppl 8): S42, 1991.
Rizzoni D., Muiesan M.L., Montani G., Zulli R., Calebich S., Agabiti-Rosei E. Relationship between initial cardiovascular structural changes and daytime and nighttime blood pressure monitoring. Am. J. Hypertens. 5: 180, 1992.
Bianchi S., Bigazzi R., Baldari G., Sgherri G., Campese VM. Diurnal variations of blood pressure and microalbuminuria in essential hypertension. Am. J. Hypertens. 7: 23, 1994.
Streitberg B., Meyer-Sabellek W. Smoothing twenty-four-hour ambulatory blood pressure profiles: a comparison of alternative methods. J. Hypertens. 8(Suppl 6): S21, 1990.
Stanton A., Tan S., Crowley J., Mullaney P., Atkins N., O’Malley K., O’Brien E. Circadian blood pressure changes and target organ damage in untreated essential hypertension. J. Hypertens. 9: 1092, 1991.
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Stiefel, P., Gimenez, J., Miranda, M.L. et al. Description of a new quotient that may differentiate blood pressure profiles in essential versus Cushing’s syndrome-related hypertension. J Endocrinol Invest 18, 789–795 (1995). https://doi.org/10.1007/BF03349812
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DOI: https://doi.org/10.1007/BF03349812