Reproducibility of blood pressure dipping: Relation to day-to-day variability in sleep quality |
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| Authors: | Alan L. Hinderliter Faye S. Routledge James A. Blumenthal Gary Koch Michael A. Hussey William K. Wohlgemuth Andrew Sherwood |
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| Affiliation: | 1. University of North Carolina at Chapel Hill, Chapel Hill, NC;2. Duke University Medical Center, Durham, NC;3. Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA;4. Psychology Service, Miami VA Healthcare System, Miami, FL;1. Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Claire Fagin Hall, 418 Curie Blvd., Philadelphia, PA 19104, USA;2. Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Suite 1-300S, 3400 Civic Center Blvd., Philadelphia, PA 19104, USA;1. Department of Vascular Medicine, Peking University Shougang Hospital, Beijing 100144, Peoples'' Republic of China;2. Department of Endocrinology, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, Peoples'' Republic of China;1. Departments of Medicine and Psychiatry & Human Behavior, Alpert Medical School of Brown University/Rhode Island Hospital, 300 Duncan Drive, Providence, RI, USA;2. Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Shaw Building Room 228, Worcester, MA 01655, USA;3. Women’s Hormones and Aging Research Program, Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA;4. Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Harvard Medical School, 44 Binney Street, Boston, MA 02115, USA;1. Department of Public Health, State University of Ceará (UECE), Fortaleza-CE, Brazil;2. Department of Obstetrics, Paulista School of Medicine – Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil;3. Department of Obstetrics and Gynaecology, University of Melbourne and Department of Perinatal Medicine, Royal Women''s Hospital, Melbourne, Victoria, Australia;4. Department of Obstetrics and Gynecology, Ribeirão Preto Medical School, University of São Paulo (DGO-FMRP-USP), Ribeirão Preto-SP, Brazil;5. Monash Ultrasound for Women, Melbourne, Victoria, Australia |
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| Abstract: | ![]()
Previous studies of the reproducibility of blood pressure (BP) dipping have yielded inconsistent results. Few have examined factors that may influence day-to-day differences in dipping. Ambulatory BP monitoring was performed on three occasions, approximately 1 week apart, in 115 untreated adult subjects with elevated clinic BPs. The mean ± standard deviation BP dip was 18 ± 7/15 ± 5 mm Hg (sleep/awake BP ratio = 0.87 ± 0.05/0.82 ± 0.06), with a median (interquartile range) day-to-day variation of 5.2 (3.1–8.1)/4.3 (2.8–5.6) mm Hg. There was no decrease in variability with successive measurements. The reproducibility coefficient (5.6 [95% confidence interval, 5.1–6.1] mm Hg) was greater and the intraclass correlation coefficient (0.53 [95% confidence interval, 0.42–0.63]) was smaller for the systolic dip than for 24-hour or awake systolic BPs, suggesting greater day-to-day variability in dipping. Variability in systolic dipping was greater in subjects with higher awake BP, but was not related to age, gender, race, or body mass index. Within individuals, day-to-day variations in dipping were related to variations in the fragmentation index (P < .001), a measure of sleep quality. Although mean 24-hour and awake BPs were relatively stable over repeated monitoring days, our study confirms substantial variability in BP dipping. Day-to-day differences in dipping are related to sleep quality. |
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| Keywords: | Ambulatory blood pressure monitoring fragmentation index actigraphy |
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