Determinants of the circadian blood pressure pattern in hospitalised hypertensive patients

Background. Non-dipping hypertension might be associated with increased cardiovascular risk and multiple diseases. The aim of our study was to assess if there are parameters identified in 24-hour ECG-Holter monitoring (ECG-Holter), transthoracic echocardiography (TTE), ECG parameters or laboratory data that allow prediction of circadian blood pressure profile (CBPP). Material and methods. One hundred and three consecutive patients (male: 50.5%), who underwent 24-hour ambulatory BP measurement and ECG-Holter simultaneously were analyzed. We divided patients into 3 groups: dipping was defined as 10-20% (28.2%), non-dipping as < 10% (50.5%) fall in nocturnal BP and reverse-dipping as higher nocturnal than diurnal BP (21.4%). Additionally, we performed TTE and laboratory check-up in all patients. We built multivariable models for nocturnal fall in systolic BP (SBP) and CBPP. Results. Multivariable model based on clinical factors was: nocturnal fall in SBP (%) = [13.28 -0.11 x age -8.33 x (dilated cardiomyopathy) - 5.95 x PAD - 6.02 x alpha-adrenolytic]. Multivariable model based on laboratory, echocardiographic and electrocardiographic parameters was: nocturnal fall in SBP (%) = [-27.28 + 1.47 x hemoglobin - 0.14 x CK-MB + 0.14 x maximal heart rate]. Multivariable model for CBPP based on clinical factors included use of beta- or alpha-adrenolytics or torasemide. Conclusions. We proved that nocturnal fall in SBP and CBPP could be predicted based on ECG-Holter parameters, laboratory data and TTE results, as well as based on detailed medical history. These findings may have implications on care of patients with hypertension.