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Diagnosing hypertension in primary care: a retrospective cohort study to investigate the importance of night-time blood pressure assessment
BACKGROUND: Ambulatory blood-pressure monitoring (ABPM) has become less frequent in primary care since the COVID-19 pandemic, with home blood-pressure monitoring (HBPM) often the preferred alternative; however, HBPM cannot measure night-time blood pressure (BP), and patients whose night-time BP does...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Royal College of General Practitioners
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9639598/ https://www.ncbi.nlm.nih.gov/pubmed/36316162 http://dx.doi.org/10.3399/BJGP.2022.0160 |
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author | Armitage, Laura C Davidson, Shaun Mahdi, Adam Harford, Mirae McManus, Richard Farmer, Andrew Watkinson, Peter Tarassenko, Lionel |
author_facet | Armitage, Laura C Davidson, Shaun Mahdi, Adam Harford, Mirae McManus, Richard Farmer, Andrew Watkinson, Peter Tarassenko, Lionel |
author_sort | Armitage, Laura C |
collection | PubMed |
description | BACKGROUND: Ambulatory blood-pressure monitoring (ABPM) has become less frequent in primary care since the COVID-19 pandemic, with home blood-pressure monitoring (HBPM) often the preferred alternative; however, HBPM cannot measure night-time blood pressure (BP), and patients whose night-time BP does not dip, or rises (reverse dipping), have poorer cardiovascular outcomes. AIM: To investigate the importance of measuring night-time BP when assessing individuals for hypertension. DESIGN AND SETTING: Retrospective cohort study of two patient populations — namely, hospital patients admitted to four UK acute hospitals located in Oxfordshire, and participants of the BP in different ethnic groups (BP-Eth) study, who were recruited from 28 UK general practices in the West Midlands. METHOD: Using BP data collected for the two cohorts, three systolic BP phenotypes (dipper, non-dipper, and reverse dipper) were studied. RESULTS: Among the hospital cohort, 48.9% (n = 10 610/21 716) patients were ‘reverse dippers’, with an average day–night systolic BP difference of +8.0 mmHg. Among the community (BP-Eth) cohort, 10.8% (n = 63/585) of patients were reverse dippers, with an average day–night systolic BP difference of +8.5 mmHg. Non-dipper and reverse-dipper phenotypes both had lower daytime systolic BP and higher night-time systolic BP than the dipper phenotype. Average daytime systolic BP was lowest in the reverse-dipping phenotype (this was 6.5 mmHg and 6.8 mmHg lower than for the dipper phenotype in the hospital and community cohorts, respectively), thereby placing them at risk of undiagnosed, or masked, hypertension. CONCLUSION: Not measuring night-time BP puts all groups, other than dippers, at risk of failure to identify hypertension. As a result of this study, it is recommended that GPs should offer ABPM to all patients aged ≥60 years as a minimum when assessing for hypertension. |
format | Online Article Text |
id | pubmed-9639598 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Royal College of General Practitioners |
record_format | MEDLINE/PubMed |
spelling | pubmed-96395982022-11-14 Diagnosing hypertension in primary care: a retrospective cohort study to investigate the importance of night-time blood pressure assessment Armitage, Laura C Davidson, Shaun Mahdi, Adam Harford, Mirae McManus, Richard Farmer, Andrew Watkinson, Peter Tarassenko, Lionel Br J Gen Pract Research BACKGROUND: Ambulatory blood-pressure monitoring (ABPM) has become less frequent in primary care since the COVID-19 pandemic, with home blood-pressure monitoring (HBPM) often the preferred alternative; however, HBPM cannot measure night-time blood pressure (BP), and patients whose night-time BP does not dip, or rises (reverse dipping), have poorer cardiovascular outcomes. AIM: To investigate the importance of measuring night-time BP when assessing individuals for hypertension. DESIGN AND SETTING: Retrospective cohort study of two patient populations — namely, hospital patients admitted to four UK acute hospitals located in Oxfordshire, and participants of the BP in different ethnic groups (BP-Eth) study, who were recruited from 28 UK general practices in the West Midlands. METHOD: Using BP data collected for the two cohorts, three systolic BP phenotypes (dipper, non-dipper, and reverse dipper) were studied. RESULTS: Among the hospital cohort, 48.9% (n = 10 610/21 716) patients were ‘reverse dippers’, with an average day–night systolic BP difference of +8.0 mmHg. Among the community (BP-Eth) cohort, 10.8% (n = 63/585) of patients were reverse dippers, with an average day–night systolic BP difference of +8.5 mmHg. Non-dipper and reverse-dipper phenotypes both had lower daytime systolic BP and higher night-time systolic BP than the dipper phenotype. Average daytime systolic BP was lowest in the reverse-dipping phenotype (this was 6.5 mmHg and 6.8 mmHg lower than for the dipper phenotype in the hospital and community cohorts, respectively), thereby placing them at risk of undiagnosed, or masked, hypertension. CONCLUSION: Not measuring night-time BP puts all groups, other than dippers, at risk of failure to identify hypertension. As a result of this study, it is recommended that GPs should offer ABPM to all patients aged ≥60 years as a minimum when assessing for hypertension. Royal College of General Practitioners 2022-11-01 /pmc/articles/PMC9639598/ /pubmed/36316162 http://dx.doi.org/10.3399/BJGP.2022.0160 Text en © The Authors https://creativecommons.org/licenses/by/4.0/This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ). |
spellingShingle | Research Armitage, Laura C Davidson, Shaun Mahdi, Adam Harford, Mirae McManus, Richard Farmer, Andrew Watkinson, Peter Tarassenko, Lionel Diagnosing hypertension in primary care: a retrospective cohort study to investigate the importance of night-time blood pressure assessment |
title | Diagnosing hypertension in primary care: a retrospective cohort study to investigate the importance of night-time blood pressure assessment |
title_full | Diagnosing hypertension in primary care: a retrospective cohort study to investigate the importance of night-time blood pressure assessment |
title_fullStr | Diagnosing hypertension in primary care: a retrospective cohort study to investigate the importance of night-time blood pressure assessment |
title_full_unstemmed | Diagnosing hypertension in primary care: a retrospective cohort study to investigate the importance of night-time blood pressure assessment |
title_short | Diagnosing hypertension in primary care: a retrospective cohort study to investigate the importance of night-time blood pressure assessment |
title_sort | diagnosing hypertension in primary care: a retrospective cohort study to investigate the importance of night-time blood pressure assessment |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9639598/ https://www.ncbi.nlm.nih.gov/pubmed/36316162 http://dx.doi.org/10.3399/BJGP.2022.0160 |
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