Nighttime SBP variability (SD) from ABPM independently predicts subclinical TOD and guides organ protection in hypertension and subclinical TOD prediction in hypertension is confirmed.
Abstract
Background Short-term blood pressure variability (BPV) from 24-h ambulatory blood pressure monitoring (ABPM) lacks evidence for predicting subclinical target organ damage (TOD). Objective The study assessed BPV from ABPM for subclinical TOD prediction in hypertension. Methods This retrospective study screened 180 essential hypertension patients at Quanzhou First Hospital between January 2023 and December 2025, and 176 patients were enrolled after exclusion. All participants underwent standardized 24-h ABPM examination. Several short-term BPV parameters were calculated, including standard deviation (SD), coefficient of variation (CV), and average real variability (ARV) for systolic blood pressure (SBP) and diastolic blood pressure (DBP) across 24-h, daytime, and nighttime periods. Patients were allocated into a TOD group and a non-TOD group based on the presence or absence of subclinical TOD. Multivariate logistic regression was used to assess BPV indices as independent predictors of subclinical TOD. Receiver operating characteristic (ROC) curve analysis assessed the predictive performance of these indices with the area under the curve (AUC) calculated. Results Among 176 patients, 94 were assigned to the TOD group and 82 to the non-TOD group, with balanced baseline characteristics (all P > 0.05). The TOD group showed significantly higher 24-h, daytime, and nighttime BP SD, CV, and ARV (all P < 0.001). Multivariate logistic regression identified nighttime SBP SD, 24-h SBP ARV, and nighttime SBP ARV as independent predictors of subclinical TOD (all P < 0.05). ROC analysis showed nighttime SBP SD had an AUC of 0.837 (95% CI: 0.773–0.901), cutoff 12.25 mmHg, sensitivity 89.4%, specificity 78.0%, outperforming other indices (all P < 0.05). Subgroup analyses confirmed nighttime SBP SD independently predicted cardiac, vascular, and renal TOD, while 24-h SBP ARV predicted cardiac and vascular injury (all P < 0.05). Conclusion Nighttime SBP variability (SD) from ABPM independently predicts subclinical TOD and guides organ protection in hypertension.
Hypertension is a major contributor to cardiovascular morbidity and mortality. Ambulatory blood pressure monitoring (ABPM) complements office blood pressure measurement by detecting white-coat hypertension, masked hypertension, and nocturnal blood pressure abnormalities, and this study aimed to assess its diagnostic value in the management of hypertension in private cardiology practice in Senegal. A prospective, descriptive, and analytical study was conducted from July to September 2024 at Clinique Urgence Cardio in Dakar, including patients aged 18 years or older with a valid 24-hour ABPM recording. Clinical, anthropometric, and treatment data, together with cardiovascular risk factors, were collected; office and ambulatory blood pressure measurements were compared; and logistic regression was used to identify factors associated with discordance between the two methods. Of the 104 patients assessed, 97 had valid ABPM recordings. The mean age was 53.2 ± 14.1 years, and women predominated. Cardiovascular risk factors included abdominal obesity (77.3%), known hypertension (54.6%), physical inactivity (43.3%), dyslipidemia (37.1%), and diabetes (16.5%). Mean office blood pressure was 145.7/91.4 mmHg, compared with 130.5/80.2 mmHg over 24 hours, 134.4/82.4 mmHg during daytime, and 125/75 mmHg during nighttime. ABPM identified sustained hypertension in 53.61% of patients, white-coat hypertension in 18.56%, masked hypertension in 9.28%, and normotension in 18.56%, with overall agreement between office and ambulatory measurements of 72.2%. Among patients with elevated office blood pressure, 25.7% had white-coat hypertension, while 33.3% of those with normal office blood pressure had masked hypertension. Non-dipping and reverse-dipping patterns were observed in 45.4% and 19.6% of patients, respectively, and discordance was independently associated with alcohol consumption (OR = 5.08; p = 0.007). ABPM improves the diagnostic classification of hypertension and reveals a high prevalence of discordant phenotypes and nocturnal blood pressure abnormalities, and wider use of ABPM may help optimize patient management in this setting.
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