Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

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 reverse-dippers (those with a BP rise at night-time) 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.

Original publication

DOI

10.3399/BJGP.2022.0160

Type

Journal article

Journal

Br J Gen Pract

Publication Date

30/08/2022

Keywords

ambulatory blood-pressure monitoring, blood pressure monitoring, cardiovascular disease, hypertension