Usefulness of Blood Pressure Variability Indices Derived From 24‐Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure
Background Increased blood pressure (BP) variability and nondipping status seen on 24‐hour ambulatory BP monitoring are often observed in autonomic failure (ATF). Methods and Results We assessed BP variability and nocturnal BP dipping in 273 patients undergoing ambulatory BP monitoring at Southweste...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.010161 |
| _version_ | 1818393492105199616 |
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| author | Hamza A. Lodhi Poghni A. Peri‐Okonny Kevin Schesing Kamal Phelps Christian Ngo Hillary Evans Debbie Arbique Angela L. Price Steven Vernino Lauren Phillips Jere H. Mitchell Scott A. Smith Yuichiro Yano Sandeep R. Das Tao Wang Wanpen Vongpatanasin |
| author_facet | Hamza A. Lodhi Poghni A. Peri‐Okonny Kevin Schesing Kamal Phelps Christian Ngo Hillary Evans Debbie Arbique Angela L. Price Steven Vernino Lauren Phillips Jere H. Mitchell Scott A. Smith Yuichiro Yano Sandeep R. Das Tao Wang Wanpen Vongpatanasin |
| author_sort | Hamza A. Lodhi |
| collection | DOAJ |
| description | Background Increased blood pressure (BP) variability and nondipping status seen on 24‐hour ambulatory BP monitoring are often observed in autonomic failure (ATF). Methods and Results We assessed BP variability and nocturnal BP dipping in 273 patients undergoing ambulatory BP monitoring at Southwestern Medical Center between 2010 and 2017. SD, average real variability, and variation independent of mean were calculated from ambulatory BP monitoring. Patients were divided into a discovery cohort (n=201) and a validation cohort (n=72). ATF was confirmed by formal autonomic function test. In the discovery cohort, 24‐hour and nighttime average real variability, SD, and variation independent of mean did not differ significantly between ATF (n=25) and controls (n=176, all P>0.05). However, daytime SD, daytime coefficient of variation, and daytime variation independent of mean of systolic BP (SBP) were all significantly higher in patients with ATF than in controls in both discovery and validation cohorts. Nocturnal BP dipping was more blunted in ATF patients than controls in both cohorts (both P<0.01). Using the threshold of 16 mm Hg, daytime SD SBP yielded a sensitivity of 77% and specificity of 82% in detecting ATF in the validation cohort, whereas nondipping status had a sensitivity of 80% and specificity of 44%. The area under the receiver operator characteristic of daytime SD SBP was greater than the area under the receiver operator characteristic of nocturnal SBP dipping (0.79 [0.66‐0.91] versus 0.73 [0.58‐0.87], respectively). Conclusions Daytime SD of SBP is a better screening tool than nondipping status in detecting autonomic dysfunction. |
| first_indexed | 2024-12-14T05:46:10Z |
| format | Article |
| id | doaj.art-df2d06d4b36b4620bbe4f6da40697ffe |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-14T05:46:10Z |
| publishDate | 2019-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-df2d06d4b36b4620bbe4f6da40697ffe2022-12-21T23:14:52ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-04-018710.1161/JAHA.118.010161Usefulness of Blood Pressure Variability Indices Derived From 24‐Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic FailureHamza A. Lodhi0Poghni A. Peri‐Okonny1Kevin Schesing2Kamal Phelps3Christian Ngo4Hillary Evans5Debbie Arbique6Angela L. Price7Steven Vernino8Lauren Phillips9Jere H. Mitchell10Scott A. Smith11Yuichiro Yano12Sandeep R. Das13Tao Wang14Wanpen Vongpatanasin15Hypertension Section University of Texas Southwestern Medical Center Dallas TXHypertension Section University of Texas Southwestern Medical Center Dallas TXInternal Medicine Department University of Texas Southwestern Medical Center Dallas TXHypertension Section University of Texas Southwestern Medical Center Dallas TXInternal Medicine Department University of Texas Southwestern Medical Center Dallas TXInternal Medicine Department University of Texas Southwestern Medical Center Dallas TXHypertension Section University of Texas Southwestern Medical Center Dallas TXHypertension Section University of Texas Southwestern Medical Center Dallas TXDepartment of Neurology and Neurotherapeutics University of Texas Southwestern Medical Center Dallas TXDepartment of Neurology and Neurotherapeutics University of Texas Southwestern Medical Center Dallas TXCardiology Division University of Texas Southwestern Medical Center Dallas TXDepartment of Health Care Sciences University of Texas Southwestern Medical Center Dallas TXDepartment of Community and Family Medicine Duke University Durham NCCardiology Division University of Texas Southwestern Medical Center Dallas TXQuantitative Biomedical Research Center University of Texas Southwestern Medical Center Dallas TXHypertension Section University of Texas Southwestern Medical Center Dallas TXBackground Increased blood pressure (BP) variability and nondipping status seen on 24‐hour ambulatory BP monitoring are often observed in autonomic failure (ATF). Methods and Results We assessed BP variability and nocturnal BP dipping in 273 patients undergoing ambulatory BP monitoring at Southwestern Medical Center between 2010 and 2017. SD, average real variability, and variation independent of mean were calculated from ambulatory BP monitoring. Patients were divided into a discovery cohort (n=201) and a validation cohort (n=72). ATF was confirmed by formal autonomic function test. In the discovery cohort, 24‐hour and nighttime average real variability, SD, and variation independent of mean did not differ significantly between ATF (n=25) and controls (n=176, all P>0.05). However, daytime SD, daytime coefficient of variation, and daytime variation independent of mean of systolic BP (SBP) were all significantly higher in patients with ATF than in controls in both discovery and validation cohorts. Nocturnal BP dipping was more blunted in ATF patients than controls in both cohorts (both P<0.01). Using the threshold of 16 mm Hg, daytime SD SBP yielded a sensitivity of 77% and specificity of 82% in detecting ATF in the validation cohort, whereas nondipping status had a sensitivity of 80% and specificity of 44%. The area under the receiver operator characteristic of daytime SD SBP was greater than the area under the receiver operator characteristic of nocturnal SBP dipping (0.79 [0.66‐0.91] versus 0.73 [0.58‐0.87], respectively). Conclusions Daytime SD of SBP is a better screening tool than nondipping status in detecting autonomic dysfunction.https://www.ahajournals.org/doi/10.1161/JAHA.118.010161ambulatory blood pressure monitoringautonomic functionblood pressure variabilityhypertensionlabile hypertensionorthostatic hypotension |
| spellingShingle | Hamza A. Lodhi Poghni A. Peri‐Okonny Kevin Schesing Kamal Phelps Christian Ngo Hillary Evans Debbie Arbique Angela L. Price Steven Vernino Lauren Phillips Jere H. Mitchell Scott A. Smith Yuichiro Yano Sandeep R. Das Tao Wang Wanpen Vongpatanasin Usefulness of Blood Pressure Variability Indices Derived From 24‐Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ambulatory blood pressure monitoring autonomic function blood pressure variability hypertension labile hypertension orthostatic hypotension |
| title | Usefulness of Blood Pressure Variability Indices Derived From 24‐Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure |
| title_full | Usefulness of Blood Pressure Variability Indices Derived From 24‐Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure |
| title_fullStr | Usefulness of Blood Pressure Variability Indices Derived From 24‐Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure |
| title_full_unstemmed | Usefulness of Blood Pressure Variability Indices Derived From 24‐Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure |
| title_short | Usefulness of Blood Pressure Variability Indices Derived From 24‐Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure |
| title_sort | usefulness of blood pressure variability indices derived from 24 hour ambulatory blood pressure monitoring in detecting autonomic failure |
| topic | ambulatory blood pressure monitoring autonomic function blood pressure variability hypertension labile hypertension orthostatic hypotension |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.010161 |
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