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Sleep actigraphy in hypertensive patients with the ‘non-dipper’ blood pressure profile

Abstract

Several prospective studies have demonstrated a higher cardiovascular complication rate in patients with a non-dipping compared with a dipping blood pressure profile. However, the extent of blood pressure reduction during sleep can be highly variable in an individual patient, and a repeat ambulatory blood pressure study commonly shows a change in category. The reasons for this variability are not clear. In general, hypertensive patients with a non-dipper blood pressure profile have higher actigraphy-measured activity during time in bed than dipper hypertensive patients but no analysis of acti- graphy-determined sleep parameters has been published. We therefore prospectively studied 52 hypertensive patients who were off antihypertensive drugs for at least 3 weeks and who underwent simultaneous ambulatory and wrist actigraphy monitoring. All patients were clinically free of any sleep-related disorder. The blood pressure profile was labelled dipper when the change in mean awake blood pressure to sleep blood pressure was 10% or higher and non-dipper if less than 10%. Overall activity levels were higher during the time in bed in the non-dipper group compared with the dipper group. An inverse relationship of daytime activity with age was seen in men (r = −0.54, P = 0.001) but not in women (r = −0.06, P = 0.79). Both groups of hypertensive patients had a similar total time in bed (458 ± 92 min, in dippers and 433 ± 106 min in non-dippers, P = 0.39). Sleep latency (time to onset of sleep after getting into bed) was a median of 7 min in dippers and 15 min in non-dippers (P = 0.10). In addition, dipper hypertensives spent more of the time in bed asleep than non-dippers (87% vs 76%, P = 0.004). Logistic regression analysis revealed that body mass index, kg/m2 (OR, 1.3), and night-time activity (units/min) (OR, 1.1) were predictive of a non-dipping blood pressure profile. These data show a possible disturbance of sleep in non-dipper hypertensive patients.

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Acknowledgements

This study was supported in part by a General Clinical Research Center Grant from NIH (MO1-RR-06192) awarded to the University of Connecticut Health Center, by the Research Initiative Support Endeavor (RISE) of the University of Connecticut Health Center. The authors also acknowledge manuscript review from William B White, MD.

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Correspondence to G A Mansoor.

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Mansoor, G. Sleep actigraphy in hypertensive patients with the ‘non-dipper’ blood pressure profile. J Hum Hypertens 16, 237–242 (2002). https://doi.org/10.1038/sj.jhh.1001383

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