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Pitfalls in the measurement of the nocturnal blood pressure dip in adolescents with type 1 diabetes.

Delaney A, Pellizzari M, Speiser PW, Frank GR - Diabetes Care (2008)

Bottom Line: For aim 2, blood pressure monitoring from 98 patients using actual reported sleep time was reviewed.Repeat ABPM performed in 22 of the 35 nondippers revealed that only 36% had abnormal systolic dipping confirmed on the repeat ABPM.Repeating ABPM in nondippers is essential to confirm this abnormality.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Endocrinology, Schneider Children's Hospital, North-Shore Long Island Jewish Health System, New Hyde Park, New York, USA.

ABSTRACT

Objective: The purpose of this study was to screen adolescents with type 1 diabetes using ambulatory blood pressure monitoring (ABPM) to 1) test the hypothesis that using a preset sleep time results in an overdiagnosis of abnormal nocturnal dipping in systolic blood pressure and 2) assess the reproducibility of an abnormal nocturnal systolic blood pressure dip.

Research design and methods: For aim 1, ABPM from 53 adolescent patients with type 1 diabetes was reviewed. Nocturnal dips in systolic blood pressure calculated by actual sleep time were compared with those from a preset sleep time. For aim 2, blood pressure monitoring from 98 patients using actual reported sleep time was reviewed. Reproducibility of the nocturnal dip in systolic blood pressure was assessed in a subset of "nondippers."

Results: For aim 1, the actual mean +/- SE decline in nocturnal systolic blood pressure was 11.6 +/- 4.7%, whereas the mean decline in nocturnal systolic blood pressure calculated using the preset sleep time was 8.8 +/- 4.9% (P < 0.0001). For aim 2, 64% of patients had a normal nocturnal decline in systolic blood pressure (14.9 +/- 3.1% mmHg), whereas 36% had an abnormal dip (5.7 +/- 2.8% mmHg). Repeat ABPM performed in 22 of the 35 nondippers revealed that only 36% had abnormal systolic dipping confirmed on the repeat ABPM.

Conclusions: The use of actual reported sleep time is required to accurately determine the nocturnal dip in systolic blood pressure. Repeating ABPM in nondippers is essential to confirm this abnormality.

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Related in: MedlinePlus

ABPM from an individual patient. Shaded area indicates sleep time. A: Actual sleep time 2:00–7:00 a.m. Mean daytime systolic blood pressure (BP) 124 mmHg; mean nighttime systolic blood pressure 107 mmHg; percent dip 13.7%. B: Preset sleep time 10 p.m.–8 a.m. Mean daytime systolic blood pressure 122 mmHg; mean nighttime systolic blood pressure 117 mmHg; percent dip 4%.
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f3: ABPM from an individual patient. Shaded area indicates sleep time. A: Actual sleep time 2:00–7:00 a.m. Mean daytime systolic blood pressure (BP) 124 mmHg; mean nighttime systolic blood pressure 107 mmHg; percent dip 13.7%. B: Preset sleep time 10 p.m.–8 a.m. Mean daytime systolic blood pressure 122 mmHg; mean nighttime systolic blood pressure 117 mmHg; percent dip 4%.

Mentions: Characteristics of the initial group of 53 adolescents are shown in Table 1. On the basis of age, duration of diabetes, and mean A1C, this group of adolescents was representative of our entire adolescent population with type 1 diabetes. By using the actual reported sleep time, the mean ± SE fall in nocturnal systolic blood pressure was 11.6 ± 4.7%. When the mean systolic nocturnal dip was measured using the preset sleep time, the mean fall in nighttime systolic blood pressure was 8.8 ± 4.9% (P < 0.0001) (Fig. 1). The Brand and Altman plot demonstrates an average discrepancy of 2.8% with relatively consistent variability across the graph (Fig. 2). An example of one adolescent in whom the percent dip in nocturnal systolic blood pressure calculated from the preset sleep time of 10:00 p.m.–8:00 a.m. was abnormal (4%), whereas use of the actual reported sleep time of 2:00–7:00 a.m. identified a normal nocturnal dip (13.7%), is shown in Fig. 3.


Pitfalls in the measurement of the nocturnal blood pressure dip in adolescents with type 1 diabetes.

Delaney A, Pellizzari M, Speiser PW, Frank GR - Diabetes Care (2008)

ABPM from an individual patient. Shaded area indicates sleep time. A: Actual sleep time 2:00–7:00 a.m. Mean daytime systolic blood pressure (BP) 124 mmHg; mean nighttime systolic blood pressure 107 mmHg; percent dip 13.7%. B: Preset sleep time 10 p.m.–8 a.m. Mean daytime systolic blood pressure 122 mmHg; mean nighttime systolic blood pressure 117 mmHg; percent dip 4%.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2606854&req=5

f3: ABPM from an individual patient. Shaded area indicates sleep time. A: Actual sleep time 2:00–7:00 a.m. Mean daytime systolic blood pressure (BP) 124 mmHg; mean nighttime systolic blood pressure 107 mmHg; percent dip 13.7%. B: Preset sleep time 10 p.m.–8 a.m. Mean daytime systolic blood pressure 122 mmHg; mean nighttime systolic blood pressure 117 mmHg; percent dip 4%.
Mentions: Characteristics of the initial group of 53 adolescents are shown in Table 1. On the basis of age, duration of diabetes, and mean A1C, this group of adolescents was representative of our entire adolescent population with type 1 diabetes. By using the actual reported sleep time, the mean ± SE fall in nocturnal systolic blood pressure was 11.6 ± 4.7%. When the mean systolic nocturnal dip was measured using the preset sleep time, the mean fall in nighttime systolic blood pressure was 8.8 ± 4.9% (P < 0.0001) (Fig. 1). The Brand and Altman plot demonstrates an average discrepancy of 2.8% with relatively consistent variability across the graph (Fig. 2). An example of one adolescent in whom the percent dip in nocturnal systolic blood pressure calculated from the preset sleep time of 10:00 p.m.–8:00 a.m. was abnormal (4%), whereas use of the actual reported sleep time of 2:00–7:00 a.m. identified a normal nocturnal dip (13.7%), is shown in Fig. 3.

Bottom Line: For aim 2, blood pressure monitoring from 98 patients using actual reported sleep time was reviewed.Repeat ABPM performed in 22 of the 35 nondippers revealed that only 36% had abnormal systolic dipping confirmed on the repeat ABPM.Repeating ABPM in nondippers is essential to confirm this abnormality.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Endocrinology, Schneider Children's Hospital, North-Shore Long Island Jewish Health System, New Hyde Park, New York, USA.

ABSTRACT

Objective: The purpose of this study was to screen adolescents with type 1 diabetes using ambulatory blood pressure monitoring (ABPM) to 1) test the hypothesis that using a preset sleep time results in an overdiagnosis of abnormal nocturnal dipping in systolic blood pressure and 2) assess the reproducibility of an abnormal nocturnal systolic blood pressure dip.

Research design and methods: For aim 1, ABPM from 53 adolescent patients with type 1 diabetes was reviewed. Nocturnal dips in systolic blood pressure calculated by actual sleep time were compared with those from a preset sleep time. For aim 2, blood pressure monitoring from 98 patients using actual reported sleep time was reviewed. Reproducibility of the nocturnal dip in systolic blood pressure was assessed in a subset of "nondippers."

Results: For aim 1, the actual mean +/- SE decline in nocturnal systolic blood pressure was 11.6 +/- 4.7%, whereas the mean decline in nocturnal systolic blood pressure calculated using the preset sleep time was 8.8 +/- 4.9% (P < 0.0001). For aim 2, 64% of patients had a normal nocturnal decline in systolic blood pressure (14.9 +/- 3.1% mmHg), whereas 36% had an abnormal dip (5.7 +/- 2.8% mmHg). Repeat ABPM performed in 22 of the 35 nondippers revealed that only 36% had abnormal systolic dipping confirmed on the repeat ABPM.

Conclusions: The use of actual reported sleep time is required to accurately determine the nocturnal dip in systolic blood pressure. Repeating ABPM in nondippers is essential to confirm this abnormality.

Show MeSH
Related in: MedlinePlus