| Autor: |
Lodhi HA; 1 Hypertension Section University of Texas Southwestern Medical Center Dallas TX., Peri-Okonny PA; 1 Hypertension Section University of Texas Southwestern Medical Center Dallas TX., Schesing K; 2 Internal Medicine Department University of Texas Southwestern Medical Center Dallas TX., Phelps K; 1 Hypertension Section University of Texas Southwestern Medical Center Dallas TX., Ngo C; 2 Internal Medicine Department University of Texas Southwestern Medical Center Dallas TX., Evans H; 2 Internal Medicine Department University of Texas Southwestern Medical Center Dallas TX., Arbique D; 1 Hypertension Section University of Texas Southwestern Medical Center Dallas TX., Price AL; 1 Hypertension Section University of Texas Southwestern Medical Center Dallas TX., Vernino S; 3 Department of Neurology and Neurotherapeutics University of Texas Southwestern Medical Center Dallas TX., Phillips L; 3 Department of Neurology and Neurotherapeutics University of Texas Southwestern Medical Center Dallas TX., Mitchell JH; 4 Cardiology Division University of Texas Southwestern Medical Center Dallas TX., Smith SA; 5 Department of Health Care Sciences University of Texas Southwestern Medical Center Dallas TX., Yano Y; 6 Department of Community and Family Medicine Duke University Durham NC., Das SR; 4 Cardiology Division University of Texas Southwestern Medical Center Dallas TX., Wang T; 7 Quantitative Biomedical Research Center University of Texas Southwestern Medical Center Dallas TX.; 8 Center for the Genetics of Host Defense University of Texas Southwestern Medical Center Dallas TX., Vongpatanasin W; 1 Hypertension Section University of Texas Southwestern Medical Center Dallas TX.; 4 Cardiology Division University of Texas Southwestern Medical Center Dallas TX. |
| Jazyk: |
angličtina |
| Zdroj: |
Journal of the American Heart Association [J Am Heart Assoc] 2019 Apr 02; Vol. 8 (7), pp. e010161. |
| DOI: |
10.1161/JAHA.118.010161 |
| Abstrakt: |
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. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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