Usefulness of Blood Pressure Variability Indices Derived From 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure

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

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)e010161
JournalJournal of the American Heart Association
Volume8
Issue number7
DOIs
StatePublished - Apr 2 2019

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Ambulatory Blood Pressure Monitoring
Blood Pressure
Sensitivity and Specificity

Keywords

  • ambulatory blood pressure monitoring
  • autonomic function
  • blood pressure variability
  • hypertension
  • labile hypertension
  • orthostatic hypotension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Usefulness of Blood Pressure Variability Indices Derived From 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure. / Lodhi, Hamza A.; Peri-Okonny, Poghni A.; Schesing, Kevin; Phelps, Kamal; Ngo, Christian; Evans, Hillary; Arbique, Debbie; Price, Angela L.; Vernino, Steven; Phillips, Lauren; Mitchell, Jere H.; Smith, Scott A.; Yano, Yuichiro; Das, Sandeep R.; Wang, Tao; Vongpatanasin, Wanpen.

In: Journal of the American Heart Association, Vol. 8, No. 7, 02.04.2019, p. e010161.

Research output: Contribution to journalArticle

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abstract = "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.",
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author = "Lodhi, {Hamza A.} and Peri-Okonny, {Poghni A.} and Kevin Schesing and Kamal Phelps and Christian Ngo and Hillary Evans and Debbie Arbique and Price, {Angela L.} and Steven Vernino and Lauren Phillips and Mitchell, {Jere H.} and Smith, {Scott A.} and Yuichiro Yano and Das, {Sandeep R.} and Tao Wang and Wanpen Vongpatanasin",
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T1 - Usefulness of Blood Pressure Variability Indices Derived From 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure

AU - Lodhi, Hamza A.

AU - Peri-Okonny, Poghni A.

AU - Schesing, Kevin

AU - Phelps, Kamal

AU - Ngo, Christian

AU - Evans, Hillary

AU - Arbique, Debbie

AU - Price, Angela L.

AU - Vernino, Steven

AU - Phillips, Lauren

AU - Mitchell, Jere H.

AU - Smith, Scott A.

AU - Yano, Yuichiro

AU - Das, Sandeep R.

AU - Wang, Tao

AU - Vongpatanasin, Wanpen

PY - 2019/4/2

Y1 - 2019/4/2

N2 - 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.

AB - 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.

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KW - labile hypertension

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