Do In-Hospital Circadian BP Patterns Mirror Those in the Community?

The circadian patterns of blood pressure (BP) are similar between hospitalized and outpatient populations, according to a new study.

To evaluate the circadian BP variations in an acute hospital setting, the researchers retrospectively analyzed 1.7 million sets of vital-sign measurements from 41,455 unique patient admissions. This data had been collected between March 2014 and April 2018 from the adult general wards of 4 acute hospitals in Oxford, United Kingdom.

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The researchers stratified the in-hospital patients’ BP data by age and gender.

The researchers computed patients’ 24-hour BP profiles by assessing the BP recordings in the hospital setting over a number of days and nights. Individuals who stayed in the hospital for fewer than 24 hours, who had fewer than 3 BP measurements, or who did not have either daytime measurements or nighttime measurements were excluded.

A typical 24-hour systolic BP profile was defined as having a dipping pattern in BP during sleep followed by a gradual increase in BP during the day. This pattern was observed only among the younger age groups (age groups 16-29 years, 30-39 years, and 40-49 years for men and age group 30-39 years for women), not among patients who were late-middle-age or older. 

The patients in the older age groups demonstrated a late nocturnal rise in systolic BP, the amplitude of which had increased with age. Patients who were older than age 50 years experienced this rise in late nocturnal BP regardless of whether they had been treated for or been diagnosed with hypertension.

According to the study authors, in-hospital variations of mean systolic and mean diastolic BP with age were similar to those observed in the outpatient populations. Furthermore, the researchers found the 24-hour BP patterns in the overall population were similar to those described in outpatient populations using ambulatory BP monitoring.

“Hospitalized patients’ circadian patterns of BP largely mirror those found in the community,” the researchers concluded. “High-quality hospital data may allow for the identification of patients at significant cardiovascular risk through either opportunistic screening or systematic screening.”

—Colleen Murphy

Reference:

Mahdi A, Watkinson P, McManus RJ, Tarassenko L. Circadian blood pressure variations computed from 1.7 million measurements in an acute hospital setting. Am J Hypertens. 2019;32(12):1154-1161. https://doi.org/10.1093/ajh/hpz130.