Circadian pattern of blood pressure in patients with stable COPD

Patrón circadiano de presión arterial en pacientes con EPOC estable

J. Díez-Manglanoa,b,c,

Corresponding author

[e-mail]

Corresponding author at: Duquesa Villahermosa nº 163, 8 D. 50009 Zaragoza, Spain.

, J.A. Díaz-Peromingoc,d, R. Boixeda-Viuc,e

a Internal Medicine Department, University Hospital Royo Villanova, Zaragoza, Spain

b Department of Medicine, Dermatology and Psychiatry, School of Medicine, University of Zaragoza, Spain

c Working Group on COPD, Spanish Society of Internal Medicine, Spain

d Internal Medicine Department, University Clinical Hospital of Santiago de Compostela, A Coruña, Galicia, Spain

e Internal Medicine Department, Hospital de Mataró-CSDM, Barcelona, Mataró, Spain

Abstract

Objective

To describe the circadian blood pressure (BP) pattern in stable COPD patients.

Methods

We included stable COPD patients from Internal Medicine Departments. Office BP and ambulatory BP monitoring were performed. Patients were classified as BP reducers (dipper or extreme dipper) or non-reducers (non-dipper or riser).

Results

We included 43 patients (5 women, mean age 69.5 ± 9.5 years). Among them, 11 had sustained normotension, 13 sustained hypertension, 2 white coat hypertension, and 17 masked hypertension. Arterial stiffness was observed in 12 (27.9%) patients. Overall, 26 (60.5%) exhibited a non-reducer BP profile. Non-reducers had a higher frequency of previous major cardiovascular events (50% vs. 11.8%, p = 0.020) and long-acting muscarinic antagonist use (84.6% vs. 47.1%, p = 0.009).

Conclusions

Hypertension is often masked in COPD patients, who frequently display an altered circadian BP pattern. Longitudinal studies with larger samples are needed to evaluate the impact of these patterns on COPD progression.

Keywords:

COPD

hypertension

ambulatory blood pressure monitoring

Resumen

Objetivo

Describir el patrón circadiano de presión arterial (PA) en pacientes con EPOC estable.

Métodos

Incluimos pacientes con EPOC estable desde servicios de Medicina Interna midiendo en consulta y ambulatoriamente la PA. Clasificamos los pacientes en reductores de PA (patrones dipper o dipper extremo), y no reductores (no-dipper o riser).

Resultados

Incluimos 43 pacientes (5 mujeres, edad 69.5 ± 9,5 años). Once pacientes tenían normotensión mantenida, 13 hipertensión mantenida, dos hipertensión de bata blanca y 17 hipertensión enmascarada. Doce (27,9%) presentaban rigidez arterial y 26 (60,5%) perfil no reductor de PA. Los no reductores tuvieron más eventos cardiovasculares previos (50% vs 11,8%, p = 0,020) y mayor uso de antimuscarínicos de acción prolongada (8,.6% vs 47,1%, p = 0,009).

Conclusiones

Frecuentemente los pacientes EPOC tienen hipertensión enmascarada y patrón circadiano alterado de PA. Se necesitan estudios longitudinales con mayor tamaño muestral para evaluar el impacto de estos patrones en la progresión de la EPOC.

Palabras clave:

EPOC

hipertensión arterial

monitorización ambulatoria de la presión arterial