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

Publication ,  Journal Article
Lodhi, HA; Peri-Okonny, PA; Schesing, K; Phelps, K; Ngo, C; Evans, H; Arbique, D; Price, AL; Vernino, S; Phillips, L; Mitchell, JH; Smith, SA ...
Published in: J Am Heart Assoc
April 2, 2019

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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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

April 2, 2019

Volume

8

Issue

7

Start / End Page

e010161

Location

England

Related Subject Headings

  • Sensitivity and Specificity
  • Pure Autonomic Failure
  • Primary Dysautonomias
  • Parkinson Disease
  • Multiple System Atrophy
  • Middle Aged
  • Male
  • Humans
  • Female
  • Dysautonomia, Familial
 

Citation

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Lodhi, H. A., Peri-Okonny, P. A., Schesing, K., Phelps, K., Ngo, C., Evans, H., … Vongpatanasin, W. (2019). Usefulness of Blood Pressure Variability Indices Derived From 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure. J Am Heart Assoc, 8(7), e010161. https://doi.org/10.1161/JAHA.118.010161
Lodhi, Hamza A., Poghni A. Peri-Okonny, Kevin Schesing, Kamal Phelps, Christian Ngo, Hillary Evans, Debbie Arbique, et al. “Usefulness of Blood Pressure Variability Indices Derived From 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure.J Am Heart Assoc 8, no. 7 (April 2, 2019): e010161. https://doi.org/10.1161/JAHA.118.010161.
Lodhi HA, Peri-Okonny PA, Schesing K, Phelps K, Ngo C, Evans H, et al. Usefulness of Blood Pressure Variability Indices Derived From 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure. J Am Heart Assoc. 2019 Apr 2;8(7):e010161.
Lodhi, Hamza A., et al. “Usefulness of Blood Pressure Variability Indices Derived From 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure.J Am Heart Assoc, vol. 8, no. 7, Apr. 2019, p. e010161. Pubmed, doi:10.1161/JAHA.118.010161.
Lodhi HA, Peri-Okonny PA, Schesing K, Phelps K, Ngo C, Evans H, Arbique D, Price AL, Vernino S, Phillips L, Mitchell JH, Smith SA, Yano Y, Das SR, Wang T, Vongpatanasin W. Usefulness of Blood Pressure Variability Indices Derived From 24-Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure. J Am Heart Assoc. 2019 Apr 2;8(7):e010161.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

April 2, 2019

Volume

8

Issue

7

Start / End Page

e010161

Location

England

Related Subject Headings

  • Sensitivity and Specificity
  • Pure Autonomic Failure
  • Primary Dysautonomias
  • Parkinson Disease
  • Multiple System Atrophy
  • Middle Aged
  • Male
  • Humans
  • Female
  • Dysautonomia, Familial