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BMC Cardiovascular Disorders
Published in: BMC Cardiovascular Disorders 1/2021

Open Access 01-12-2021 | Perindopril | Research

High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

Authors: Prossie Merab Ingabire, Dike B. Ojji, Brian Rayner, Elijah Ogola, Albertino Damasceno, Erika Jones, Anastase Dzudie, Okechukwu S. Ogah, Neil Poulter, Mahmoud U. Sani, Felix Ayub Barasa, Grace Shedul, John Mukisa, David Mukunya, Bonnie Wandera, Charles Batte, James Kayima, Shahiemah Pandie, Charles Kiiza Mondo, CREOLE Study Investigators

Published in: BMC Cardiovascular Disorders | Issue 1/2021

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Abstract

Background

Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of antihypertensive therapy, and intensifying salt restriction.

Objectives

To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of 6 months of three antihypertensive regimens on the dipping pattern among Black African hypertensive patients.

Methods

This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-h ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures.

Results

The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium > 140 mmol/l (OR = 1.72, 95% CI 1.17–2.51, p-value 0.005), a higher office systolic BP (OR = 1.03, 95% CI 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR = 0.97, 95% CI 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar’s Chi2 0.71, p-value 0.40).

Conclusion

There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes.
Trial registration ClinicalTrials.gov (NCT02742467).
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Metadata
Title
High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial
Authors
Prossie Merab Ingabire
Dike B. Ojji
Brian Rayner
Elijah Ogola
Albertino Damasceno
Erika Jones
Anastase Dzudie
Okechukwu S. Ogah
Neil Poulter
Mahmoud U. Sani
Felix Ayub Barasa
Grace Shedul
John Mukisa
David Mukunya
Bonnie Wandera
Charles Batte
James Kayima
Shahiemah Pandie
Charles Kiiza Mondo
CREOLE Study Investigators
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2021
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-021-02074-7

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