engleski

Ambulatory blood pressure monitoring in morbidly obese patients

Objective: Our aim was to analyze blood pressure characteristics in morbidly obese patients using validated devices and appropriate cuffs. Design and method: In this pilot study we enrolled 52 consecutive obese subjects (42 w, 10 m, average BMI 39.4 ± 4.71, average age 47.37 ± 10.83) who visited our outpatient clinic. Office BP was measured three times using Omron HBP 1100 and ABPM (Mobilograph) was recorded during regular working using appropriate cuff. Dipping and non-dipping status was defined according the ESH/ESC guidelines. Results: Non-dipping and dipping pattern were diagnosed in 30 (57.6%) and 22 (42.7%) patients, respectively. Non- significant differences were observed between non-dippers and dippers in 24-hour ABPM (125/80 ± 10.6/8.5 vs.123/76 ± 13.23/10) and night-time ABPM values (121/71 ± 10.17/7.59 vs. 109/64 ± 11.17/7.38). Pulse pressure was significantly higher in non-dippers both during day-time (47.1 ± 9.15 vs 46.3 ± 6.35 ; p = 0.05) and night-time (49.2 ± 8.91 vs.45.5 ± 5.89 ; p = 0.04). Non-dippers had higher incidence of opstructive sleep apnea (OSA) (43.3% vs. 40.9% ; X2 = 0.03 ; p = 0.86) and higher average AHI index (12.05 ± 9.94 vs. 11.1 ± 8.17 ; p > 0.05). There were no differences in white coat effect between dippers and non-dippers (X2 = 0.132 ; p = 0.71), there were morning BP surge differences between non-dippers -<25mmHg (43%), 25–50 mmHg (57%) and dippers <25 mmHg (18%), 25–50 mmHg (64%), > 50mmHg (18%). Non-dipping pattern was associated with higher HOMA index (4.1 ± 2.58 vs 3.3 ± 1.74 ; p > 0.05), haemoglobin values (140.5 ± 11.89 vs. 140 ± 10.92 ; p > 0.05), serum uric acid (407.7 50.3 vs 324.0 10.0 ; p = 0.05) and triglycerides (1.94 ± 1.41 vs 1.7 ± 0.96 ; p = 0.017). We failed to observe differences in eGFR (76 ± 20.88 vs 76 ± 23.6 ; p > 0.05) and in other laboratory parameters. Conclusions: In our group of morbidly obese patients we observed very high prevalence of non-dipping pattern which was associated with positive trends for OSA and metabolic disturbances what is in line with previously reported higher global cardiovascular risk in non-dippers.

ambulatory blood pressure measurement ; morbidly obese patients

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