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Randomized Controlled Trial
. 2021 May 22;21(1):254.
doi: 10.1186/s12872-021-02074-7.

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

Prossie Merab Ingabire  1   2 , Dike B Ojji  3   4 , Brian Rayner  5 , Elijah Ogola  6 , Albertino Damasceno  7 , Erika Jones  5 , Anastase Dzudie  8 , Okechukwu S Ogah  9 , Neil Poulter  10 , Mahmoud U Sani  11 , Felix Ayub Barasa  12 , Grace Shedul  13 , John Mukisa  14 , David Mukunya  14   15 , Bonnie Wandera  14 , Charles Batte  14 , James Kayima  14 , Shahiemah Pandie  16 , Charles Kiiza Mondo  17 ; CREOLE Study Investigators
Affiliations
Randomized Controlled Trial

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

Prossie Merab Ingabire et al. BMC Cardiovasc Disord. .

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).

Keywords: Black African; Dipping pattern; Non-dipping pattern; Uncontrolled hypertension.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Pie chart showing the baseline systolic dipping patterns among Black African hypertensive patients in the CREOLE trial
See this image and copyright information in PMC

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