Title : 24 hour ambulatory blood pressure profile of hypertensive and pre-hypertesive healthcare workers in a Philippine tertiary hospital
Abstract:
Background: Hypertension is a leading cause of cardiovascular morbidity, and its prevalence is increasing most rapidly in developing countries like the Philippines, where there is poor hypertension treatment and control ABPM is an important diagnostic tool among patients because it identifies hypertension phenotypes and circadian blood pressure profile that are known to be predictors for target organ damage and increased incidence of future cardiovascular event.
Objectives: To determine the blood pressure profile and phenotypes of hypertensive and pre-hypertensive health care workers and its association to BP control and dipping status.
Design and Methods: This is a cross-sectional study of hypertensive employees who underwent 24 hr ambulatory blood pressure monitoring (ABPM).
Results: 181 patients were included with majority from 50-59 years old age group (33.3%), female (70.17%), non-shift workers (61.88%) with the most common comorbidity of obesity (60.22%) and suspected obstructive sleep apnea (60.22%). All the known hypertensives (100%) had uncontrolled blood pressure despite being on antihypertensive medication. The following hypertension phenotypes were identified: Sustained hypertension (64.7%), masked hypertension (13.26%), white coat hypertension (7.18%), and non-dippers (66%). Majority of the study population were identified as non-dippers (65%).Healthcare workers who work > 9 hours were 2.05 times more likely to be non-dippers compared to healthcare workers who works up to 9 hours.Other variables were insignificant predictor of nocturnal non dipping pattern.
Conclusion: There was high prevalence of sustained hypertension among healthcare workers included in this study. All those known hypertensives tested had uncontrolled blood pressure despite being on one or more antihypertensive therapy, while there were also newly diagnosed with masked hypertension.
The overall prevalence of non-dippers and those with elevated mean 24- hour blood pressure levels was high, and there is significant association of working longer hours and nocturnal dipping pattern. However, there was no significant difference on nocturnal dipping status and blood pressure elevation among those with those with shift work, compared to usual office work hours.
Keywords: ambulatory blood pressure, ABPM, health care workers, non-dipper, blood pressure control
Audience Takeaway:
- This study is one of the few local data on 24hr ambulatory blood pressure measurement of Filipino hypertensive and prehypertensive patients and is one of few data on use of ambulatory blood pressure monitoring among Asians
- This study identifies possible reasons for high prevalence of uncontrolled hypertension among Filipino hypertensive and prehypertensive patients despite being on maintenance medications.
- This also highlights the importance of 24-hour ABPM to identify ABPM parameters at high risk for cardiovascular outcomes and finally determine blood pressure control among known hypertensive patients according to the locally available maintenance medications.
