Abstract

BACKGROUND

Hypertension is the leading cause of global cardiovascular diseases and deaths, but its management remains poor in sub-Saharan Africa. Ambulatory blood pressure monitoring (ABPM) provides more detailed information on variations in blood pressure during the day and circadian patterns than office measurements. Unfortunately, there is a paucity of information regarding ABPM patterns among Nigerian adults.

OBJECTIVE

To determine the prevalence and circadian patterns of abnormal ambulatory blood pressure, as well as to identify sociodemographic, anthropometric and lifestyle predictors of systolic and diastolic dipping status in the adult population of Ido Ekiti, Nigeria.

METHODS

A community-based cross-sectional study involving 352 adults aged ≥ 18 years was conducted using a multistage sampling method. Office blood pressure and 24-h ABPM were recorded with validated automated devices. Dipping patterns were classified as dipper (10%-20%), nondipper (< 10%), reverse dipper (no decrease or increase) or extreme dipper (≥ 20%). Logistic regression was used to identify predictors of nondipping patterns.

RESULTS

The mean age was 48.6 ± 17.9 years, and 55.7% of the participants were females. Thirty-nine-point-eight percentage of the subjects had abnormal 24-h blood pressure (≥ 130/80 mmHg). Only 22.2% and 36.9% showed normal systolic and diastolic dipping, respectively. Nondipping was associated with higher income (₦70,000-₦500,000; adjusted odds ratio [AOR] 7.91-104.0; p < 0.05) and central obesity (AOR 1.67 × 10 3-1.95 × 10 4; p < 0.05). Elevated 24-h systolic blood pressure increased the likelihood of nondipping (AOR 6.35-7.63), whereas abnormal diastolic blood pressure appeared to have a protective effect (AOR 0.09-0.84). Following WHO physical activity recommendations resulted in a reduction of systolic nondipping (AOR 0.23; p = 0.010), whereas it was associated with an increase in diastolic nondipping (AOR 3.97; p = 0.004). Being male and having a higher office diastolic blood pressure level were protective against systolic nondipping.

CONCLUSION

Abnormal circadian blood pressure patterns are frequent among Nigerian adults, and nondipping is the predominant pattern. Socioeconomic status, central adiposity and 24-h BP load are the most influential factors. The promotion of ABPM in primary care is a vital step in detecting hypertension early and managing it in a personalised way.

MeSH

Hypertension, Blood, Circadian Rhythm, Blood Pressure, Prevalence, Obesity, Blood Pressure Monitoring, Ambulatory