Reproducibility of ambulatory blood pressure values and circadian blood pressure patterns in untreated subjects in a 1–11 month interval | Revista Portuguesa de Cardiologia (English edition)

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ABPM: ambulatory blood pressure monitoring; DBP: diastolic blood pressure; SBP: systolic blood pressure; V1: first ABPM visit; V2: second ABMP visit." ] ] ] "textoCompleto" => "IntroductionAmbulatory blood pressure (BP) monitoring (ABPM) is the gold standard for assessment of overall BP load. ABPM has high predictive value for cardiovascular events and target organ damage, provides information on circadian BP patterns, and can be used to monitor the effects of various antihypertensive therapies.<a class="elsevierStyleCrossRefs" href="#bib0255">1–4</a>Several studies have shown that compared to a dipper pattern (nighttime BP fall of >10% or ratio of nighttime to daytime BP <0.9), the absence of the usual nighttime BP fall – non-dipper pattern – is associated with greater target organ damage,<a class="elsevierStyleCrossRefs" href="#bib0260">2,5</a> higher albuminuria levels,<a class="elsevierStyleCrossRef" href="#bib0280">6</a> left ventricular hypertrophy,<a class="elsevierStyleCrossRef" href="#bib0260">2</a> renal dysfunction<a class="elsevierStyleCrossRef" href="#bib0285">7</a> and cerebrovascular lesions.<a class="elsevierStyleCrossRefs" href="#bib0290">8–11</a> However, an issue with ABPM is its reproducibility<a class="elsevierStyleCrossRefs" href="#bib0310">12–21</a> in two or more recordings separated in time with regard to mean 24-h, daytime and nighttime BP values and to dipper vs. non-dipper patterns. In a recent review of 12 studies,<a class="elsevierStyleCrossRef" href="#bib0360">22</a> the reproducibility of circadian BP patterns in normotensive, hypertensive and diabetic individuals ranged between 29% and 92%. Furthermore, in most if not all of these studies only dipper and non-dipper patterns were analyzed, not other patterns such as extreme dipper or reverse dipper, the prognostic value of which differs from that of the classic patterns.<a class="elsevierStyleCrossRefs" href="#bib0365">23–25</a> Another little-studied question is the reproducibility of mean 24-h BP and circadian patterns by ABPM in individuals for whom the European guidelines<a class="elsevierStyleCrossRef" href="#bib0255">1</a> recommend postponing initiation of antihypertensive medication in favor of monitoring BP by repeat ABPM after some months.The aim of the present study is to evaluate the reproducibility of ABPM values and the four principal circadian patterns in untreated subjects undergoing two ABPM recordings separated by less than 12 months.MethodsThe data for the study were taken from our database of ABPM records, a total of 21000 ABPM recordings. We selected only recordings from individuals aged over 18, with no cardiovascular events, not taking antihypertensive medication, not diabetic, and with office BP <150/95 mmHg, for whom ABPM had been requested by their attending physician. All subjects were at low or moderate to low cardiovascular risk according to the table in the European guidelines<a class="elsevierStyleCrossRef" href="#bib0255">1</a> based on BP values and other cardiovascular risk factors. Only individuals whose attending physicians had requested a second ABPM recording within 12 months were included; those who took any antihypertensive medication or whose weight changed by more than 5% between the two recordings, and those with any cardiovascular complication, including arrhythmias, were excluded.24-hour ambulatory blood pressure monitoringAll subjects underwent two 25-hour ABPM recordings using a SpaceLabs 90207 monitor (SpaceLabs Inc., Redmond, WA), measured on two normal working days or equivalent every 20 min during the day and every 30 min during the night. The device was fitted between 8.00 and 10.00 am. Data from the first hour of recording were excluded from the analysis, the following 24 h being used to calculate daytime and nighttime BP according to the individual's daily schedule of rising and going to bed, but fixed between 7.00 and 9.00 am and 11.00 pm and 1.00 am, respectively. Only records with more than 85% of valid recordings were analyzed. All procedures for fitting and recording have been described in detail in previous works by our group.<a class="elsevierStyleCrossRefs" href="#bib0380">26–28</a> Mean 24-h heart rate and 24-h, daytime and nighttime BP were calculated for each ABPM recording. Four circadian BP patterns were defined according to the guidelines<a class="elsevierStyleCrossRef" href="#bib0255">1</a> by the ratio of nighttime to daytime systolic blood pressure (SBP) or the percentage of nighttime BP fall compared to daytime as reverse dippers (RD), ratio >1.0 (or nighttime fall >0%); non-dippers (ND), ratio 0.9–1.0 (or nighttime fall 9.9–0%); dippers (D), ratio 0.8–<0.9 (or nighttime fall 10–19.9%); and extreme dippers (ED), ratio <0.8 (or nighttime fall ≥20%).No significant differences were observed between genders in the parameters analyzed.Statistical analysisThe data are presented as means ± standard error of the mean if normally distributed or as percentages. Continuous variables were compared by analysis of variance with the Bonferroni correction for multiple comparisons, while categorical variables were compared using the chi-square test or Fisher's exact test. The following tests were used to assess the reproducibility of mean 24-h, daytime and nighttime BP values and the differences between the first and second ABPM recordings: (a) Pearson's correlation coefficient between the same data from the first and second ABPBM recordings; (b) the concordance coefficient (Φc)=2RΘxΘy/Θx2+Θy2+(μx−μy)2, where μx and μy are the means for the two variables and Θx2 and Θy2 are the corresponding variances<a class="elsevierStyleCrossRef" href="#bib0395">29</a> (concordance coefficients are more suitable for assessing reproducibility, since they represent the dispersion of values around the line of identity, while correlation coefficients compare these values as a function of a regression line); and (c) standard deviations (SD) of the differences and coefficients of variation.<a class="elsevierStyleCrossRef" href="#bib0320">14</a> The reproducibility of different dipping patterns was assessed by calculating the proportion of subjects who were in the same category at the second ABPM recording.<a class="elsevierStyleCrossRef" href="#bib0400">30</a> Bland–Altman<a class="elsevierStyleCrossRef" href="#bib0405">31</a> plots were used to provide a graphical comparison of the differences between the night/day ratios on the two recordings with the mean ratios for each subject; the differences were used to calculate the coefficient of reproducibility of the observed values. Values of p<0.05 were considered statistically significant.ResultsA total of 481 individuals met the criteria and were included in the analysis. The mean interval between the two ABPM recordings was 5.5 months (1–11). The characteristics of the population are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The differences between the two recordings were 0.38 mmHg for 24-h SBP (95% confidence interval [CI]: −0.61–1.39, p=0.455) and 0.26 mmHg for 24-h diastolic blood pressure (DBP) (95% CI: −0.43–0.96, p=0.457). There were no significant differences between the two recordings in daytime or nighttime BP values or nighttime fall, although values tended to be lower on the second recording.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>As seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>, the coefficient of correlation between 24-h, daytime and nighttime BP and nighttime fall ranged between 0.41 and 0.69 (p<0.001), with higher values for DBP than for SBP. The concordance coefficients were generally lower than the correlation coefficients, but still statistically significant (p<0.001). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> also shows the SDs of the differences in 24-h, daytime and nighttime BP and the coefficient of variation from the first recording. Comparing the two recordings, the SDs of the differences varied between 5.7 and 11.0 mmHg, and the coefficient of variation ranged between 6.8% and 9.6%.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Based only on nighttime fall in SBP on the first recording, 38 individuals (7.9%) were classified as ED, 216 (44.9%) as D, 187 (38.9%) as ND and 40 (8.3%) as RD. As shown in <a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>, between the first and second visits 26.3% of ED, 51.4% of D, 54.5% of ND and 40% of RD maintained the same pattern. In multivariate analysis, these rates of persistence remained after adjustment for age, gender, body mass index (BMI) and baseline 24-h SBP. Of those classified as D on the first recording, 77 (35.6%) changed to ND, 19 to ED and nine to RD, while of those classified as ND on the first recording, 68 (36.4%) changed to D, 11 to RD and six to ED. The individuals classified as D on the first recording who remained as D on the second (n=111) had significantly (p<0.01) lower night/day SBP (0.854±0.003) and DBP (0.807±0.005) ratios than those initially classified as D who changed to ND (night/day SBP and DBP ratios of 0.865±0.003 and 0.823±0.005, respectively).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>No differences were observed between genders in mean 24-h BP values in the two recordings: in women (n=260), 24-h SBP was 126.9/75.7±0.6/0.5 vs. 126.3/75.5±0.6/0.5 mmHg (NS) on first and second recordings, respectively, and in men (n=221), 24-h SBP was 127.0/76.1±0.5/0.5 vs. 126.8/75.9±0.6/0.5 mmHg (NS) on the first and second recordings, respectively. There was also no significant difference in the percentage of women whose circadian pattern did not change between the two recordings (127/239, 53.1%) and whose pattern did change (133/242, 54.9%).On the basis of data in the ABPM reports, BMI could be calculated for 178/239 (74%) of those whose circadian pattern did not change and for 192/242 (79%) of those whose pattern did change. In the former, mean BMI changed from 27.8±0.5 to 27.7±0.4 kg/m2 (NS) between the two recordings, and from 27.6±0.4 to 27.7±0.4 kg/m2 (NS) in the latter.DiscussionThe diagnostic and prognostic value of 24-h ABPM for the assessment of BP and its circadian variation has been clearly demonstrated and its use is recommended in the guidelines.<a class="elsevierStyleCrossRef" href="#bib0255">1</a> However, questions remain concerning the reproducibility of BP levels and circadian patterns by ABPM.<a class="elsevierStyleCrossRef" href="#bib0410">32</a> Most studies have been limited to analysis of dipper and non-dipper patterns only,<a class="elsevierStyleCrossRef" href="#bib0360">22</a> in particular the known relationship between a non-dipper pattern and increased cardiovascular risk and target organ damage.<a class="elsevierStyleCrossRefs" href="#bib0275">5,25,33–37</a> One of the most important elements of the present study is its analysis of the reproducibility of ABPM over two recordings separated by less than 12 months in untreated individuals, considering not only dipper and non-dipper patterns<a class="elsevierStyleCrossRef" href="#bib0360">22</a> but also extreme dipper and reverse dipper patterns, which are independently associated with various aspects of cardiovascular risk.<a class="elsevierStyleCrossRefs" href="#bib0260">2,11,38–40</a>Our results confirm those of other studies showing good reproducibility of mean 24-h BP values even when ABPM recordings are separated by weeks<a class="elsevierStyleCrossRefs" href="#bib0350">20,41,42</a> or months.<a class="elsevierStyleCrossRefs" href="#bib0325">15,19,43</a> In the present study mean 24-h, daytime and nighttime BP levels did not differ significantly between the two recordings, and the coefficients of correlation and concordance between the equivalent BP values on the two recordings were also significant. The SDs of the differences in 24-h BP ranged between 5.7 and 8.8 mmHg, with coefficients of variation of 6.8%–7.1%, which is within the limits observed in other studies of ABPM recordings separated by weeks<a class="elsevierStyleCrossRefs" href="#bib0350">20,41,42</a> or months.<a class="elsevierStyleCrossRefs" href="#bib0325">15,19,43</a> Although better indices of reproducibility can be obtained by using shorter intervals between recordings<a class="elsevierStyleCrossRef" href="#bib0410">32</a> or longer (48-h) recordings,<a class="elsevierStyleCrossRefs" href="#bib0400">30,44</a> these methods are not in common clinical practice, and may be difficult to implement as patients may be reluctant to undergo more frequent or longer continuous BP recordings. Our study, on the other hand, set out to examine this question from the standpoint of everyday clinical practice, in which repeat ABPM recordings are requested as part of a diagnostic algorithm and used to guide appropriate clinical decisions.We found no significant differences between genders in ABPM parameters, unlike other authors<a class="elsevierStyleCrossRefs" href="#bib0320">14,45</a> who reported greater BP variability in women than in men, but in agreement with others.<a class="elsevierStyleCrossRefs" href="#bib0325">15,42,43</a> The fact that we excluded the first hour of each ABPM recording from the analysis may have eliminated the alerting reaction that according to some authors<a class="elsevierStyleCrossRefs" href="#bib0320">14,45</a> may explain some of the differences observed between genders.In the first ABPM recording in our study, around 45% of individuals were classified as D, 39% as ND, 8% as ED and 8% as RD. This distribution is similar to that seen in other studies.<a class="elsevierStyleCrossRef" href="#bib0450">40</a> However, no more than 55% of D and ND maintained the same pattern on the second recording, and the percentage was even lower for those initially classified as ED or RD. Studies with similar sample sizes to ours<a class="elsevierStyleCrossRefs" href="#bib0360">22,46,47</a> found higher rates of persistence of dipper patterns, but in these studies only dipper and non-dipper patterns were analyzed, while our study extends this relatively low reproducibility to extreme and reverse dippers. This is important, because the division between dippers and non-dippers is too simplistic. Most of the studies cited above<a class="elsevierStyleCrossRefs" href="#bib0260">2,5,7,12–15,19–24,29,30,32,35–37,41–43,46</a> included extreme dippers among dippers and reverse dippers in non-dippers, but not only does each pattern represent a different level of cardiovascular risk, this simplification may overestimate the true reproducibility of dipper and non-dipper patterns. Our study shows that the overall low reproducibility of all circadian patterns must be taken into account if they are to be used as predictors of cardiovascular risk.As in other studies,<a class="elsevierStyleCrossRef" href="#bib0400">30</a> we found that the night/day BP ratio was lower in dippers who were still classified as such on the second recording than in those who changed from dipper to non-dipper. This suggests that analyzing the night/day ratio can help identify individuals who are likely to change from a dipper to a non-dipper pattern.The present study has certain limitations. Although efforts were made to ensure that each subject experienced similar conditions for both ABPM recordings, it is not possible to exclude differences in ambient temperature, physical activity or quality of sleep, or changes in lifestyle or diet or other variables that could influence BP levels and circadian patterns in the medium term. However, the fact that BMI did not change significantly between the two recordings reduces, but does not eliminate, the risk that these variables influenced the results.Several studies<a class="elsevierStyleCrossRefs" href="#bib0445">39,48–50</a> have shown that in terms of the predictive value of ABPM for assessing cardiovascular risk, the absolute value of nighttime BP, taken as a continuous variable, is a much stronger and more reliable predictor than any change in circadian pattern. This may be due to the low reproducibility of circadian patterns, in contrast to the excellent reproducibility of mean BP levels taken from ABPM recordings.In conclusion, our study shows that in untreated subjects at low or moderate cardiovascular risk, ABPM has high reproducibility for mean values but not for circadian patterns between two ABPM recordings separated by less than 12 months. These findings, based on clinical practice, support the good reproducibility of mean ABPM values at an interval of up to one year. However, they also highlight the unreliability of predicting cardiovascular risk on the basis of circadian BP patterns.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on humans or animals for this investigation.Confidentiality of dataThe authors declare that no patient data appears in this article.Right to privacy and informed consentThe authors declare that no patient data appears in this article.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres816379" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec813616" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres816380" "titulo" => "Resumo" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec813617" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "24-hour ambulatory blood pressure monitoring" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-03-12" "fechaAceptado" => "2015-05-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec813616" "palabras" => array:4 [ 0 => "24-hour ambulatory blood pressure monitoring" 1 => "Reproducibility" 2 => "Circadian patterns" 3 => "Dipping" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec813617" "palabras" => array:4 [ 0 => "Pressurometria ambulatória de 24 horas" 1 => "MAPA" 2 => "Reprodutibilidade" 3 => "Perfis circadiários (dipping)" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo evaluate in untreated subjects the reproducibility of mean values and four circadian patterns between two ambulatory blood pressure monitoring (ABPM) recordings separated by 1–11 months. MethodsWe performed a retrospective analysis of 481 individuals (59% women) evaluated by ABPM on two occasions, visit 1 (V1) and 2 (V2), separated by 5.5+0.2 months. Four circadian patterns were defined by night/day systolic blood pressure (SBP) ratios: reverse dippers (RD), ratio >1.0; non-dippers (ND), ratio 0.9–1.0; dippers (D), ratio 0.8–<0.9; and extreme dippers (ED), ratio <0.8. Coefficients of correlation and concordance between the ABPM values at V1 and V2 and the reproducibility of the RD, ND, D and ED patterns were calculated by the percentage of the same profile from V1 to V2. ResultsMean 24-h blood pressure (BP) at V1 and V2 was 126.8/75.9±0.5/0.5 vs. 126.5/75.7±0.5/0.4 mmHg (NS). Nighttime SBP fall was 9.8±0.4 (V1) and 9.6±0.3% (V2) (NS). The correlation coefficient of ABPM data at V1 vs. at V2 was 0.41–0.69 (p<0.001) and the concordance coefficient was 0.34–0.57 (p<0.01). At V1, 38 subjects were classified as ED (7.9%); D, n=216 (44.9%), 187 as ND (38.9%) and 40 as RD (8.3%). At V2 only 26.3% of ED, 44.9% of D, 54.5% of ND and 40% of RD maintained the same profile as at V1. ConclusionIn untreated subjects ABPM has high reproducibility for mean values but only modest reproducibility for circadian profiles, thereby challenging the prognostic value of BP dipping patterns." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "pt" => array:3 [ "titulo" => "Resumo" "resumen" => "IntroduçãoAvaliar em indivíduos não medicados a reprodutibilidade dos valores médios e dos quatro perfis circadiários entre dois registos de pressurometria ambulatória de 24 horas (MAPA) separados de 1-11 meses. MétodosAnálise retrospetiva de 481 indivíduos (59% mulheres) avaliados por MAPA em dois dias, visita um (V1) e visita dois (V2) separados por 5,5 + 0,2 meses. Perfis circadiários definidos pelos ratios noite/dia da pressão sistólica (PAS) em: reverted dippers, RD se ratio > 1,0, non-dippers, ND se ratio 0,9- < 1,0, dippers, D se ratio 0,8- < 0,9 e extreme dippers, ED se ratio < 0,8. Cálculo dos coeficientes de correlação (CCc) e de concordância (Φ) entre os valores da MAPA nas V1-V2 e a reprodutibilidade dos perfis RD, ND, D e ED em V1 pela proporção de indivíduos que permaneceram no mesmo perfil em V2. ResultadosAs médias de 24 horas foram 126,8/75,9 ± 0,5/0,5 (V1) versus 126,5/75,7 ± 0,5/0,4 mm Hg (V2) (n.s.). A descida noturna da PAS foi 9,8 ± 0,4 (V1) e 9,6 ± 0,3% (V2) (n.s.). Entre os vários parâmetros da MAPA, os CC oscilaram 0,41-0,69 (p < 0,001) e os ΦC entre 0,34-0,57 (p < 0,01). Em V1, ED foram n = 38 (7,9%), D n = 216 (44,9%), ND n = 187 (38,9%) e RD n = 40 (8,3%). Em V2 somente mantiveram o perfil de V1, 26,3% dos ED, 44,9% dos D, 54,5% dos ND e 40% dos RD. ConclusãoEm indivíduos não tratados, a reprodutibilidade a menos de um ano da MAPA é elevada para os valores médios mas modesta relativamente aos perfis circadiários, sugerindo baixa preditibilidade de risco cardiovascular dos perfis de descida noturna da pressão arterial." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introdução" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusão" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Monte M, Cambão M, Mesquita Bastos JM, et al. Reprodutibilidade dos valores da pressurometria ambulatória de 24 horas e dos perfis circadiários de descida noturna registados com intervalo 1-11 meses em indivíduos não medicados. Rev Port Cardiol. 2015;34:643–650." ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 4443 "Ancho" => 2897 "Tamanyo" => 1311909 ] ] "descripcion" => array:1 [ "en" => "Linear correlation and coefficients of concordance (Φ) between the two 24-h ABPM recordings. ABPM: ambulatory blood pressure monitoring; DBP: diastolic blood pressure; SBP: systolic blood pressure; V1: first ABPM visit; V2: second ABMP visit." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1427 "Ancho" => 1633 "Tamanyo" => 140557 ] ] "descripcion" => array:1 [ "en" => "Distribution of circadian blood pressure patterns on the first ABPM recording and analysis of reproducibility based on percentages of persistence or change in patterns between first and second recordings. Rates of persistence of circadian patterns were independent of age, gender, body mass index and 24-h blood pressure on the first recording. ABPM: ambulatory blood pressure monitoring; D: dippers; ED: extreme dippers; ND: non-dippers; RD: reverse dippers." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "CoC: coefficient of concordance; COR: coefficient of correlation; COV: coefficient of variation; DBP: diastolic blood pressure; Diff.: difference; HR: heart rate; SBP: systolic blood pressure; SD: standard deviation; V1: first ABPM visit; V2: second ABMP visit." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V1 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V2 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diff. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD of Diff. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">COV (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">COR<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CoC<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">49±1</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">27.6±0.3</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Women (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">59%</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">V1–V2 interval (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="2" align="center" valign="top">5.5±0.2</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Office SBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">131.9±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130.5±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.11±0.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.9±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.7±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.21 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Office DBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.2±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79.1±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.10±0.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.8±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.5±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.44 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">24-h SBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126.8±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126.5±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.38±0.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.8±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.8±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.38 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">24-h DBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.9±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.7±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.26±0.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.7±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.1±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">24-h HR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.2±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.9±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.70±0.38 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.7±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.7±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Daytime SBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">131.2±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130.6±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.55±0.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.9±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.6±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Daytime DBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79.8±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79.2±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52±0.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.4±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.1±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.56 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nighttime SBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">118.1±0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">117.7±0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.32±0.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.0±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.6±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nighttime DBP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.4±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.2±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.10±0.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.5±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.1±0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nighttime SBP fall, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.8±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.6±0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.07±0.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.9±0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.3±5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Night/day SBP ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.900±0.004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.902±0.003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002±0.002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Night/day DBP ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.858±0.004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.862±0.004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.012±0.013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1372075.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "p<0.01." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the study population (n=481) and comparison of absolute values, differences and coefficients of correlation and concordance in 24 h, daytime and nighttime blood pressure between the two recordings." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:50 [ 0 => array:3 [ "identificador" => "bib0255" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. 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Original Article

Reproducibility of ambulatory blood pressure values and circadian blood pressure patterns in untreated subjects in a 1–11 month interval

Reprodutibilidade dos valores da pressurometria ambulatória de 24 horas e dos perfis circadiários de descida noturna registados com intervalo 1-11 meses em indivíduos não medicados

Miguel Montea, Mariana Cambãoa, José Mesquita Bastosb, Jorge Polóniaa,

Corresponding author

jjpolonia@gmail.com

Corresponding author.

a Departamento de Medicina & Cintesis, Faculdade de Medicina, Universidade do Porto, Porto, Portugal

b Departamento Medicina, Escola Superior de Saúde da Universidade de Aveiro, Aveiro, Portugal

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    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Reproducibility of ambulatory blood pressure values and circadian blood pressure patterns in untreated subjects in a 1&#8211;11 month interval"
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        "titulo" => "Reprodutibilidade dos valores da pressurometria ambulat&#243;ria de 24 horas e dos perfis circadi&#225;rios de descida noturna registados com intervalo 1-11 meses em indiv&#237;duos n&#227;o medicados"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Linear correlation and coefficients of concordance &#40;&#934;&#41; between the two 24-h ABPM recordings&#46; ABPM&#58; ambulatory blood pressure monitoring&#59; DBP&#58; diastolic blood pressure&#59; SBP&#58; systolic blood pressure&#59; V1&#58; first ABPM visit&#59; V2&#58; second ABMP visit&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Ambulatory blood pressure &#40;BP&#41; monitoring &#40;ABPM&#41; is the gold standard for assessment of overall BP load&#46; ABPM has high predictive value for cardiovascular events and target organ damage&#44; provides information on circadian BP patterns&#44; and can be used to monitor the effects of various antihypertensive therapies&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Several studies have shown that compared to a dipper pattern &#40;nighttime BP fall of &#62;10&#37; or ratio of nighttime to daytime BP &#60;0&#46;9&#41;&#44; the absence of the usual nighttime BP fall &#8211; non-dipper pattern &#8211; is associated with greater target organ damage&#44;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">2&#44;5</span></a> higher albuminuria levels&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">6</span></a> left ventricular hypertrophy&#44;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">2</span></a> renal dysfunction<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">7</span></a> and cerebrovascular lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">8&#8211;11</span></a> However&#44; an issue with ABPM is its reproducibility<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">12&#8211;21</span></a> in two or more recordings separated in time with regard to mean 24-h&#44; daytime and nighttime BP values and to dipper vs&#46; non-dipper patterns&#46; In a recent review of 12 studies&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">22</span></a> the reproducibility of circadian BP patterns in normotensive&#44; hypertensive and diabetic individuals ranged between 29&#37; and 92&#37;&#46; Furthermore&#44; in most if not all of these studies only dipper and non-dipper patterns were analyzed&#44; not other patterns such as extreme dipper or reverse dipper&#44; the prognostic value of which differs from that of the classic patterns&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">23&#8211;25</span></a> Another little-studied question is the reproducibility of mean 24-h BP and circadian patterns by ABPM in individuals for whom the European guidelines<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">1</span></a> recommend postponing initiation of antihypertensive medication in favor of monitoring BP by repeat ABPM after some months&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of the present study is to evaluate the reproducibility of ABPM values and the four principal circadian patterns in untreated subjects undergoing two ABPM recordings separated by less than 12 months&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The data for the study were taken from our database of ABPM records&#44; a total of 21<span class="elsevierStyleHsp" style=""></span>000 ABPM recordings&#46; We selected only recordings from individuals aged over 18&#44; with no cardiovascular events&#44; not taking antihypertensive medication&#44; not diabetic&#44; and with office BP &#60;150&#47;95 mmHg&#44; for whom ABPM had been requested by their attending physician&#46; All subjects were at low or moderate to low cardiovascular risk according to the table in the European guidelines<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">1</span></a> based on BP values and other cardiovascular risk factors&#46; Only individuals whose attending physicians had requested a second ABPM recording within 12 months were included&#59; those who took any antihypertensive medication or whose weight changed by more than 5&#37; between the two recordings&#44; and those with any cardiovascular complication&#44; including arrhythmias&#44; were excluded&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">24-hour ambulatory blood pressure monitoring</span><p id="par0025" class="elsevierStylePara elsevierViewall">All subjects underwent two 25-hour ABPM recordings using a SpaceLabs 90207 monitor &#40;SpaceLabs Inc&#46;&#44; Redmond&#44; WA&#41;&#44; measured on two normal working days or equivalent every 20 min during the day and every 30 min during the night&#46; The device was fitted between 8&#46;00 and 10&#46;00 am&#46; Data from the first hour of recording were excluded from the analysis&#44; the following 24 h being used to calculate daytime and nighttime BP according to the individual&#39;s daily schedule of rising and going to bed&#44; but fixed between 7&#46;00 and 9&#46;00 am and 11&#46;00 pm and 1&#46;00 am&#44; respectively&#46; Only records with more than 85&#37; of valid recordings were analyzed&#46; All procedures for fitting and recording have been described in detail in previous works by our group&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">26&#8211;28</span></a> Mean 24-h heart rate and 24-h&#44; daytime and nighttime BP were calculated for each ABPM recording&#46; Four circadian BP patterns were defined according to the guidelines<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">1</span></a> by the ratio of nighttime to daytime systolic blood pressure &#40;SBP&#41; or the percentage of nighttime BP fall compared to daytime as reverse dippers &#40;RD&#41;&#44; ratio &#62;1&#46;0 &#40;or nighttime fall &#62;0&#37;&#41;&#59; non-dippers &#40;ND&#41;&#44; ratio 0&#46;9&#8211;1&#46;0 &#40;or nighttime fall 9&#46;9&#8211;0&#37;&#41;&#59; dippers &#40;D&#41;&#44; ratio 0&#46;8&#8211;&#60;0&#46;9 &#40;or nighttime fall 10&#8211;19&#46;9&#37;&#41;&#59; and extreme dippers &#40;ED&#41;&#44; ratio &#60;0&#46;8 &#40;or nighttime fall &#8805;20&#37;&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">No significant differences were observed between genders in the parameters analyzed&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">The data are presented as means &#177; standard error of the mean if normally distributed or as percentages&#46; Continuous variables were compared by analysis of variance with the Bonferroni correction for multiple comparisons&#44; while categorical variables were compared using the chi-square test or Fisher&#39;s exact test&#46; The following tests were used to assess the reproducibility of mean 24-h&#44; daytime and nighttime BP values and the differences between the first and second ABPM recordings&#58; &#40;a&#41; Pearson&#39;s correlation coefficient between the same data from the first and second ABPBM recordings&#59; &#40;b&#41; the concordance coefficient &#40;&#934;c&#41;&#61;2R&#920;x&#920;y&#47;&#920;x2&#43;&#920;y2&#43;&#40;&#956;x&#8722;&#956;y&#41;2&#44; where &#956;<span class="elsevierStyleInf">x</span> and &#956;<span class="elsevierStyleInf">y</span> are the means for the two variables and &#920;x2 and &#920;y2 are the corresponding variances<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">29</span></a> &#40;concordance coefficients are more suitable for assessing reproducibility&#44; since they represent the dispersion of values around the line of identity&#44; while correlation coefficients compare these values as a function of a regression line&#41;&#59; and &#40;c&#41; standard deviations &#40;SD&#41; of the differences and coefficients of variation&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">14</span></a> The reproducibility of different dipping patterns was assessed by calculating the proportion of subjects who were in the same category at the second ABPM recording&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">30</span></a> Bland&#8211;Altman<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">31</span></a> plots were used to provide a graphical comparison of the differences between the night&#47;day ratios on the two recordings with the mean ratios for each subject&#59; the differences were used to calculate the coefficient of reproducibility of the observed values&#46; Values of p&#60;0&#46;05 were considered statistically significant&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">A total of 481 individuals met the criteria and were included in the analysis&#46; The mean interval between the two ABPM recordings was 5&#46;5 months &#40;1&#8211;11&#41;&#46; The characteristics of the population are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The differences between the two recordings were 0&#46;38 mmHg for 24-h SBP &#40;95&#37; confidence interval &#91;CI&#93;&#58; &#8722;0&#46;61&#8211;1&#46;39&#44; p&#61;0&#46;455&#41; and 0&#46;26 mmHg for 24-h diastolic blood pressure &#40;DBP&#41; &#40;95&#37; CI&#58; &#8722;0&#46;43&#8211;0&#46;96&#44; p&#61;0&#46;457&#41;&#46; There were no significant differences between the two recordings in daytime or nighttime BP values or nighttime fall&#44; although values tended to be lower on the second recording&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">As seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#44; the coefficient of correlation between 24-h&#44; daytime and nighttime BP and nighttime fall ranged between 0&#46;41 and 0&#46;69 &#40;p&#60;0&#46;001&#41;&#44; with higher values for DBP than for SBP&#46; The concordance coefficients were generally lower than the correlation coefficients&#44; but still statistically significant &#40;p&#60;0&#46;001&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> also shows the SDs of the differences in 24-h&#44; daytime and nighttime BP and the coefficient of variation from the first recording&#46; Comparing the two recordings&#44; the SDs of the differences varied between 5&#46;7 and 11&#46;0 mmHg&#44; and the coefficient of variation ranged between 6&#46;8&#37; and 9&#46;6&#37;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Based only on nighttime fall in SBP on the first recording&#44; 38 individuals &#40;7&#46;9&#37;&#41; were classified as ED&#44; 216 &#40;44&#46;9&#37;&#41; as D&#44; 187 &#40;38&#46;9&#37;&#41; as ND and 40 &#40;8&#46;3&#37;&#41; as RD&#46; As shown in <a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#44; between the first and second visits 26&#46;3&#37; of ED&#44; 51&#46;4&#37; of D&#44; 54&#46;5&#37; of ND and 40&#37; of RD maintained the same pattern&#46; In multivariate analysis&#44; these rates of persistence remained after adjustment for age&#44; gender&#44; body mass index &#40;BMI&#41; and baseline 24-h SBP&#46; Of those classified as D on the first recording&#44; 77 &#40;35&#46;6&#37;&#41; changed to ND&#44; 19 to ED and nine to RD&#44; while of those classified as ND on the first recording&#44; 68 &#40;36&#46;4&#37;&#41; changed to D&#44; 11 to RD and six to ED&#46; The individuals classified as D on the first recording who remained as D on the second &#40;n&#61;111&#41; had significantly &#40;p&#60;0&#46;01&#41; lower night&#47;day SBP &#40;0&#46;854&#177;0&#46;003&#41; and DBP &#40;0&#46;807&#177;0&#46;005&#41; ratios than those initially classified as D who changed to ND &#40;night&#47;day SBP and DBP ratios of 0&#46;865&#177;0&#46;003 and 0&#46;823&#177;0&#46;005&#44; respectively&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">No differences were observed between genders in mean 24-h BP values in the two recordings&#58; in women &#40;n&#61;260&#41;&#44; 24-h SBP was 126&#46;9&#47;75&#46;7&#177;0&#46;6&#47;0&#46;5 vs&#46; 126&#46;3&#47;75&#46;5&#177;0&#46;6&#47;0&#46;5 mmHg &#40;NS&#41; on first and second recordings&#44; respectively&#44; and in men &#40;n&#61;221&#41;&#44; 24-h SBP was 127&#46;0&#47;76&#46;1&#177;0&#46;5&#47;0&#46;5 vs&#46; 126&#46;8&#47;75&#46;9&#177;0&#46;6&#47;0&#46;5 mmHg &#40;NS&#41; on the first and second recordings&#44; respectively&#46; There was also no significant difference in the percentage of women whose circadian pattern did not change between the two recordings &#40;127&#47;239&#44; 53&#46;1&#37;&#41; and whose pattern did change &#40;133&#47;242&#44; 54&#46;9&#37;&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">On the basis of data in the ABPM reports&#44; BMI could be calculated for 178&#47;239 &#40;74&#37;&#41; of those whose circadian pattern did not change and for 192&#47;242 &#40;79&#37;&#41; of those whose pattern did change&#46; In the former&#44; mean BMI changed from 27&#46;8&#177;0&#46;5 to 27&#46;7&#177;0&#46;4 kg&#47;m<span class="elsevierStyleSup">2</span> &#40;NS&#41; between the two recordings&#44; and from 27&#46;6&#177;0&#46;4 to 27&#46;7&#177;0&#46;4 kg&#47;m<span class="elsevierStyleSup">2</span> &#40;NS&#41; in the latter&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">The diagnostic and prognostic value of 24-h ABPM for the assessment of BP and its circadian variation has been clearly demonstrated and its use is recommended in the guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">1</span></a> However&#44; questions remain concerning the reproducibility of BP levels and circadian patterns by ABPM&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">32</span></a> Most studies have been limited to analysis of dipper and non-dipper patterns only&#44;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">22</span></a> in particular the known relationship between a non-dipper pattern and increased cardiovascular risk and target organ damage&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">5&#44;25&#44;33&#8211;37</span></a> One of the most important elements of the present study is its analysis of the reproducibility of ABPM over two recordings separated by less than 12 months in untreated individuals&#44; considering not only dipper and non-dipper patterns<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">22</span></a> but also extreme dipper and reverse dipper patterns&#44; which are independently associated with various aspects of cardiovascular risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">2&#44;11&#44;38&#8211;40</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Our results confirm those of other studies showing good reproducibility of mean 24-h BP values even when ABPM recordings are separated by weeks<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">20&#44;41&#44;42</span></a> or months&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">15&#44;19&#44;43</span></a> In the present study mean 24-h&#44; daytime and nighttime BP levels did not differ significantly between the two recordings&#44; and the coefficients of correlation and concordance between the equivalent BP values on the two recordings were also significant&#46; The SDs of the differences in 24-h BP ranged between 5&#46;7 and 8&#46;8 mmHg&#44; with coefficients of variation of 6&#46;8&#37;&#8211;7&#46;1&#37;&#44; which is within the limits observed in other studies of ABPM recordings separated by weeks<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">20&#44;41&#44;42</span></a> or months&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">15&#44;19&#44;43</span></a> Although better indices of reproducibility can be obtained by using shorter intervals between recordings<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">32</span></a> or longer &#40;48-h&#41; recordings&#44;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">30&#44;44</span></a> these methods are not in common clinical practice&#44; and may be difficult to implement as patients may be reluctant to undergo more frequent or longer continuous BP recordings&#46; Our study&#44; on the other hand&#44; set out to examine this question from the standpoint of everyday clinical practice&#44; in which repeat ABPM recordings are requested as part of a diagnostic algorithm and used to guide appropriate clinical decisions&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">We found no significant differences between genders in ABPM parameters&#44; unlike other authors<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">14&#44;45</span></a> who reported greater BP variability in women than in men&#44; but in agreement with others&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">15&#44;42&#44;43</span></a> The fact that we excluded the first hour of each ABPM recording from the analysis may have eliminated the alerting reaction that according to some authors<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">14&#44;45</span></a> may explain some of the differences observed between genders&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the first ABPM recording in our study&#44; around 45&#37; of individuals were classified as D&#44; 39&#37; as ND&#44; 8&#37; as ED and 8&#37; as RD&#46; This distribution is similar to that seen in other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">40</span></a> However&#44; no more than 55&#37; of D and ND maintained the same pattern on the second recording&#44; and the percentage was even lower for those initially classified as ED or RD&#46; Studies with similar sample sizes to ours<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">22&#44;46&#44;47</span></a> found higher rates of persistence of dipper patterns&#44; but in these studies only dipper and non-dipper patterns were analyzed&#44; while our study extends this relatively low reproducibility to extreme and reverse dippers&#46; This is important&#44; because the division between dippers and non-dippers is too simplistic&#46; Most of the studies cited above<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">2&#44;5&#44;7&#44;12&#8211;15&#44;19&#8211;24&#44;29&#44;30&#44;32&#44;35&#8211;37&#44;41&#8211;43&#44;46</span></a> included extreme dippers among dippers and reverse dippers in non-dippers&#44; but not only does each pattern represent a different level of cardiovascular risk&#44; this simplification may overestimate the true reproducibility of dipper and non-dipper patterns&#46; Our study shows that the overall low reproducibility of all circadian patterns must be taken into account if they are to be used as predictors of cardiovascular risk&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">As in other studies&#44;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">30</span></a> we found that the night&#47;day BP ratio was lower in dippers who were still classified as such on the second recording than in those who changed from dipper to non-dipper&#46; This suggests that analyzing the night&#47;day ratio can help identify individuals who are likely to change from a dipper to a non-dipper pattern&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The present study has certain limitations&#46; Although efforts were made to ensure that each subject experienced similar conditions for both ABPM recordings&#44; it is not possible to exclude differences in ambient temperature&#44; physical activity or quality of sleep&#44; or changes in lifestyle or diet or other variables that could influence BP levels and circadian patterns in the medium term&#46; However&#44; the fact that BMI did not change significantly between the two recordings reduces&#44; but does not eliminate&#44; the risk that these variables influenced the results&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Several studies<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">39&#44;48&#8211;50</span></a> have shown that in terms of the predictive value of ABPM for assessing cardiovascular risk&#44; the absolute value of nighttime BP&#44; taken as a continuous variable&#44; is a much stronger and more reliable predictor than any change in circadian pattern&#46; This may be due to the low reproducibility of circadian patterns&#44; in contrast to the excellent reproducibility of mean BP levels taken from ABPM recordings&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In conclusion&#44; our study shows that in untreated subjects at low or moderate cardiovascular risk&#44; ABPM has high reproducibility for mean values but not for circadian patterns between two ABPM recordings separated by less than 12 months&#46; These findings&#44; based on clinical practice&#44; support the good reproducibility of mean ABPM values at an interval of up to one year&#46; However&#44; they also highlight the unreliability of predicting cardiovascular risk on the basis of circadian BP patterns&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical disclosures</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Protection of human and animal subjects</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Confidentiality of data</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Right to privacy and informed consent</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "identificador" => "xres816379"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
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            1 => array:2 [
              "identificador" => "abst0010"
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              "identificador" => "abst0015"
              "titulo" => "Results"
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              "identificador" => "abst0020"
              "titulo" => "Conclusion"
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        ]
        1 => array:2 [
          "identificador" => "xpalclavsec813616"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres816380"
          "titulo" => "Resumo"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introdu&#231;&#227;o"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
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              "titulo" => "Conclus&#227;o"
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          "identificador" => "xpalclavsec813617"
          "titulo" => "Palavras-chave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
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          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "24-hour ambulatory blood pressure monitoring"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Results"
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          "identificador" => "sec0030"
          "titulo" => "Discussion"
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          "identificador" => "sec0035"
          "titulo" => "Ethical disclosures"
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            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Protection of human and animal subjects"
            ]
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              "identificador" => "sec0045"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
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          "identificador" => "sec0055"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-03-12"
    "fechaAceptado" => "2015-05-01"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec813616"
          "palabras" => array:4 [
            0 => "24-hour ambulatory blood pressure monitoring"
            1 => "Reproducibility"
            2 => "Circadian patterns"
            3 => "Dipping"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec813617"
          "palabras" => array:4 [
            0 => "Pressurometria ambulat&#243;ria de 24 horas"
            1 => "MAPA"
            2 => "Reprodutibilidade"
            3 => "Perfis circadi&#225;rios &#40;<span class="elsevierStyleItalic">dipping</span>&#41;"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate in untreated subjects the reproducibility of mean values and four circadian patterns between two ambulatory blood pressure monitoring &#40;ABPM&#41; recordings separated by 1&#8211;11 months&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective analysis of 481 individuals &#40;59&#37; women&#41; evaluated by ABPM on two occasions&#44; visit 1 &#40;V1&#41; and 2 &#40;V2&#41;&#44; separated by 5&#46;5&#43;0&#46;2 months&#46; Four circadian patterns were defined by night&#47;day systolic blood pressure &#40;SBP&#41; ratios&#58; reverse dippers &#40;RD&#41;&#44; ratio &#62;1&#46;0&#59; non-dippers &#40;ND&#41;&#44; ratio 0&#46;9&#8211;1&#46;0&#59; dippers &#40;D&#41;&#44; ratio 0&#46;8&#8211;&#60;0&#46;9&#59; and extreme dippers &#40;ED&#41;&#44; ratio &#60;0&#46;8&#46; Coefficients of correlation and concordance between the ABPM values at V1 and V2 and the reproducibility of the RD&#44; ND&#44; D and ED patterns were calculated by the percentage of the same profile from V1 to V2&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mean 24-h blood pressure &#40;BP&#41; at V1 and V2 was 126&#46;8&#47;75&#46;9&#177;0&#46;5&#47;0&#46;5 vs&#46; 126&#46;5&#47;75&#46;7&#177;0&#46;5&#47;0&#46;4 mmHg &#40;NS&#41;&#46; Nighttime SBP fall was 9&#46;8&#177;0&#46;4 &#40;V1&#41; and 9&#46;6&#177;0&#46;3&#37; &#40;V2&#41; &#40;NS&#41;&#46; The correlation coefficient of ABPM data at V1 vs&#46; at V2 was 0&#46;41&#8211;0&#46;69 &#40;p&#60;0&#46;001&#41; and the concordance coefficient was 0&#46;34&#8211;0&#46;57 &#40;p&#60;0&#46;01&#41;&#46; At V1&#44; 38 subjects were classified as ED &#40;7&#46;9&#37;&#41;&#59; D&#44; n&#61;216 &#40;44&#46;9&#37;&#41;&#44; 187 as ND &#40;38&#46;9&#37;&#41; and 40 as RD &#40;8&#46;3&#37;&#41;&#46; At V2 only 26&#46;3&#37; of ED&#44; 44&#46;9&#37; of D&#44; 54&#46;5&#37; of ND and 40&#37; of RD maintained the same profile as at V1&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In untreated subjects ABPM has high reproducibility for mean values but only modest reproducibility for circadian profiles&#44; thereby challenging the prognostic value of BP dipping patterns&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusion"
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      ]
      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introdu&#231;&#227;o</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Avaliar em indiv&#237;duos n&#227;o medicados a reprodutibilidade dos valores m&#233;dios e dos quatro perfis circadi&#225;rios entre dois registos de pressurometria ambulat&#243;ria de 24 horas &#40;MAPA&#41; separados de 1-11 meses&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">An&#225;lise retrospetiva de 481 indiv&#237;duos &#40;59&#37; mulheres&#41; avaliados por MAPA em dois dias&#44; visita um &#40;V1&#41; e visita dois &#40;V2&#41; separados por 5&#44;5 &#43; 0&#44;2 meses&#46; Perfis circadi&#225;rios definidos pelos <span class="elsevierStyleItalic">ratios</span> noite&#47;dia da press&#227;o sist&#243;lica &#40;PAS&#41; em&#58; <span class="elsevierStyleItalic">reverted dippers</span>&#44; RD se <span class="elsevierStyleItalic">ratio</span> &#62; 1&#44;0&#44; <span class="elsevierStyleItalic">non-dippers</span>&#44; ND se <span class="elsevierStyleItalic">ratio</span> 0&#44;9- &#60; 1&#44;0&#44; <span class="elsevierStyleItalic">dippers</span>&#44; D se <span class="elsevierStyleItalic">ratio</span> 0&#44;8- &#60; 0&#44;9 e <span class="elsevierStyleItalic">extreme dippers</span>&#44; ED se <span class="elsevierStyleItalic">ratio</span> &#60; 0&#44;8&#46; C&#225;lculo dos coeficientes de correla&#231;&#227;o &#40;CCc&#41; e de concord&#226;ncia &#40;&#934;&#41; entre os valores da MAPA nas V1-V2 e a reprodutibilidade dos perfis RD&#44; ND&#44; D e ED em V1 pela propor&#231;&#227;o de indiv&#237;duos que permaneceram no mesmo perfil em V2&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">As m&#233;dias de 24 horas foram 126&#44;8&#47;75&#44;9 &#177; 0&#44;5&#47;0&#44;5 &#40;V1&#41; <span class="elsevierStyleItalic">versus</span> 126&#44;5&#47;75&#44;7 &#177; 0&#44;5&#47;0&#44;4 mm Hg &#40;V2&#41; &#40;n&#46;s&#46;&#41;&#46; A descida noturna da PAS foi 9&#44;8 &#177; 0&#44;4 &#40;V1&#41; e 9&#44;6 &#177; 0&#44;3&#37; &#40;V2&#41; &#40;n&#46;s&#46;&#41;&#46; Entre os v&#225;rios par&#226;metros da MAPA&#44; os CC oscilaram 0&#44;41-0&#44;69 &#40;p &#60; 0&#44;001&#41; e os &#934;C entre 0&#44;34-0&#44;57 &#40;p &#60; 0&#44;01&#41;&#46; Em V1&#44; ED foram n &#61; 38 &#40;7&#44;9&#37;&#41;&#44; D n &#61; 216 &#40;44&#44;9&#37;&#41;&#44; ND n &#61; 187 &#40;38&#44;9&#37;&#41; e RD n &#61; 40 &#40;8&#44;3&#37;&#41;&#46; Em V2 somente mantiveram o perfil de V1&#44; 26&#44;3&#37; dos ED&#44; 44&#44;9&#37; dos D&#44; 54&#44;5&#37; dos ND e 40&#37; dos RD&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Em indiv&#237;duos n&#227;o tratados&#44; a reprodutibilidade a menos de um ano da MAPA &#233; elevada para os valores m&#233;dios mas modesta relativamente aos perfis circadi&#225;rios&#44; sugerindo baixa preditibilidade de risco cardiovascular dos perfis de descida noturna da press&#227;o arterial&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introdu&#231;&#227;o"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
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      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Monte M&#44; Camb&#227;o M&#44; Mesquita Bastos JM&#44; et al&#46; Reprodutibilidade dos valores da pressurometria ambulat&#243;ria de 24 horas e dos perfis circadi&#225;rios de descida noturna registados com intervalo 1-11 meses em indiv&#237;duos n&#227;o medicados&#46; Rev Port Cardiol&#46; 2015&#59;34&#58;643&#8211;650&#46;</p>"
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 4443
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Linear correlation and coefficients of concordance &#40;&#934;&#41; between the two 24-h ABPM recordings&#46; ABPM&#58; ambulatory blood pressure monitoring&#59; DBP&#58; diastolic blood pressure&#59; SBP&#58; systolic blood pressure&#59; V1&#58; first ABPM visit&#59; V2&#58; second ABMP visit&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribution of circadian blood pressure patterns on the first ABPM recording and analysis of reproducibility based on percentages of persistence or change in patterns between first and second recordings&#46; Rates of persistence of circadian patterns were independent of age&#44; gender&#44; body mass index and 24-h blood pressure on the first recording&#46; ABPM&#58; ambulatory blood pressure monitoring&#59; D&#58; dippers&#59; ED&#58; extreme dippers&#59; ND&#58; non-dippers&#59; RD&#58; reverse dippers&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">CoC&#58; coefficient of concordance&#59; COR&#58; coefficient of correlation&#59; COV&#58; coefficient of variation&#59; DBP&#58; diastolic blood pressure&#59; Diff&#46;&#58; difference&#59; HR&#58; heart rate&#59; SBP&#58; systolic blood pressure&#59; SD&#58; standard deviation&#59; V1&#58; first ABPM visit&#59; V2&#58; second ABMP visit&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">V2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diff&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SD of Diff&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">COV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">COR<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CoC<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">49&#177;1</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">27&#46;6&#177;0&#46;3</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Women &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">59&#37;</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">V1&#8211;V2 interval &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="2" align="center" valign="top">5&#46;5&#177;0&#46;2</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Office SBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131&#46;9&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&#46;5&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;11&#177;0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;9&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;7&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Office DBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&#46;2&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;1&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;10&#177;0&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;8&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">24-h SBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">126&#46;8&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">126&#46;5&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;38&#177;0&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;8&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;8&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">24-h DBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;9&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;7&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;26&#177;0&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;7&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;1&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">24-h HR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;2&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;9&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;70&#177;0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;7&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;7&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Daytime SBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131&#46;2&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&#46;6&#177;0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;55&#177;0&#46;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;9&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;6&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Daytime DBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;8&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;2&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;52&#177;0&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;4&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;1&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nighttime SBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">118&#46;1&#177;0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">117&#46;7&#177;0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;32&#177;0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;0&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nighttime DBP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;4&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68&#46;2&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;10&#177;0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;5&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;1&#177;0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Nighttime SBP fall&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;8&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&#177;0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;07&#177;0&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;9&#177;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;3&#177;5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Night&#47;day SBP ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;900&#177;0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;902&#177;0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&#177;0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Night&#47;day DBP ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;858&#177;0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;862&#177;0&#46;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;012&#177;0&#46;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the study population &#40;n&#61;481&#41; and comparison of absolute values&#44; differences and coefficients of correlation and concordance in 24 h&#44; daytime and nighttime blood pressure between the two recordings&#46;</p>"
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                    0 => array:2 [
                      "titulo" => "ESH&#47;ESC guidelines for the management of arterial hypertension&#58; the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension &#40;ESH&#41; and of the European Society of Cardiology &#40;ESC&#41;"
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                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/eht151"
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                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "2159"
                        "paginaFinal" => "2219"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23771844"
                            "web" => "Medline"
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              "identificador" => "bib0260"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ambulatory pulse pressure&#58; a potent predictor of total cardiovascular risk in hypertension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; Verdecchia"
                            1 => "G&#46; Schillaci"
                            2 => "C&#46; Borgioni"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hypertension"
                        "fecha" => "1998"
                        "volumen" => "32"
                        "paginaInicial" => "983"
                        "paginaFinal" => "988"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9856961"
                            "web" => "Medline"
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                0 => array:2 [
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                      "titulo" => "Ambulatory blood pressure as a predictor of target organ disease and outcome in the hypertensive patient"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "W&#46;B&#46; White"
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                        "tituloSerie" => "Blood Press Monit"
                        "fecha" => "1999"
                        "volumen" => "4"
                        "paginaInicial" => "181"
                        "paginaFinal" => "184"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10490872"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ambulatory blood pressure monitoring&#58; dippers compared with non-dippers"
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                          "etal" => false
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                            0 => "W&#46;B&#46; White"
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                        "tituloSerie" => "Blood Press Monit"
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                        "numero" => "Suppl&#46; 1"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10904238"
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                      "titulo" => "Evaluation of carotid intima-media thickness and aortic elasticity in patients with nondipper hypertension"
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                            0 => "E&#46; Ozdemir"
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                    0 => array:2 [
                      "doi" => "10.1111/echo.12444"
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                        "tituloSerie" => "Echocardiography"
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Article information

ISSN: 21742049
Original language: English

DOI:10.1016/j.repce.2015.10.001

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	6	4	10
2024 October	43	38	81
2024 September	45	32	77
2024 August	64	34	98
2024 July	47	31	78
2024 June	28	19	47
2024 May	32	30	62
2024 April	31	21	52
2024 March	50	21	71
2024 February	43	32	75
2024 January	38	33	71
2023 December	24	27	51
2023 November	38	18	56
2023 October	35	19	54
2023 September	32	15	47
2023 August	29	18	47
2023 July	44	8	52
2023 June	29	9	38
2023 May	29	22	51
2023 April	17	17	34
2023 March	18	18	36
2023 February	23	11	34
2023 January	19	14	33
2022 December	30	16	46
2022 November	44	19	63
2022 October	25	17	42
2022 September	33	31	64
2022 August	26	20	46
2022 July	30	33	63
2022 June	20	12	32
2022 May	22	35	57
2022 April	25	21	46
2022 March	20	33	53
2022 February	23	26	49
2022 January	16	27	43
2021 December	14	26	40
2021 November	27	34	61
2021 October	36	40	76
2021 September	21	24	45
2021 August	38	22	60
2021 July	23	23	46
2021 June	16	17	33
2021 May	25	31	56
2021 April	25	31	56
2021 March	39	14	53
2021 February	58	10	68
2021 January	32	10	42
2020 December	43	10	53
2020 November	38	19	57
2020 October	28	15	43
2020 September	45	10	55
2020 August	13	7	20
2020 July	48	6	54
2020 June	43	9	52
2020 May	37	9	46
2020 April	36	11	47
2020 March	38	11	49
2020 February	58	46	104
2020 January	33	6	39
2019 December	28	1	29
2019 November	37	11	48
2019 October	651	4	655
2019 September	28	10	38
2019 August	50	7	57
2019 July	47	10	57
2019 June	33	10	43
2019 May	34	11	45
2019 April	25	19	44
2019 March	94	5	99
2019 February	36	7	43
2019 January	18	3	21
2018 December	55	11	66
2018 November	95	8	103
2018 October	138	16	154
2018 September	63	24	87
2018 August	37	35	72
2018 July	25	9	34
2018 June	36	4	40
2018 May	36	12	48
2018 April	34	3	37
2018 March	50	9	59
2018 February	26	1	27
2018 January	28	6	34
2017 December	41	5	46
2017 November	41	9	50
2017 October	39	10	49
2017 September	32	7	39
2017 August	30	18	48
2017 July	26	11	37
2017 June	34	6	40
2017 May	42	14	56
2017 April	32	10	42
2017 March	48	67	115
2017 February	38	4	42
2017 January	58	2	60
2016 December	36	9	45
2016 November	28	9	37
2016 October	31	10	41
2016 September	36	15	51
2016 August	27	2	29
2016 July	18	3	21
2016 June	12	5	17
2016 May	11	4	15
2016 April	33	1	34
2016 March	46	20	66
2016 February	53	35	88
2016 January	50	27	77
2015 December	15	6	21

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