Office and Ambulatory Blood Pressure in Obese and Abdominally Obese Hypertensive Patients

Background and aim : Blood pressure (BP) is increased in obese subjects, as well as in those with increased abdominal fat. However, the effects of these abnormalities in fat distribution on ambulatory BP are not well known. We have evaluated both office and ambulatory BP in hypertensive patients classified on the basis of fat abnormalities (body mass index and waist circumference categories).Methods: A total of 68,015 hypertensive patients from the Spanish ABPM Registry were included in the present analysis. Office and ambulatory BP were measured under the same conditions and were compared in subjects classified on body mass index categories (normal weight, overweight, obese), and waist circumference categories (normal, abdominal obesity).Results: Prevalence of normal weight, overweight and obesity were 19%, 45.1%, and 35.8%, respectively, whereas prevalence of abdominal obesity was 41.7%. Systolic BP, both office and ambulatory were increased in obese and abdominal obese subjects, whereas diastolic BP tended to be reduced in these patients. Obese and abdominal obese patients showed lower rates of office, but not ambulatory BP control, with the exception of nocturnal hypertension, found increased in obese hypertensives. Both obese and abdominal obese exhibited a blunted nocturnal BP fall (non-dipping pattern).Conclusion: Ambulatory BP monitoring adds important clinical information to the management of hypertensive patients with abnormalities in fat deposition and distribution. An enhanced white coat phenomenon is present, but also increased nocturnal BP and a blunted nocturnal decline in BP are both relevant in terms of prognosis and management.