Circadian Blood Pressure Phenotypes and 24-Hour Variability as Determinants of Mental Health-related Quality of Life in Hypertension with Type 2 Diabetes and Obesity
Borys Shelest1, Oleksandr Kryvoshapka2, Mykola Lytvynenko3, Oleksandra Babycheva1, Yuliia Kovalova4, Iulia Rodionova51Department of Internal and Occupational Diseases, Kharkiv National Medical University, Kharkiv, Ukraine2Department of Pharmacology and Medical Prescription, Kharkiv National Medical University, Kharkiv, Ukraine
3Department of Hygiene and Ecology, Kharkiv National Medical University, Kharkiv, Ukraine
4Department of Internal Medicine No. 2, Clinical Immunology and Allergology Named After Academician L.t. Malaya, Kharkiv National Medical University, Kharkiv, Ukraine
5Government Institution L.T.Malaya Therapy National Institute of The National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
INTRODUCTION: Multimorbidity combining hypertension (HTN), type 2 diabetes mellitus (T2D), and obesity adversely affects health-related quality of life (HRQoL). Ambulatory circadian phenotypes (dipper/non-dipper/riser) and average real variability (ARV) may relate to mental well-being. We aimed to find whether ambulatory BP phenotypes and ARV are associated with the SF-36 mental component summary (MCS) in HTN+T2D+obesity.
METHODS: In an observational cohort, 314 participants with HTN+T2D+obesity (mean age 58.9±9.7 years; 54% men), 262 had evaluable ABPM (dipper 34%, non-dipper 50%, riser 16%); completed the 36-Item Short-Form Health Survey (SF-36) and underwent 24-hour ambulatory BP monitoring (ABPM). Primary outcome was MCS. 24-h systolic ARV was computed from consecutive valid readings. Receiver-operating characteristic (ROC) analyses identified an ARV threshold for low MCS (lowest quartile).
RESULTS: Adjusted MCS showed a graded decrement across phenotypes: dipper 48.8 (95% CI 47.5–50.1), non-dipper 46.1 (45.1–47.2), riser 44.0 (42.5–45.6); p<0.001. ARV was independently and inversely associated with MCS; for low MCS, ARV discriminated better than SD and mean 24-h SBP (AUC 0.69 vs 0.63 and 0.58). The Youden-derived ARV cut-off ~12.5 mmHg yielded a sensitivity of 0.66 and specificity of 0.62. Simultaneous attainment of 24-h BP and HbA1c targets related to higher MCS (+3.1 points; p<0.001) and a greater high-MCS responder rate (52% vs 31%).
DISCUSSION AND CONCLUSION: In HTN+T2D+obesity, abnormal circadian BP phenotypes and higher ARV identify patients with lower MCS beyond mean BP and may flag risk of low mental HRQoL and support integrated management toward dual control of 24-h BP and HbA1c.
Keywords: Blood pressure monitoring, hypertension, diabetes mellitus, obesity, quality of life, circadian rhythm.
Manuscript Language: English
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