Özgür Yaşar AKBAL, Barkın KÜLTÜRSAY, Berhan KESKİN, Doğancan ÇENELİ, Seda TANYERİ, Ali KARAGÖZ, Süleyman Çağan EFE, Hacer Ceren TOKGÖZ, Zübeyde BAYRAM, Nihal ÖZDEMİR, Cihangir KAYMAZ, Uğur FINDIKÇIOĞLU

Non-Dipper Hipertansiyonu Öngörmede Malnütrisyon Skorlarının Rolü Var mıdır?

Giriş: Normalde kan basıncı sirkadiyen bir ritim gösterir, buna paralel olarak gece kan basıncı gündüz kan basıncına göre %10 düşer. Çalışmalar, dipper olmayanların artmış kardiyovasküler ve serebrovasküler morbidite ve mortalitesine sahip olduğunu göstermiştir. Yetersiz beslenme ve obezite, genel popülasyonda ölüme neden olabilecek artmış kardiyovasküler hastalık riskiyle ilişkilidir. Bu çalışma, “controlling nutritional status (CONUT)” ve “nutrition risk index (NRI)” malnütrisyon skorlarının dipper olmama durumunun öngörülmesindeki değerini diğer ölçümlerle karşılaştırıldığında değerlendirmek için yapılmıştır. Hastalar ve Yöntem: Bu retrospektif çalışmada, hastanemizde ambulatuvar kan basıncı ölçümleri yapılan 167 hasta çalışmaya dahil edildi. Yüz dokuz hasta hipertansiyon tanısı olan hastaydı, 58 hasta hipertansif olmayan hastalara dahil edildi. CONUT ve NRI skorları hesaplandı ve dipper ve dipper olmayan hastalarla ilişkilendirildi. Bulgular: Hastalar dipper ve dipper olmayan tansiyon paternine göre iki gruba ayrılmıştır. Dipper ve dipper olmayan hastaların ortanca yaşı sırasıyla 69 (67-72, IQR), 51.5 (45-60) idi. Ayrıca 109 (%65.2) hastanın hipertansiyon tanısı mevcuttu. Dipper olmayan 93 (%57) hastada görülmüştür. Dipper olmayan grupta maksimum gece kan basıncı ve ortalama gece kan basıncı daha yüksek bulunmuştur [sırasıyla 144 (134-160), 133 (119-140)-126 (115-137); 111 (101-120), p< 0.001]. Dipper olmayan grupta NRI düşük saptanmıştır (düşük değer yetersiz beslenmeyi gösterir) [59 (55-63), 60.5 (56-72) sırasıyla p= 0.008]. Herhangi bir derece CONUT pozitifliği (pozitiflik malnütrisyonu gösterir) dipper olmayan grupta daha fazladır [32 (%43.2), 25 (%26.9), p= 0.027]. Aynı zamanda optimum kesme tahmini dipper olmayan hipertansiyon için ROC eğrisi analizi yapılmıştır. Youden indeksine göre optik kesme değeri 0.297, analiz kesme değeri 57.9, duyarlılık %71, özgüllük %58.06, pozitif öngörü değeri %57.61 ve negatif öngörü değeri %72 bulunmuştur. Sonuç: Çalışmamız, CONUT veya NRI skorlarıyla tanımlanan malnütrisyon durumunun dipper olmayan hipertansiyon paterni ile ilişkili olduğunu göstermiştir

Do Malnutrition Scores Have a Role in Prediction of Non-Dipper Hypertension?

Introduction: Normally, blood pressure shows a circadian rhythm, in line with this, blood pressure at night falls by 10% compared to daytime blood pressure. Studies have shown that non-dippers have an increased mortality and morbidity of cardiovascular and cerebrovascular diseases. Malnutrition and obesity are associated with an increased risk of cardiovascular disease, and increased mortality in general population. This study was conducted to evaluate the value of controlling nutritional status (CONUT) and nutrition risk index (NRI) malnutrition scores in prediction of non-dipper status, compared with other measurements. Patients and Methods: In this retrospective study, 167 patients who had ambulatory blood pressure measurements in our hospital were included. One hundred nine patients had previous diagnosis of hypertension; 58 patients were non-hypertensive. CONUT and NRI scores were calculated and their association between dipper and non-dipper patterns were examined. Results: Patients were divided into two groups according to dipper or non-dipper status. The median age of patients with dipper and non-dipper were 50 (45-55, IQR), 51.5 (45-60) respectively. In addition, 109 (65.2%) subjects were hypertensive. Non-dipper status was seen in 93 (57%) patients. Max night blood pressure (BP) and mean night BP were higher in non-dipper group [144 (134-160), 133 (119-140)-126 (115-137); 111 (101-120), p< 0.001, respectively]. NRI was lower (low value denotes malnutrition) in non-dipper group [59 (55-63); 60.5 (56-72), p= 0.008, respectively]. CONUT any degree positive (any degree positive denotes malnutrition) in non-dipper group was higher than dipper group [32 (43.2%); 25 (26.9%), p= 0.027]. We also performed ROC curve analysis for optimal cut-off threshold to predict non-dipper hypertension. Optimal cut-off according to Youden index was 0.297, analysis showed cut-off value 57.9, sensitivity 71%, specificity 58.06%, positive predictive value 57.61%, and negative predictive value 72%. Conclusion: Our study showed that malnutrition status defined by CONUT or NRI scores are associated with non-dipper hypertension pattern.

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ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi