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merged from an investigation that evaluated seasonal variations in fibrinogen among hypertensive patients. Hermida and colleagues in Vigo and at the University of Santiago in Spain compared fibrinogen levels in 741 patients who had mild or moderate hypertension, defined as greater than 140/90 millimeters of mercury (mm Hg) but less than 180/110 mm Hg.

Blood pressure was monitored continuously over 48 hours by ambulatory blood pressure monitoring devices. Blood and urine samples were obtained before monitoring started. Each patient had a single evaluation, and the individual evaluations were distributed throughout the year.

Overall, fibrinogen levels averaged 323 milligrams per liter (mg/dL) in the patients, well within the normal range of 160-400 mg/dL says Hermida. As with previous studies, the results showed a difference of 75 mg/dL between highest and lowest fibrinogen levels. The highest readings occurred in patients evaluated during the winter, peaking in the first week of March.

Results of the 48-hour blood pressure monitoring showed that almost half the patients (365 of 741) were non-dippers, defined by a decrease in nocturnal blood pressure of less than 10 percent. A comparison of fibrinogen levels in dippers and non-dippers showed that non-dippers had a 21 mg/dL higher mean fibrinogen value over the course of the year, which was statistically different from dippers.

The proportion of non-dippers identified in the study conflicts with other research showing that non-dippers account for 15 percent to 20 percent of hypertensive patients. However, Hermida says recent European studies employing continuous ambulatory blood pressure monitoring have consistently shown non-dipper rates of about 40 percent.

"This emphasizes the importance of ambulatory blood pressure monitoring for identification of non-dippers," he says. "Many studies have indicated that ambulatory blood pressure monitoring is a much better predictor of morbidity and
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Contact: Maggie Francis
maggie.francis@heart.org
214-706-1397
American Heart Association
26-Sep-2002

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