Özgür Yaşar Akbal1, Barkın Kültürsay1, Uğur Fındıkçıoğlu2, Berhan Keskin1, Doğancan Çeneli1, Seda Tanyeri1, Ali Karagöz1, Süleyman Çağan Efe1, Hacer Ceren Tokgöz1, Zübeyde Bayram1, Cem Doğan1, Nihal Özdemir1, Cihangir Kaymaz1

1Department of Cardiology, Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
2Department of Cardiology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey

Keywords: Malnutrition; hypertension; malnutrition score; dipper; non-dipper.


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.

Ethics Committee Approval

This study was approved by Kartal Lutfi Kirdar City Hospital Ethics Committee (514/192/60, Date: 30.12.2020).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept/Design - ÖA, UF, AK, SE, ST; Analysis/ Interpretation - AK, BU, BE, ZB; Data Collection - BU, BE, DÇ, CT; Writing - ÖA, BU, AK, ST, BE; Critical Revision - CK, NÖ, CD, ZB; Statistical Analysis - AK, SE, CD; Overall Responsibility - All of authors; Final Approval - All of authors.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.