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Non dipping pattern frequency and metabolic syndrome relationship according to two different metabolic syndrome diagnostic methods in newly diagnosed hypertensive individuals

Yıl 2023, Cilt: 4 Sayı: 4, 373 - 379, 30.08.2023

Elif Güneş Mutlu Güneş Aslı Çurgunlu

https://doi.org/10.47582/jompac.1333399

Öz

Aim: The literature presents conflicting data regarding whether the non dipping pattern (NDP) in patients with metabolic syndrome (MS) compared to those without. In our study, we aimed to investigate the MS effect of the NDP in individuals with hypertension.
Methods: This prospective study included 117 newly diagnosed hypertensive patients (79 women and 38 men) who were not receiving any anti-hypertensive treatment. MS was evaluated according to the currently used the US National Cholesterol Education Programme Adult Treatment Panel-III definition criteria (MS-ATP-III) and a new diagnostic scoring method (MS-Score). NDP defined, nocturnal blood pressure (BP) fell by <10% from daytime BP
Results: The mean age of the patients who met the MS-ATP-III criteria was 53.9+8.1 years. The prevalence of the MS-ATP-III among the study population was 60.6%. The NDP frequency was similar in patients with and without MS-ATP-III, high MS-Score and low MS-Score group (respectively; 44.8%, 47.5%, p=0.79, 44.7%, 46.9%, p= 0.9). The reverse dipping pattern (RDP) frequency was higher in patients with MS-ATP-III compared to those without MS (13.8% and 2.5%, p=0.021), RDP was 10.8% in the high MS-Score group and 8.2% in the low MS-Score group (p=0.66). The LDL (mg/dL) values were higher in those with NDP compared to those without (142.6+32.2, 125.5+28.9, p=0.008).
Conclusion: Despite the high prevalence of MS among newly diagnosed hypertensive patients, the prevalence of NDP does not show a different distribution in patients with MS in both the MS-ATP-III and MS-Score method.

Anahtar Kelimeler

Hypertension non-dipping pattern metabolic syndrome reverse dipping pattern metabolic score

Kaynakça

  • Lorenzo C, Williams K, Hunt KJ, Haffner SM. The National Cholesterol Education Program - Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care. 2007;30(1):8-13. doi:10.2337/dc06-1414
  • Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001;24(4):683-689. doi:10.2337/diacare.24.4.683
  • Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation. 2003;107(3):391-397. doi:10.1161/01.cir.0000055014.62083.05
  • Schillaci G, Pirro M, Vaudo G, et al. Prognostic value of the metabolic syndrome in essential hypertension. J Am Coll Cardiol. 2004;43(10):1817-1822. doi:10.1016/j.jacc.2003.12.049
  • Cuspidi C, Meani S, Fusi V, et al. Metabolic syndrome and target organ damage in untreated essential hypertensives. J Hypertens. 2004;22(10):1991-1998. doi:10.1097/00004872-200410000-00023
  • Preda A, Liberale L, Montecucco F. Imaging techniques for the assessment of adverse cardiac remodeling in metabolic syndrome. Heart Fail Rev. 2022;27(5):1883-1897. doi:10.1007/s10741-021-10195-6
  • Saadi MM, Roy MN, Haque R, Tania FA, Mahmood S, Ali N. Association of microalbuminuria with metabolic syndrome: a cross-sectional study in Bangladesh. BMC Endocr Disord. 2020;20(1):153. doi:10.1186/s12902-020-00634-0
  • Schillaci G, Pirro M, Pucci G, et al. Different impact of the metabolic syndrome on left ventricular structure and function in hypertensive men and women. Hypertension. 2006;47(5):881-886. doi:10.1161/01.HYP.0000216778.83626.39
  • O'Brien E, Sheridan J, O'Malley K. Dippers and non-dippers. Lancet. 1988;2(8607):397. doi:10.1016/s0140-6736(88)92867-x
  • Chobanian AC, Bakris GL, Black HR, et al. National Heart, Lung, and Blood Institue Joint National Committe on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National Hİgh Blood Pressure Education Program Coordination Committee The JNC 7 Report. JAMA. 2003;289:2560-2572.
  • Chia J, Bhatia KS, Mihailidou AS, Kanagaratnam LB. The role of ambulatory blood pressure monitoring in current clinical practice. Heart Lung Circ. 2022;31(10):1333-1340. doi:10.1016/j.hlc.2022.06.670
  • Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006;354(22):2368-2374. doi:10.1056/NEJMra060433
  • Kohara K, Nishida W, Maguchi M, Hiwada K. Autonomic nervous function in non-dipper essential hypertensive subjects. Evaluation by power spectral analysis of heart rate variability. Hypertension. 1995;26(5):808-814. doi:10.1161/01.hyp.26.5.808
  • Lind L, Andersson PE, Andrén B, Hänni A, Lithell HO. Left ventricular hypertrophy in hypertension is associated with the insulin resistance metabolic syndrome. J Hypertens. 1995;13(4):433-438.
  • De Pergola G, Ciccone M, Pannacciulli N, et al. Lower insulin sensitivity as an independent risk factor for carotid wall thickening in normotensive, non-diabetic, non-smoking normal weight and obese premenopausal women. Int J Obes Relat Metab Disord. 2000;24(7):825-829. doi:10.1038/sj.ijo.0801239
  • Brotman DJ, Davidson MB, Boumitri M, Vidt DG. Impaired diurnal blood pressure variation and all-cause mortality. Am J Hypertens. 2008;21(1):92-97. doi:10.1038/ajh.2007.7
  • Dolan E, Stanton A, Thijs L, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension. 2005;46(1):156-161. doi:10.1161/01.HYP.0000170138.56903.7a
  • Ayala DE, Hermida RC, Chayan L, Mojón A, Fontao MJ, Fernández JR. Circadian pattern of ambulatory blood pressure in untreated hypertensive patients with and without metabolic syndrome. Chronobiol Int. 2009;26(6):1189-1205. doi:10.3109/07420520903206294
  • Mulè G, Nardi E, Cottone S, et al. Relationship of metabolic syndrome with pulse pressure in patients with essential hypertension. Am J Hypertens. 2007;20(2):197-203. doi: 10.1016/j.amjhyper.2006.07.016
  • Vyssoulis GP, Karpanou EA, Kyvelou SM, et al. Nocturnal blood pressure fall and metabolic syndrome score in hypertensive patients. Blood Pressure Monitoring. 2007;12(6):351-356. DOI: 10.1097/mbp.0b013e3282cb5ad3. PMID: 18004102.
  • Tartan Z, Uyarel H, Kasikcioglu H, et al. Metabolic syndrome as a predictor of non-dipping hypertension. Tohoku J Exp Med. 2006;210(1):57-66. doi:10.1620/tjem.210.57
  • Cuspidi C, Meani S, Valerio C, et al. Metabolic syndrome score and ambulatory blood pressure in untreated essential hypertension. Blood Press Monit. 2005;10(4):175-180. doi:10.1097 /01.mbp.0000170921.55412.02
  • Bastos JM, Bertoquini S, Polónia J. Relationship of circadian blood pressure and morning blood pressure surge with the severity of metabolic syndrome in newly diagnosed hypertensives. Rev Port Cardiol. 2007;26(7-8):731-741.
  • Foss CH, Vestbo E, Frøland A, Gjessing HJ, Mogensen CE, Damsgaard EM. Normal blood pressure and preserved diurnal variation in offspring of type 2 diabetic patients characterized by features of the metabolic syndrome: the Fredericia Study. Diabetes Care. 2000;23(3):283-289. doi:10.2337/diacare.23.3.283
  • Mancia G, Bombelli M, Corrao G, et al. Metabolic syndrome in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study: daily life blood pressure, cardiac damage, and prognosis. Hypertension. 2007;49(1):40-47. doi:10.1161/01.HYP.0000251933.22091.24
  • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-2497. doi:10.1001/jama.285.19.2486
  • Ford ES, Schulze MB, Pischon T, Bergmann MM, Joost HG, Boeing H. Metabolic syndrome and risk of incident diabetes: findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam Study. Cardiovasc Diabetol. 2008;7:35. Published 2008 Dec 12. doi:10.1186/1475-2840-7-35
  • Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105-1187. doi:10.1097/HJH.0b013e3281fc975a
  • Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008;29(19):2388-2442. doi:10.1093/eurheartj/ehn309
  • Benetos A, Safar M, Rudnichi A, et al. Pulse pressure: a predictor of long-term cardiovascular mortality in a French male population. Hypertension. 1997;30(6):1410-1415. doi:10.1161/01.hyp.30.6.1410
  • Blacher J, Staessen JA, Girerd X, et al. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med. 2000;160(8):1085-1089. doi:10.1001/archinte.160.8.1085
  • Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Is pulse pressure useful in predicting risk for coronary heart Disease? The Framingham heart study. Circulation. 1999;100(4):354-360. doi:10.1161/01.cir.100.4.354
  • Yan B, Yan H, Sun L, et al. Novel association between the reverse-dipper pattern of ambulatory blood pressure monitoring and metabolic syndrome in men but not in women. Medicine (Baltimore). 2015;94(47):e2115. doi:10.1097/MD.0000000000002115
  • Yan B, Peng L, Dong Q, et al. Reverse-dipper pattern of blood pressure may predict lacunar infarction in patients with essential hypertension. Eur J Neurol. 2015;22(6):1022-1025. doi:10.1111/ene.12659
  • Chen YK, Ni ZX, Li W, et al. Diurnal blood pressure and heart rate variability in hypertensive patients with cerebral small vessel disease: a case-control study. J Stroke Cerebrovasc Dis. 2021;30(5):105673. doi:10.1016/j.jstrokecerebrovasdis.2021.105673
  • Kim BK, Kim YM, Lee Y, Lim YH, Shin J. A reverse dipping pattern predicts cardiovascular mortality in a clinical cohort. J Korean Med Sci. 2013;28(10):1468-1473. doi:10.3346/jkms. 2013.28.10.1468
  • Cuspidi C, Tadic M, Sala C, Carugo S, Mancia G, Grassi G. Reverse dipping and subclinical cardiac organ damage: a meta-analysis of echocardiographic studies. J Hypertens. 2021;39(8):1505-1512. doi:10.1097/HJH.0000000000002836

Yeni tanı almış hipertansif bireylerde iki farklı metabolik sendrom tanı yöntemine göre non dipping patern sıklığı ve metabolik sendrom ilişkisi

Yıl 2023, Cilt: 4 Sayı: 4, 373 - 379, 30.08.2023

Elif Güneş Mutlu Güneş Aslı Çurgunlu

https://doi.org/10.47582/jompac.1333399

Öz

Amaç: Literatürde, metabolik sendromu (MS) olan hastalarda non dipping paterninin (NDP) olmayanlara kıyasla daha yüksek olup olmadığı konusunda çelişkili veriler bulunmaktadır. Çalışmamızda hipertansiyonu olan bireylerde NDP'nin MS etkisini araştırmayı amaçladık.
Yöntemler: Bu prospektif çalışmaya yeni tanı konmuş ve herhangi bir anti-hipertansif tedavi almayan 117 hipertansif hasta (79 kadın ve 38 erkek) dahil edildi. MS, halen kullanılmakta olan US National Cholesterol Education Programme Adult Treatment Panel-III tanım kriterlerine (MS-ATP-III) ve yeni bir tanısal skorlama yöntemine (MS-Skor) göre değerlendirildi. NDP tanımlı, gece kan basıncının (KB) gündüz KB'ye göre <%10 düşmesi.
Bulgular: MS-ATP-III kriterlerini karşılayan hastaların yaş ortalaması 53.9+8.1 yıldı. Çalışma popülasyonunda MS-ATP-III prevalansı %60.6 idi. NDP sıklığı MS-ATP-III olan ve olmayan hastalarda, yüksek MS-Skoru ve düşük MS-Skoru grubunda benzerdi (sırasıyla; %44.8, %47.5, p=0.79, %44.7, %46.9, p= 0.9). Ters dalma paterni (RDP) sıklığı MS-ATP-III olan hastalarda MS olmayanlara kıyasla daha yüksekti (%13,8 ve %2,5, p=0,021), RDP yüksek MS-Skoru grubunda %10,8 ve düşük MS-Skoru grubunda %8,2 idi (p=0,66). LDL (mg/dl) değerleri NDP olanlarda olmayanlara kıyasla daha yüksekti (142.6+32.2, 125.5+28.9, p=0.008).
Sonuç: Yeni tanı konmuş hipertansif hastalar arasında MS prevalansının yüksek olmasına rağmen, NDP prevalansı hem MS-ATP-III hem de MS-Skor yönteminde MS'li hastalarda farklı bir dağılım göstermemektedir.

Anahtar Kelimeler

Hipertansiyon Non-dipping patern Metabolik sendrom Ters dipping paterni Metabolik skor.

Kaynakça

  • Lorenzo C, Williams K, Hunt KJ, Haffner SM. The National Cholesterol Education Program - Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome as predictors of incident cardiovascular disease and diabetes. Diabetes Care. 2007;30(1):8-13. doi:10.2337/dc06-1414
  • Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care. 2001;24(4):683-689. doi:10.2337/diacare.24.4.683
  • Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation. 2003;107(3):391-397. doi:10.1161/01.cir.0000055014.62083.05
  • Schillaci G, Pirro M, Vaudo G, et al. Prognostic value of the metabolic syndrome in essential hypertension. J Am Coll Cardiol. 2004;43(10):1817-1822. doi:10.1016/j.jacc.2003.12.049
  • Cuspidi C, Meani S, Fusi V, et al. Metabolic syndrome and target organ damage in untreated essential hypertensives. J Hypertens. 2004;22(10):1991-1998. doi:10.1097/00004872-200410000-00023
  • Preda A, Liberale L, Montecucco F. Imaging techniques for the assessment of adverse cardiac remodeling in metabolic syndrome. Heart Fail Rev. 2022;27(5):1883-1897. doi:10.1007/s10741-021-10195-6
  • Saadi MM, Roy MN, Haque R, Tania FA, Mahmood S, Ali N. Association of microalbuminuria with metabolic syndrome: a cross-sectional study in Bangladesh. BMC Endocr Disord. 2020;20(1):153. doi:10.1186/s12902-020-00634-0
  • Schillaci G, Pirro M, Pucci G, et al. Different impact of the metabolic syndrome on left ventricular structure and function in hypertensive men and women. Hypertension. 2006;47(5):881-886. doi:10.1161/01.HYP.0000216778.83626.39
  • O'Brien E, Sheridan J, O'Malley K. Dippers and non-dippers. Lancet. 1988;2(8607):397. doi:10.1016/s0140-6736(88)92867-x
  • Chobanian AC, Bakris GL, Black HR, et al. National Heart, Lung, and Blood Institue Joint National Committe on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National Hİgh Blood Pressure Education Program Coordination Committee The JNC 7 Report. JAMA. 2003;289:2560-2572.
  • Chia J, Bhatia KS, Mihailidou AS, Kanagaratnam LB. The role of ambulatory blood pressure monitoring in current clinical practice. Heart Lung Circ. 2022;31(10):1333-1340. doi:10.1016/j.hlc.2022.06.670
  • Pickering TG, Shimbo D, Haas D. Ambulatory blood-pressure monitoring. N Engl J Med. 2006;354(22):2368-2374. doi:10.1056/NEJMra060433
  • Kohara K, Nishida W, Maguchi M, Hiwada K. Autonomic nervous function in non-dipper essential hypertensive subjects. Evaluation by power spectral analysis of heart rate variability. Hypertension. 1995;26(5):808-814. doi:10.1161/01.hyp.26.5.808
  • Lind L, Andersson PE, Andrén B, Hänni A, Lithell HO. Left ventricular hypertrophy in hypertension is associated with the insulin resistance metabolic syndrome. J Hypertens. 1995;13(4):433-438.
  • De Pergola G, Ciccone M, Pannacciulli N, et al. Lower insulin sensitivity as an independent risk factor for carotid wall thickening in normotensive, non-diabetic, non-smoking normal weight and obese premenopausal women. Int J Obes Relat Metab Disord. 2000;24(7):825-829. doi:10.1038/sj.ijo.0801239
  • Brotman DJ, Davidson MB, Boumitri M, Vidt DG. Impaired diurnal blood pressure variation and all-cause mortality. Am J Hypertens. 2008;21(1):92-97. doi:10.1038/ajh.2007.7
  • Dolan E, Stanton A, Thijs L, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension. 2005;46(1):156-161. doi:10.1161/01.HYP.0000170138.56903.7a
  • Ayala DE, Hermida RC, Chayan L, Mojón A, Fontao MJ, Fernández JR. Circadian pattern of ambulatory blood pressure in untreated hypertensive patients with and without metabolic syndrome. Chronobiol Int. 2009;26(6):1189-1205. doi:10.3109/07420520903206294
  • Mulè G, Nardi E, Cottone S, et al. Relationship of metabolic syndrome with pulse pressure in patients with essential hypertension. Am J Hypertens. 2007;20(2):197-203. doi: 10.1016/j.amjhyper.2006.07.016
  • Vyssoulis GP, Karpanou EA, Kyvelou SM, et al. Nocturnal blood pressure fall and metabolic syndrome score in hypertensive patients. Blood Pressure Monitoring. 2007;12(6):351-356. DOI: 10.1097/mbp.0b013e3282cb5ad3. PMID: 18004102.
  • Tartan Z, Uyarel H, Kasikcioglu H, et al. Metabolic syndrome as a predictor of non-dipping hypertension. Tohoku J Exp Med. 2006;210(1):57-66. doi:10.1620/tjem.210.57
  • Cuspidi C, Meani S, Valerio C, et al. Metabolic syndrome score and ambulatory blood pressure in untreated essential hypertension. Blood Press Monit. 2005;10(4):175-180. doi:10.1097 /01.mbp.0000170921.55412.02
  • Bastos JM, Bertoquini S, Polónia J. Relationship of circadian blood pressure and morning blood pressure surge with the severity of metabolic syndrome in newly diagnosed hypertensives. Rev Port Cardiol. 2007;26(7-8):731-741.
  • Foss CH, Vestbo E, Frøland A, Gjessing HJ, Mogensen CE, Damsgaard EM. Normal blood pressure and preserved diurnal variation in offspring of type 2 diabetic patients characterized by features of the metabolic syndrome: the Fredericia Study. Diabetes Care. 2000;23(3):283-289. doi:10.2337/diacare.23.3.283
  • Mancia G, Bombelli M, Corrao G, et al. Metabolic syndrome in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study: daily life blood pressure, cardiac damage, and prognosis. Hypertension. 2007;49(1):40-47. doi:10.1161/01.HYP.0000251933.22091.24
  • Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-2497. doi:10.1001/jama.285.19.2486
  • Ford ES, Schulze MB, Pischon T, Bergmann MM, Joost HG, Boeing H. Metabolic syndrome and risk of incident diabetes: findings from the European Prospective Investigation into Cancer and Nutrition-Potsdam Study. Cardiovasc Diabetol. 2008;7:35. Published 2008 Dec 12. doi:10.1186/1475-2840-7-35
  • Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25(6):1105-1187. doi:10.1097/HJH.0b013e3281fc975a
  • Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008;29(19):2388-2442. doi:10.1093/eurheartj/ehn309
  • Benetos A, Safar M, Rudnichi A, et al. Pulse pressure: a predictor of long-term cardiovascular mortality in a French male population. Hypertension. 1997;30(6):1410-1415. doi:10.1161/01.hyp.30.6.1410
  • Blacher J, Staessen JA, Girerd X, et al. Pulse pressure not mean pressure determines cardiovascular risk in older hypertensive patients. Arch Intern Med. 2000;160(8):1085-1089. doi:10.1001/archinte.160.8.1085
  • Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Is pulse pressure useful in predicting risk for coronary heart Disease? The Framingham heart study. Circulation. 1999;100(4):354-360. doi:10.1161/01.cir.100.4.354
  • Yan B, Yan H, Sun L, et al. Novel association between the reverse-dipper pattern of ambulatory blood pressure monitoring and metabolic syndrome in men but not in women. Medicine (Baltimore). 2015;94(47):e2115. doi:10.1097/MD.0000000000002115
  • Yan B, Peng L, Dong Q, et al. Reverse-dipper pattern of blood pressure may predict lacunar infarction in patients with essential hypertension. Eur J Neurol. 2015;22(6):1022-1025. doi:10.1111/ene.12659
  • Chen YK, Ni ZX, Li W, et al. Diurnal blood pressure and heart rate variability in hypertensive patients with cerebral small vessel disease: a case-control study. J Stroke Cerebrovasc Dis. 2021;30(5):105673. doi:10.1016/j.jstrokecerebrovasdis.2021.105673
  • Kim BK, Kim YM, Lee Y, Lim YH, Shin J. A reverse dipping pattern predicts cardiovascular mortality in a clinical cohort. J Korean Med Sci. 2013;28(10):1468-1473. doi:10.3346/jkms. 2013.28.10.1468
  • Cuspidi C, Tadic M, Sala C, Carugo S, Mancia G, Grassi G. Reverse dipping and subclinical cardiac organ damage: a meta-analysis of echocardiographic studies. J Hypertens. 2021;39(8):1505-1512. doi:10.1097/HJH.0000000000002836
Toplam 37 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Endokrinoloji
Bölüm Research Articles [en] Araştırma Makaleleri [tr]
Yazarlar

Elif Güneş 0000-0002-5441-2604

Mutlu Güneş 0000-0001-9756-2285

Aslı Çurgunlu 0000-0003-2874-8769

Yayımlanma Tarihi 30 Ağustos 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 4 Sayı: 4

Kaynak Göster

AMA Güneş E, Güneş M, Çurgunlu A. Non dipping pattern frequency and metabolic syndrome relationship according to two different metabolic syndrome diagnostic methods in newly diagnosed hypertensive individuals. J Med Palliat Care / JOMPAC / Jompac. Ağustos 2023;4(4):373-379. doi:10.47582/jompac.1333399
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