{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T10:21:58Z","timestamp":1789640518816,"version":"4.0.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,4,2]]},"abstract":"\n Background<\/jats:title>\n \n Increased blood pressure (\n BP<\/jats:styled-content>\n ) variability and nondipping status seen on 24\u2010hour ambulatory\n BP<\/jats:styled-content>\n monitoring are often observed in autonomic failure (\n ATF<\/jats:styled-content>\n ).\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We assessed\n BP<\/jats:styled-content>\n variability and nocturnal\n BP<\/jats:styled-content>\n dipping in 273 patients undergoing ambulatory\n BP<\/jats:styled-content>\n monitoring at Southwestern Medical Center between 2010 and 2017.\n SD<\/jats:styled-content>\n , average real variability, and variation independent of mean were calculated from ambulatory\n BP<\/jats:styled-content>\n monitoring. Patients were divided into a discovery cohort (n=201) and a validation cohort (n=72).\n ATF<\/jats:styled-content>\n was confirmed by formal autonomic function test. In the discovery cohort, 24\u2010hour and nighttime average real variability,\n SD<\/jats:styled-content>\n , and variation independent of mean did not differ significantly between\n ATF<\/jats:styled-content>\n (n=25) and controls (n=176, all\n P<\/jats:italic>\n >0.05). However, daytime SD, daytime coefficient of variation, and daytime variation independent of mean of systolic\n BP<\/jats:styled-content>\n (\n SBP<\/jats:styled-content>\n ) were all significantly higher in patients with\n ATF<\/jats:styled-content>\n than in controls in both discovery and validation cohorts. Nocturnal\n BP<\/jats:styled-content>\n dipping was more blunted in\n ATF<\/jats:styled-content>\n patients than controls in both cohorts (both\n P<\/jats:italic>\n <0.01). Using the threshold of 16\u00a0mm\u00a0Hg, daytime SD\n SBP<\/jats:styled-content>\n yielded a sensitivity of 77% and specificity of 82% in detecting\n ATF<\/jats:styled-content>\n in the validation cohort, whereas nondipping status had a sensitivity of 80% and specificity of 44%. The area under the receiver operator characteristic of daytime\n SD SBP<\/jats:styled-content>\n was greater than the area under the receiver operator characteristic of nocturnal\n SBP<\/jats:styled-content>\n dipping (0.79 [0.66\u20100.91] versus 0.73 [0.58\u20100.87], respectively).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Daytime\n SD<\/jats:styled-content>\n of\n SBP<\/jats:styled-content>\n is a better screening tool than nondipping status in detecting autonomic dysfunction.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.010161","type":"journal-article","created":{"date-parts":[[2019,3,23]],"date-time":"2019-03-23T09:01:25Z","timestamp":1553331685000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":35,"title":["Usefulness of Blood Pressure Variability Indices Derived From 24\u2010Hour Ambulatory Blood Pressure Monitoring in Detecting Autonomic Failure"],"prefix":"10.1161","volume":"8","author":[{"given":"Hamza A.","family":"Lodhi","sequence":"first","affiliation":[{"name":"Hypertension Section University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poghni A.","family":"Peri\u2010Okonny","sequence":"additional","affiliation":[{"name":"Hypertension Section University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Schesing","sequence":"additional","affiliation":[{"name":"Internal Medicine Department University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Phelps","sequence":"additional","affiliation":[{"name":"Hypertension Section University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Ngo","sequence":"additional","affiliation":[{"name":"Internal Medicine Department University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillary","family":"Evans","sequence":"additional","affiliation":[{"name":"Internal Medicine Department University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie","family":"Arbique","sequence":"additional","affiliation":[{"name":"Hypertension Section University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela L.","family":"Price","sequence":"additional","affiliation":[{"name":"Hypertension Section University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven","family":"Vernino","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurotherapeutics University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurotherapeutics University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jere H.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Cardiology Division University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott A.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Health Care Sciences University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Yano","sequence":"additional","affiliation":[{"name":"Department of Community and Family Medicine Duke University Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep R.","family":"Das","sequence":"additional","affiliation":[{"name":"Cardiology Division University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Wang","sequence":"additional","affiliation":[{"name":"Quantitative Biomedical Research Center University of Texas Southwestern Medical Center Dallas TX"},{"name":"Center for the Genetics of Host Defense University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanpen","family":"Vongpatanasin","sequence":"additional","affiliation":[{"name":"Hypertension Section University of Texas Southwestern Medical Center Dallas TX"},{"name":"Cardiology Division University of Texas Southwestern Medical Center Dallas TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000154900.76284.F6"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e328363e964"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-88-0020"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e318065c03b"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.3988\/jcn.2015.11.3.220"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pharmthera.2011.05.009"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2008.11.011"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/mus.25446"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1042\/CS20010071"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.68.3.477"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jhh.1002162"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.108.124552"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.004847"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200105150-00016"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/jch.13023"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2013.1"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.109.140798"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60308-X"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000000497"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.010075"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000000221"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004691-199301000-00003"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(12)60631-4"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.hjh.0000160205.81652.5a"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.107.088708"},{"key":"e_1_3_2_27_2","volume-title":"The Theory of Probability","author":"Jeffreys H","year":"1961","unstructured":"Jeffreys H. The Theory of Probability. Oxford, UK: Oxford University Press; 1961."},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01819837"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.3109\/10641968509073538"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1681.1984.tb00276.x"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40885-016-0059-4"},{"key":"e_1_3_2_33_2","first-page":"3","article-title":"Prognostic significance of blood pressure variability in essential hypertension","volume":"1","author":"Verdecchia P","year":"1996","unstructured":"Verdecchia P, Borgioni C, Ciucci A, Gattobigio R, Schillaci G, Sacchi N, Santucci A, Santucci C, Reboldi G, Porcellati C. Prognostic significance of blood pressure variability in essential hypertension. Blood Press Monit. 1996;1:3\u201311.","journal-title":"Blood Press Monit"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.36.5.901"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10286-017-0409-7"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.7326\/M15-2223"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.118.010161","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:44:12Z","timestamp":1715600652000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.118.010161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,2]]},"references-count":35,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2019,4,2]]}},"alternative-id":["10.1161\/JAHA.118.010161"],"URL":"https:\/\/doi.org\/10.1161\/jaha.118.010161","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,2]]},"assertion":[{"value":"2018-06-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-12-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e010161"}}