OS 09-04 UNEMPLOYMENT IS INDEPENDENTLY ASSOCIATED WITH REVERSE DIPPER IN 24HR AMBULATORY BLOOD PRESSURE MONITORING

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Abstract

Objective

: Regarding that lack of evidences about the role of SES predicting cardiovascular risks, we investigated the association between SES and parameters in ABPM in prospective cohort registry.

Design and Method

: The data was retrieved from the Cardiovascular and Metabolic Disease Etiology Research Center – High Risk Cohort (CMERC-HI, NCT02003781). Total 1,333 patients implementing ABPM were initially screened, then 9 patients with incomplete data and 178 patients with end-stage renal disease were excluded. Finally, 1,146 patients were eligible for present analysis.

Results:

The mean age was 60.6 ± 11.4 years, and 642 patients (56.0%) were male. The patients were divided into two groups according to the status of employment and unemployment was reported with 227 (19.8%). Unemployment group showed significantly older (66.9 ± 9.4 vs, 59.0 ± 10.6, P < 0.001), more male (194 [85.5%] vs. 448 [48.7%], P < 0.001), and history of diabetes (93 [41.0%] vs. 23 [29.8%], P = 0.001). Office diastolic blood pressure (DBP, 73.2 ± 9.2 vs. 76.5 ± 10.3, P < 0.001), 24-hr total ambulatory DBP (76.5 ± 7.1 vs. 78.1 ± 8.1, P = 0.005), and daytime DBP (79.2 ± 7.3 vs. 81.5 ± 8.8, P < 0.001) are significantly lower, while pulse pressure (55.2 ± 15.3 vs. 50.2 ± 13.1, P < 0.001) and 24-hr night-time systolic blood pressure (123.3 ± 18.3 vs. 119.3 ± 14.9, P = 0.002) are significantly higher in unemployment group. Dipper, non-dipper, extreme dipper, and reverse dipper were observed with 379 (41.2%), 350 (38.1%), 112 (12.2%), and 78 (8.5%) in employment group, 78 (34.4%), 100 (44.1%), 19 (8.4%), and 30 (13.2%) in unemployment groups, respectively. Multiple logistic regression analysis showed that unemployment was a significantly associated with reverse dipper after adjustment for multiple confounding factors (odds ratio [95% confidence interval] = 1.928 [1.097–3.388], P = 0.022).

Conclusions:

Unemployment was independently associated with reverse dipper even after adjustment for SES as well as biochemical risk factors. Therefore, effective improvement of clinical outcomes in patients with cardiovascular risks would be induced from the strategy that supported with socio-economic policies.

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