Affiliation:
1. University of Tokyo
2. Tokyo Medical University
Abstract
Abstract
Aim
Colonic diverticular bleeding is the major cause of lower gastrointestinal bleeding. Hypertension is a major risk factor for diverticular rebleeding. Direct evidence of an association between actual 24 h blood pressure (BP) and rebleeding is lacking. We analyzed the association between 24 h BP and diverticular rebleeding.
Methods
We performed a prospective observational cohort trial involving hospitalized patients with colonic diverticular bleeding. We performed 24 h blood pressure measurements (ABPMs) in the patients. The primary outcome was diverticular rebleeding. We evaluated the 24 h BP difference and the morning and pre-awaking BP surge between rebleeding and non-rebleeding patients. Morning BP surge was defined as early morning systolic BP minus the lowest night systolic BP > 45 mm Hg (highest quartile of morning BP surge). The pre-awaking BP surge was defined as the difference between morning BP and pre-awaking BP.
Results
Of 47 patients, 17 were excluded, leaving 30 who underwent ABPMs. Of the 30 patients, 4 (13.33%) had rebleeding. The mean 24 h systolic and diastolic blood pressure were 125.05 and 76.19 mmHg in rebleeding patients and 129.98 and 81.77 mmHg in non-rebleeding patients, respectively. Systolic BP at 5:00 (difference − 23.53 mmHg, p = 0.031) and 11:30 (difference − 31.48 mmHg, p = 0.006) was significantly lower in rebleeding patients than non-rebleeding patients. Diastolic BP at 2:30 (difference − 17.75 mmHg, p = 0.023) and 5:00 (difference − 16.12 mmHg, p = 0.043) was significantly lower in rebleeding patients than non-rebleeding patients. Morning surge was observed in one rebleeding patient and no non-rebleeding patients. The pre-awaking surge was significantly higher in rebleeding patients (28.44 mmHg) than in non-rebleeding patients (9.30 mmHg) (p = 0.015).
Conclusion
Lower BP in the early morning and a higher pre-awaking surge were risk factors for diverticular rebleeding. A 24 h ABPM can identify these BP findings and reduce the rebleeding risk by enabling interventions in diverticular bleeding patients.
Publisher
Research Square Platform LLC
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