Borys SHELEST, Oleksandr KRYVOSHAPKA, Mykola LYTVYNENKO, Oleksandra BABYCHEVA, Iulia RODIONOVA
Ankara Medical Journal - 2026;26(1):1-16
Objectives: Multimorbidity combining hypertension (HTN), type 2 diabetes mellitus (T2D), and obesity adversely affects health-related quality of life (HRQoL). Ambulatory circadian phenotypes (dipper/non-dipper/riser) and average real variability (ARV) may relate to mental well-being. We aimed to find whether ambulatory BP phenotypes and ARV are associated with the SF-36 mental component summary (MCS) in HTN+T2D+obesity. Materials and Methods: In an observational cohort, 314 participants with HTN+T2D+obesity (mean age 58.9+/-9.7 years; 54% men), 262 had evaluable ambulatory blood pressure monitoring (ABPM) (dipper 34%, non-dipper 50%, riser 16%); completed the 36-Item Short-Form Health Survey (SF-36) and underwent 24-hour ambulatory BP monitoring (ABPM). The primary outcome was MCS. 24-h systolic ARV was computed from consecutive valid readings. Receiver-operating characteristic (ROC) analyses identified an ARV threshold for low MCS (the lowest quartile). Results: Adjusted MCS showed a graded decrement across phenotypes: dipper 48.8 (95% CI 47.5-50.1), non-dipper 46.1 (45.1-47.2), riser 44.0 (42.5-45.6); p<0.001. ARV was independently and inversely associated with MCS; for low MCS, ARV discriminated better than SD and mean 24-h SBP (AUC 0.69 vs 0.63 and 0.58). The Youden-derived ARV cut-off ~12.5 mmHg yielded a sensitivity of 0.66 and specificity of 0.62. Simultaneous attainment of 24-h BP and HbA1c targets related to higher MCS (+3.1 points; p<0.001) and a greater high-MCS responder rate (52% vs 31%). Conclusion: In HTN+T2D+obesity, abnormal circadian BP phenotypes and higher ARV identify patients with lower MCS beyond mean BP and may flag risk of low mental HRQoL and support integrated management toward dual control of 24-h BP and HbA1c.
