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Background: Previous studies have reported that obesity increases heart rate variability. Body mass index (BMI) has beenreported to affect blood pressure variability (BPV) over 24 hours. However, the diurnal variation in the effect of BMI onBPV has not been evaluated. This study aimed to clarify the diurnal variation in the effect of BMI on BPV. Methods: A totalof 2,044 patients were consecutively enrolled in this study, and the data were analyzed retrospectively. All patientsunderwent 24-hour ambulatory blood pressure monitoring. We divided patients into two groups according to BMI(non-obese group: n = 1,145, BMI < 25; obese group: n = 899, BMI ≥ 25). We compared BPV during daytime and nighttimebetween the non-obese and obese groups. We also evaluated the impact of BMI on BPV by multivariate regression analysis. Results: On univariate regression analysis, there was no significant difference in BPV during daytime (systolic BP [SBP]variability: 20.7 vs. 21.7, p = 0.511; diastolic BP [DBP] variability: 16.8 vs. 17.5, p = 0.539). However, both SBP variability(13.8 vs. 17.6, p = 0.009) and DBP variability (11.7 vs. 14.3, p = 0.042) during nighttime were affected significantly byBMI. After adjusting other compounding variables (age > 60 years, current smoking habit, hypertension, diabetes mellitus,and use of calcium channel blockers and renin-angiotensin-aldosterone system blockers), multivariate analysis showed thatBMI was an independent factor associated with increase in BPV during the night (SBP variability: p = 0.039; DBPvariability: p = 0.034). Conclusions: Obesity increased BPV during nighttime.

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