Circadian variation of blood pressure and endothelial function in patients with essential hypertension

Higashi, Yukihito; Nakagawa, Keigo; Kimura, Masashi; Noma, Kazuhiro; Hara, Keiko; Sasaki, Satoshi; Goto, Chikara; Oshima, Tetsuya; Chayama, Kazuaki; Yoshizumi, Masao

doi:10.1016/s0735-1097(02)02535-4

Cited by 154 publications

(116 citation statements)

References 19 publications

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“…Various other studies investigating the effects of dipping and non-dipping patterns demonstrated that patients with non-dipping pattern have been associated with an increased risk of end-organ damage (Cuspidi et al 2004a) such as cerebrovascular and cardiovascular complications than other patients with dipping pattern (Staessen et al 1999;Kario et al 2001;Higashi et al 2002). Although underlying mechanisms are still unknown, sympathetic over activity, functional and structural vascular alterations, early autonomic neuropathy have all been seen in patients with non-dipping BP (Hommel et al 1989;Sherwood et al 2002).…”

Section: Discussionmentioning

confidence: 99%

Metabolic Syndrome as a Predictor of Non-Dipping Hypertension

Tartan

Uyarel

Kaşıkçıoğlu

et al. 2006

Tohoku J. Exp. Med.

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Metabolic syndrome (MS) and nondipping hypertension both increase cardiovascular mortality. Although both clinical modalities share common pathophysiologic factors in their etiologies, previous studies did not find any association between them. We aimed to investigate the association between MS and non-dipping blood pressure by comparing different definitions of MS. One hundred-thirty-two consecutive patients (58 men) who underwent 24-hour ambulatory blood pressure monitoring were analyzed. MS was evaluated according to the currently used Adult Treatment Panel (ATP) III definition criteria, named MS-ATP III. In order to reveal the weights of risk contributing to MS, a new diagnostic scoring method (MS-Score) was used in comparison with MS-ATP III. Nocturnal non-dipping refers to a reduction in average systolic and/or diastolic blood pressure at night ( 10%) compared with daytime average values. Non-dipping pattern was found in 61.4% of patients. The frequency of MS according to MS-Score, but not MS ATP III, was significantly higher in patients with nondipping pattern than those without it ( p = 0.009). Although more prominent in the nighttime, MS-Score showed positive correlation with all systolic blood pressure results (r = 0.27, p = 0.002). Adjusted for baseline characteristics, high ( 27.5) MS-Score remained as an independent predictor of non-dipping pattern (OR 2.64, p = 0.038). Finally, high MS-Score, but not MS-ATP III, is a predictor of non-dipping pattern. Nighttime systolic blood pressure is higher in patients with high MS-Score. Therefore, patients with high MS-Score may be more prone to cardiovascular events than those with low MSScore.circadian blood pressure variation; hypertension; metabolic syndrome score; metabolic syndrome adult treatment panel III; non-dipping pattern

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Section: Discussionmentioning

confidence: 99%

Metabolic Syndrome as a Predictor of Non-Dipping Hypertension

Tartan

Uyarel

Kaşıkçıoğlu

et al. 2006

Tohoku J. Exp. Med.

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“…44 Sodium Sensitivity-Nondipping has been associated with sodium sensitivity in hypertensive patients, 45 and both sodium restriction 45;46 and thiazide diuretics 47 have been shown to restore dipping in these salt sensitive patients. Potential mechanistic links between salt sensitivity and nondipping include impaired baroreflex function leading to sympathetic activation 48 and impaired endothelial function, which is both common in nondippers 49 and which has been shown to be associated with salt sensitivity in an animal model. 50 With the above in mind the high prevalence of nondipping in CKD should come as no surprise, in particular because CKD is well known to be associated with increased sympathetic activation.…”

Section: Physiology Of Dippingmentioning

confidence: 99%

The Complex Relationship Between CKD and Ambulatory Blood Pressure Patterns

Sinha

Agarwal

2015

Advances in Chronic Kidney Disease

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Hypertension and chronic kidney disease (CKD) frequently coexist, and both are risk factors for cardiovascular events and mortality. Among people with hypertension, the loss of the normal fall in nighttime BP, called nondipping, can only be diagnosed by ambulatory BP monitoring (ABPM), and is a risk factor for cardiovascular events. The pathophysiology of nondipping is complex, and CKD is an independent risk factor for non-dipping. In fact, non-dipping can be seen in as many as 80% of people with CKD. However, the evidence for nondipping as an independent risk factor or causal agent for adverse outcomes in CKD remains mixed. ABPM has been shown to be superior to clinic BP measurement for correlating with end organ damage and prognosis in CKD. This review covers the evidence for the use of ABPM in CKD, the evidence linking ABPM patterns to outcome in CKD, and the evidence for treatment of nondipping in CKD.

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“…6 In fact, many studies suggest that patients who do not show an appropriate nocturnal dip in BP can suffer from a variety of disorders associated with increased rates of cardiovascular morbidity and mortality. [7][8][9] Ohkubo et al 10 have shown that a blunted nocturnal decline in BP was a risk factor for cardiovascular mortality in the general population. In this regard, Cuspidi et al 7 have shown that the persistence of a non-dipper pattern is associated with an increased left ventricular mass index, a thicker interventricular septum and a larger diameter of both the left atrium and the aortic root, in a group of 375 previously untreated hypertensive patients.…”

Section: Introductionmentioning

confidence: 99%

“…8 These non-dipper hypertensive patients have a more severe impairment of endothelial function as manifested by a reduced ability of endothelium-dependent vasodilation, mediated by a decrease in nitric oxide release. 9 In fact, reverse dippers show wider pulse pressure at night than any other groups, suggesting the potential role of arterial stiffness as an underlying mechanism of impaired cardiovascular risk. 11 All these changes determine a worse long-term prognosis of those hypertensives with absence of nocturnal dip in BP.…”

Section: Introductionmentioning

confidence: 99%

Diurnal blood pressure variation, risk categories and antihypertensive treatment

et al. 2010

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Ambulatory blood pressure (BP) monitoring is a useful tool aiding diagnostic and management decisions in patients with hypertension. Diurnal BP variation or circadian rhythm adds prognostic value to the absolute BP elevation. The Spanish ABPM Registry has collected information from 430 000 treated hypertensive patients attended by either primary care physicians or referral specialists. The analysis of BP diurnal variation has allowed the conclusion that nocturnal BP decline is related to the level of risk. Patients with blunted nocturnal dip frequently belong to high-or very high-risk categories and specifically are often older, obese, diabetics or with overt cardiovascular or renal disease. With respect to treatment, the non-dipper profile is more often observed in patients receiving several antihypertensive drug agents, but it does not correlate with the time of drug administration. Among patients receiving only one drug, non-dihydropyridine calcium channel blockers and a-blockers are associated with less nocturnal BP decline than other antihypertensive drug classes, even after adjusting for the level of risk.

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Circadian variation of blood pressure and endothelial function in patients with essential hypertension

Abstract: These findings suggest that endothelium-dependent vasodilation is blunted through a decrease in NO release in non-dippers compared with patients who have dipper hypertension.

Cited by 154 publications

References 19 publications

Metabolic Syndrome as a Predictor of Non-Dipping Hypertension

Metabolic Syndrome as a Predictor of Non-Dipping Hypertension

The Complex Relationship Between CKD and Ambulatory Blood Pressure Patterns

Diurnal blood pressure variation, risk categories and antihypertensive treatment

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