Clinical Significance of Dipper Pattern in Hypertensive Patients

Abstract

Ambulatory blood pressure monitoring (ABPM) is a suitable method for studying the vascular risk and the degree of hypertension control. The objective of this work focuses on the dipper pattern, comparing the prevalence and characteristics with other circadian patterns in hypertensive patients. ABPM was performed in 1320 hypertensive patients. We selected those who met the requirements of "valid" according to the CardioRisc protocol (1126, 85.3%). Dipper pattern was defined when the average blood pressure (BP) at rest was between 10% and 20% below the average of the activity BP. We have considered as low vascular risk those from light to moderate levels, and the rest as high vascular risk. Controlled BP was considered when the office BP was less than 140/90 mmHg. The distribution of the patterns was as follows: dipper (476, 42.3%), non-dipper (448, 39.8%), riser (140, 12.4%) and extreme dipper (62, 5.6%). The mean age was 52.96 ± 15.37 years. 53.8% of the 476 hypertensive dipper were women, of which 25% were taking 3 or more drugs, compared with 38.7% of non-dipper (this group needed less medication to achieve an adequate control). The degree of control (51.9% vs. 45%) and vascular risk was better in patients with dipper pattern. A statistically significant difference between the average pulse pressure (PP) for the riser pattern in both the office PP (59.76 ± 16) and the 24 hours ABPM PP (58.7 ± 15.7) was observed. Hyperlipidemia was the vascular risk factor most frequently associated.