Diurnal Variation of Hemodynamic Indices in Non-Dipper Hypertensive Patients.

Takakuwa, Hiroshi; T, Ise; Kato, Tamayo; Izumiya, Yoshiaki; Shimizu, Kazuaki; Yokoyama, Hitoshi; Kobayashi, Kenichi

doi:10.1291/hypres.24.195

Cited by 35 publications

(28 citation statements)

References 23 publications

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“…There is debate surrounding the hemodynamic variations in individuals with dipping or nondipping BP patterns (45,46). Future research should focus on the underlying hemodynamic mechanisms of dipping status.…”

Section: Discussionmentioning

confidence: 99%

Stress, menopausal status and nocturnal blood pressure dipping patterns among hypertensive women

Routledge

McFetridge-Durdle

Dean

2009

Canadian Journal of Cardiology

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C ardiovascular disease is a leading cause of death of men and women in Canada (1). Cardiovascular disease-related deaths account for 34% of all deaths among Canadian women and 32% of all deaths among Canadian men (1).Hypertension is strongly and independently related to cardiovascular morbidity and mortality (2). In Canada, hypertension is more common in women older than 55 years of age than in age-matched men (3). According to the Heart and Stroke Foundation of Canada (3), more than one-third of postmenopausal Canadian women have hypertension. Although the explanation for hypertension in menopause is not fully understood, estrogen depletion, general aging and/or body weight are believed to contribute to the blood pressure (BP) changes (4).Ambulatory BP monitoring (ABPM) is a noninvasive technology used for the evaluation of individuals with suspected and established hypertension (5). ABPM has revealed a diurnal variation in BP. The normal variation in BP is characterized by a 10% or greater reduction in BP from day to night (6). Individuals with this nighttime dip in BP are known as dippers and those who do not dip are known as nondippers. Nondippers have a less than 10% reduction in BP during sleep (7).Although controversial, evidence suggests that individuals with a nondipping BP profile are at risk for greater cardiovascular morbidity and poorer outcomes (8-15). Some researchers have also reported greater target organ damage among hypertensive nondipping women than among hypertensive nondipping men (16). It has been estimated that 25% of essential hypertensive patients have a nondipping BP pattern (17).The exact mechanisms of action responsible for nondipping BP are not fully understood. It is believed that the autonomic nervous system -in particular, the sympathetic nervous system -has an effect on circadian BP variation. Researchers have demonstrated that during the night, nondippers have increased sympathetic nervous system clinical StudieS ©2009 Pulsus Group Inc. All rights reserved BACKGROUND: A less than 10% decline in blood pressure during the night is known as a nondipping blood pressure (BP) pattern. Nondipping BP has been shown to be associated with target organ damage and poorer cardiovascular outcomes. Additionally, some evidence suggests that hypertensive nondipping women are at greater risk for target organ damage than hypertensive nondipping men. OBJECTIVE: To determine whether stress, demographics, menopausal status or sleep quality are associated with nondipping BP among hypertensive women. METHODS: A cross-sectional study design was used to describe the relationship between stress and dipping status among a sample of hypertensive women and to describe the sample by age, ethnicity, marital status, menopausal status, current medications and sleep quality. RESULTS:The study sample consisted of 47 women (mean [± SD] age 57±13.9 years) with essential or office hypertension who underwent 24 h ambulatory BP monitoring, and completed stress and sleep quality measurements. Thirty-one women (66%) we...

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Section: Discussionmentioning

confidence: 99%

Stress, menopausal status and nocturnal blood pressure dipping patterns among hypertensive women

Routledge

McFetridge-Durdle

Dean

2009

Canadian Journal of Cardiology

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“…Each patient underwent 24-hour ABP using a validated device (TM2430; A&D Mercury, A&D Medical, Thebarton, South Australia, Australia) 9 with readings obtained every 30 minutes during the day (6)(7)(8)(9)(10) and every 60 minutes during the night (10 PM-6 AM). The device was fitted at the hospital by a trained nonclinician.…”

Section: Abp and Dipper Statusmentioning

confidence: 99%

Central Hemodynamics and Cardiovascular Risk in Nondippers

Coleman

Stowasser

Jenkins

et al. 2011

J of Clinical Hypertension

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Failure of blood pressure (BP) to decline appropriately overnight (nondipping) is associated with increased risk. This may be due to inappropriately raised supine central BP and this study's first aim was to examine this hypothesis. Secondly, aortic stiffness, central hemodynamics, and left ventricular (LV) mass were measured as other possible mechanisms of higher risk. Brachial and central BP (supine and seated), aortic stiffness, central hemodynamics, and LV dimensions were measured in 95 patients with hypertension (mean age 62AE8 standard deviation). Central hemodynamics were recorded by combined radial tonometry and 3-dimensional echocardiography. Seated brachial and central systolic BP (SBP) were similar between dippers (n=52) and nondippers (n=43 In normotensive and hypertensive individuals, the failure of nighttime blood pressure (BP) to decline >10% compared with daytime BP (nondipping) is associated with increased target organ damage 1 and risk of cardiovascular and all-cause mortality.2-4 Nondipping is a relatively common condition that occurs in 25% of patients with hypertension, but with greater prevalence in certain patient populations such as those with diabetes. 5 The mechanisms underlying the increased risk associated with nondipping are incompletely understood. Some data indicate that nondippers may have higher supine stroke volume 6 and increased large artery stiffness. 7,8 This hemodynamic milieu, involving delivery of increased stroke volume into a noncompliant proximal aorta, may reasonably expect to result in an increase in supine brachial BP (the hallmark of nondipping) and central BP. The first aim of this study was to determine the postural (supine and seated) differences in brachial and central BP between patients with a dipping and nondipping BP profile. We hypothesized that nondippers would have higher supine brachial and central BP. Secondly, in addition to BP, we sought to determine other factors that potentially contribute to increased risk in nondippers. This was assessed from arterial stiffness, ventricular-vascular interaction, and target organ damage defined by left ventricular (LV) mass. METHODS Patients and ProtocolStudy participants comprised 95 consecutive patients younger than 75 years with uncomplicated essential hypertension recruited by media advertisement in southeast Queensland, Australia (a population comprising approximately 3 million). Initial diagnosis of hypertension was made by each participant's general practitioner according to their usual practice. Exclusionary criteria included uncontrolled clinic BP (!180 ⁄ 100mm Hg), known secondary forms of hypertension, and a history of cardiovascular disease or renal disease, as ascertained by medical records or self-reporting. Each participant underwent assessment during a single clinic visit and were studied while taking their regular antihypertensive medications. Brachial BP and central BP were recorded in the seated and then the supine positions. Regional arterial stiffness was measured only in the supine position b...

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“…Posterior wall thickness > in nondippers (24 † ,31) Atrial/brain natriuretic peptide > in nondippers (58) Left ventricular ejection fraction ↓ in nondippers (49,58) Supraventricular/ventricular ectopies > in nondippers (49,59) QT dispersion/QTc interval > in nondippers (60,61) Systemic vascular resistance ↑ at night in nondippers (62) ↓ at night in dippers (62) Stroke index ↑ at night in nondippers (63) ↓ at night in dippers (63) Cardiac index less of a ↓ at night in nondippers (63) ↓ at night in dippers (63) Cardiac output No difference between nondippers and dippers (24,62) Pulse pressure less of a ↓ at night in nondippers (12,67) ↓ at night in dippers (12,67) Carotid artery intima-media > in nondippers (9,14 (46,(73)(74)(75) Lacunae > in nondippers (6,10) Periventricular hyperintensities > in nondippers (6,10) White matter lesions > in nondippers (76) Previous cerebrovascular event More nondipping in those with previous events (71) Cognitive impairment > in nondippers (79) Dementia > in nondippers (78,81) Memory ↓ in nondippers (82) Sensory motor speed ↓ in nondippers (82) Microalbuminuria > in nondippers (6,27,84,85) *Cardiovascular eve...…”

Section: Cardiac Structural Alterationsmentioning

confidence: 99%

Night-time blood pressure patterns and target organ damage: A review

Routledge

McFetridge-Durdle

Dean

2007

Canadian Journal of Cardiology

119

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A mbulatory blood pressure monitoring (ABPM) is a noninvasive, automated portable technology that measures and records blood pressure (BP) over a 24 h period (1). This technique has allowed researchers and clinicians to measure the percentage of elevated BP readings, as well as 24 h BP loads and BP patterns (2). Consequently, it has been discovered that BP varies over 24 h in a diurnal manner, being higher during the day and lower at night (3). The normal variation in BP is characterized by a 10% to 20% reduction in BP from day to night (2). Individuals with this decline in night-time BP are known as 'dippers', and those who experience a blunted decline in night-time BP are known as 'nondippers' (4). Researchers have determined individuals to be nondippers on the basis of a less than 10% reduction in night-time systolic BP (SBP) (5-11), diastolic BP (DBP) (5) or both SBP and DBP measurements (12-31).The exact mechanisms of action responsible for nondipping are not fully understood. However, data suggest that nondippers have an increase in sympathetic nervous system activity (32,33) and a decrease in parasympathetic nervous system activity throughout the night (32,34). Nondipping is more commonly found among individuals with renal diseases, autonomic neuropathies, diabetes, sleep apnea, autonomic dysfunction, malignant hypertension and secondary hypertension (35,36). In addition, approximately 25% of individuals with essential hypertension have a nondipping BP profile (37).There is evidence to suggest that individuals who exhibit a nondipping BP profile are at higher risk of cardiac and extracardiac morbidity (38). Verdecchia et al (39) used data from the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study to examine the morbidity and mortality rates of 715 essential hypertensive patients over a one-to 13-year BACKGROUND: Individuals who do not have a 10% to 20% reduction in blood pressure (BP) during the night are known as 'nondippers'. The cause of this nondipping phenomenon is not fully understood; however, there is a growing body of evidence linking a nondipping BP pattern with target organ damage. OBJECTIVE: To review the literature and present an overview of the target organ damage found to be associated with a nondipping BP pattern. METHODS: PubMed, CINAHL and Medscape searches of all available English language articles from 1986 to 2005 were performed. Search terms included 'BP nondipping', 'BP dipping' and 'target organ damage'. RESULTS: There is evidence to suggest that individuals with hypertension who exhibit a nondipping BP profile are at higher risk of cardiac and extracardiac morbidity and mortality. In particular, nondippers with essential hypertension have been found to have more advanced left ventricular hypertrophy, left ventricular mass and left ventricular mass index, carotid artery wall thickness, carotid artery atherosclerotic plaques, silent cerebral infarct, stroke, cognitive impairment and microalbuminuria. CONCLUSION: A better understanding of the importance of the cir...

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Diurnal Variation of Hemodynamic Indices in Non-Dipper Hypertensive Patients.

Cited by 35 publications

References 23 publications

Stress, menopausal status and nocturnal blood pressure dipping patterns among hypertensive women

Stress, menopausal status and nocturnal blood pressure dipping patterns among hypertensive women

Central Hemodynamics and Cardiovascular Risk in Nondippers

Night-time blood pressure patterns and target organ damage: A review

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