Gender, day-night blood pressure changes, and left ventricular mass in essential hypertensionDippers and peakers

Verdecchia, Paolo; Schillaci, Giuseppe; Borgioni, Claudia; Ciucci, Antonella; Sacchi, Nicola; Battistelli, Massimo; Guerrieri, Massimo; Comparato, E; Porcellati, Carlo

doi:10.1016/0895-7061(94)00187-g

Cited by 85 publications

(50 citation statements)

References 10 publications

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“…Although there could be a sex-guided difference in the relationship between the dipping profile and the left ventricular (LV) mass, 19 the latter represents a powerful predictor of nonfatal cardiac and cerebrovascular events, as well as of that CV and total mortality in various settings, including hypertension (Tables 1a and b). Twenty-four-hour BP has been extensively associated with increased ventricular mass, 20 whereas there are no prospective studies addressing the comparative prognostic value of either nocturnal BP values or night-to-day BP fall on the same outcome.…”

Section: Cardiac Adaptationsmentioning

confidence: 99%

Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes

et al. 2010

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At present, clinic blood pressure (BP) evaluation is being increasingly complemented by ambulatory BP measurements for the evaluation of haemodynamic patterns during daily activities and sleep. Nondipping pattern, a measure of decreased attenuation of nighttime over daytime BP, has been correlated with enhanced target organ damage and adverse cardiovascular (CV) outcomes in different clinical settings beyond pure hypertensive cohorts. As the nondipping pattern is a derivative extract of both daytime and nighttime BP, it is yet questionable whether the crude estimate of nocturnal BP is superior to daytime BP and nondipping pattern in the prediction of subclinical damage and CV events. In this review, we aimed at comparing the CV predictive value of the nondipping pattern with that of nocturnal BP using cross-sectional and longitudinal data obtained from different cohort studies within the past 10 years. Our findings suggest that nocturnal BP including the phenotype of isolated nocturnal hypertension is better associated with CV target organ damage and 'hard end points' as compared with the nondipping pattern.

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Section: Cardiac Adaptationsmentioning

confidence: 99%

Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes

et al. 2010

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“…Individuals who exhibit o10% fall in nocturnal MAP have been termed as 'nondippers'. According to this subdivision, nondipper hypertensives would have a greater risk of LVH 13 and cardiovascular events 14 The aim of this study was to determine the influences of the nondipper status and nocturnal BP loads on LVMI, as assessed by ABPM and echocardiography, in renal transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

Night-time blood pressure load is associated with higher left ventricular mass index in renal transplant recipients

et al. 2003

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The absence of nocturnal fall in blood pressure (BP) is named as nondipper status, which has been shown to be an additional risk factor for the development of left ventricular hypertrophy and cardiovascular events in several high-risk groups. The aim of this study was to determine the influences of the nondipper status and nocturnal blood pressure loads on left ventricular mass index (LVMI) in renal transplant recipients. A total of 35 nondiabetic renal transplant recipients were included into the study. A 24-h ambulatory blood pressure monitoring (ABPM) was performed for all recipients. The nondipper status was defined as either an increase in night-time mean arterial pressure (MAP) or a decrease of no more than 10% of daytime MAP. LVMI was measured by using two-dimensional guided M-mode echocardiography. The night-time systolic blood pressure (SBP) load was defined as the percentage of the time, during which SBP exceeded 125 mmHg during night time. The nondipping was common among renal transplant recipients, of whom 60% were nondipper in our study. LVMI was significantly higher in the nondipper group vs the dipper group (133 7 35 g/m 2 vs 109 7 26 g/m 2 , P ¼ 0.04). A fall in MAP at night time was 14.5 7 4.3% in the dipper group, while it was 1.4 7 6.1% in the nondipper group (Po0.001). On stepwise multiple regression analysis, night-time SBP load and haemoglobin were independent predictors of LVMI (R 2 ¼ 0.53).In conclusion, nondipping is common after renal transplantation. Night-time SBP load and low haemoglobin are closely related to the increase in LVMI in renal transplant recipients. ABPM may be a more useful tool in optimizing treatment strategies to reduce cardiovascular events in renal transplant recipients.

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“…In studies examining dipping status and hypertensive target organ damage, researchers found that LVM increased with ambulatory BP in women and men. However, this increase in LVM and LVMI was linked to the absence of a normal nocturnal BP fall in women only (24,(29)(30)(31). The findings remained statistically significant after adjustment for average 24 h BP values, thereby suggesting that cardiac abnormalities may be more closely related to an altered diurnal BP rhythm rather than a higher average BP over 24 h. These data may be particularly significant, given that a nondipping BP profile has been found to be more common in hypertensive women with future cardiovascular complications (41).…”

Section: Mass and The LV Mass Indexmentioning

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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Gender, day-night blood pressure changes, and left ventricular mass in essential hypertensionDippers and peakers

Cited by 85 publications

References 10 publications

Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes

Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes

Night-time blood pressure load is associated with higher left ventricular mass index in renal transplant recipients

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

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