Gender-specific cardiovascular adaptation due to circadian blood pressure variations in essential hypertension

Schmieder, Roland E.; Rockstroh, Jürgen K.; Aepfelbacher, Franz C.; Schulze, B; Messerli, Franz H.

doi:10.1016/0895-7061(95)00364-9

Cited by 56 publications

(41 citation statements)

References 32 publications

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“…We also combined data for men and women regardless of the fact that the associations between left ventricular mass and the day-night blood pressure difference may differ between men and women. 33 Furthermore, in this study, the antihypertensive treatment was not interrupted several weeks prior to the study measurements, contrary to what is done in most studies. 4 These differences in study design could explain the low correlation coefficients.…”

Section: Discussionmentioning

confidence: 90%

Relationship between left ventricular mass and blood pressure in treated hypertension

et al. 2002

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This study evaluated prospectively whether there is still a relationship between left ventricular mass and blood pressure once hypertension is treated and determined the relative importance of daytime vs night-time blood pressure, systolic vs diastolic blood pressure and office vs ambulatory blood pressure. A total of 649 patients (305 or 47% female) with essential hypertension, treated with antihypertensive drugs for at least 3 months, underwent office blood pressure measurement and both daytime and night-time ambulatory blood pressure measurement, electrocardiography and echocardiography. Correlations were made between blood pressure values and parameters of left ventricular mass. Electrocardiographic voltage criteria and even more so echocardiographic parameters correlate significantly albeit weakly (r р 0.28) with blood pressure in treated hypertension. Correlations are consistently higher when systolic blood pressure is considered. Overall, the best cor-

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Section: Discussionmentioning

confidence: 90%

Relationship between left ventricular mass and blood pressure in treated hypertension

et al. 2002

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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%

“…Schmieder et al (24) found that female hypertensive nondippers had significantly greater relative wall thickness, posterior wall thickness and concentric LVH than female hypertensive dippers and male hypertensive dippers and nondippers. Even after controlling for age, body weight and 24 h BP, the differences were maintained (24).…”

Section: Cardiac Geometrymentioning

confidence: 99%

“…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%

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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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“…18 In addition, in women, an association between BP variation and cardiac abnormalities has been reported in hypertensive dippers and nondippers. 47 These findings suggest that the effects of age and sex on surge should be considered further in hypertensive patients.…”

Section: Discussionmentioning

confidence: 95%

Effects of dipping and psychological traits on morning surge in blood pressure in healthy people

et al. 2011

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Despite the role of anxiety, depression and hostility in the pathogenesis of cardiovascular diseases, their impact on two significant cardiovascular risk factors, nocturnal dipping and morning surge in blood pressure (MSBP), are largely ignored and primarily studied in clinical populations. This study examined the effects of dipping and psychological traits on MSBP in healthy people. Nocturnal dipping and MSBP were derived from 24-h ambulatory BP obtained in 77 men and 79 women, mean age 32.8 (s.d.: 7.4). Differences in depression, anxiety and hostility were examined by questionnaires. Higher levels of dipping (Po0.0001) and depressive symptoms (P ¼ 0.01) independently contributed to increased MSBP. Dipping interacts with depression (P ¼ 0.04), hostility (P ¼ 0.01) and anxiety (P ¼ 0.04) in determining MSBP. Low dippers with higher scores on the psychological traits showed higher MSBP than high dippers. A significant MSBP interaction was found between sex and depressive symptoms (P ¼ 0.05), anxiety (Po0.0001) and hostility (P ¼ 0.01) with higher scores associated with increased MSBP observed in males. Findings underscore depression as a predictor of MSBP independent of dipping. The clinically significant relationship between dipping and non-dipping patters, psychological traits and MSBP requires further investigation.

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Gender-specific cardiovascular adaptation due to circadian blood pressure variations in essential hypertension

Cited by 56 publications

References 32 publications

Relationship between left ventricular mass and blood pressure in treated hypertension

Relationship between left ventricular mass and blood pressure in treated hypertension

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

Effects of dipping and psychological traits on morning surge in blood pressure in healthy people

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