Nighttime blood pressure dipping: the role of the sympathetic nervous system

Sherwood, Andrew; Steffen, Patrick R.; Blumenthal, James A.; Kuhn, Cynthia M.; Hinderliter, Alan L.

doi:10.1016/s0895-7061(01)02251-8

Cited by 266 publications

(208 citation statements)

References 37 publications

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“…31 Nondippers with a Ͻ10% nocturnal decrease in systolic blood pressure compared with dippers showed a reduced fall during the night in the urinary excretion rate of catecholamines. 32 The above studies 31,32 might explain why our patients with isolated nocturnal hypertension had increased heart rates at night and suggest that an attenuated withdrawal of sympathetic drive during sleep might contribute to isolated nocturnal hypertension.…”

Section: Discussionmentioning

confidence: 93%

Is Isolated Nocturnal Hypertension a Novel Clinical Entity?

et al. 2007

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Abstract-We reported previously that normotensive Chinese had higher nighttime diastolic blood pressure compared with non-Chinese. We, therefore, studied the prevalence and characteristics of isolated nocturnal hypertension (HT) and its association with arterial stiffness, an intermediate sign of target organ damage. We recorded ambulatory blood pressure, the central and peripheral systolic augmentation indexes, the ambulatory arterial stiffness index, and brachial-ankle pulse wave velocity in 677 Chinese enrolled in the JingNing population study (53.6% women; mean age: 47.6 years). [5][6][7][8] corroborated that an elevated nocturnal blood pressure is a harbinger of an unfavorable outcome. In Ohasama residents, each 5% decrease in the nocturnal blood pressure fall was associated with an Ϸ20% greater risk of cardiovascular mortality. 3 Similarly, in an Irish cohort of referred patients, each 10-mm Hg increment in the nighttime systolic pressure resulted in a 21% higher cardiovascular mortality, whereas the corresponding estimate for a 5-mm Hg diastolic increment amounted to 9%. 8 Several studies suggested that Asians 3,9 and blacks 10,11 have less nocturnal blood pressure dipping than whites. Along these lines, we noticed previously that, among the normotensive subjects enrolled in 7 population studies, Chinese compared with non-Chinese consistently had a nighttime diastolic blood pressure that was, on average, 3 to 12 mm Hg higher. 12 Based on these observations, 9,11,12 we envisaged that some subjects might have an elevated nighttime blood pressure in the presence of a normal daytime level, a condition that we termed isolated nocturnal hypertension. We further hypothesized that this special type of hypertension, which can only be diagnosed by 24-hour ambulatory monitoring, might be associated with target organ damage. To test our hypothesis, we studied the prevalence and characteristics of isolated nocturnal hypertension in a Chinese population and examined its association with various indexes of arterial stiffness. Methods Study PopulationIn the framework of our ongoing Chinese study on genes involved in hypertension, 13,14 from 2003 through 2005, we recruited participants from 14 villages in the JingNing County, a rural area Ϸ500 km south of Shanghai. The ethics committee of Ruijin Hospital and Shanghai Jiaotong University Medical School approved the study. We invited all of the villagers with a minimum age of 12 years to take part. Of

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Section: Discussionmentioning

confidence: 93%

Is Isolated Nocturnal Hypertension a Novel Clinical Entity?

et al. 2007

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“…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). Insulin resistance is the underlying mechanisms of both MS and hypertension (Modan et al 1985;Swislocki et al 1989).…”

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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“…24 Sherwood et al 25 showed that the night time fall in the excretion rate of both adrenaline and noradrenaline was reduced in nondippers compared to dippers. Non-dippers are characterized also by heightened responsiveness of a 1 adrenergic receptors.…”

Section: Discussionmentioning

confidence: 99%

Gender differences in ambulatory blood pressure monitoring profile in obese, overweight and normal subjects

Kagan

Faibel²,

Ben-Arie

et al. 2006

J Hum Hypertens

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The incidence of obesity has increased enormously in the past several decades, and has been described as a modern epidemic. Obesity is a major factor contributing to hypertension. To the best of our knowledge, no study of ambulatory blood pressure monitoring (ABPM) comparing men with women in relation to body mass indexes (BMI) has been performed. From December 2002 to May 2006, we performed 24-h ABPM in 5950 subjects (3102 men and 2848 women), with a wide range of BMI (range 15.9-53.2 kg/m 2 ). We defined obese subjects as those with BMIX30.0 kg/m 2 , overweight subjects as those with BMI425.0 and o30.0 kg/m 2 , and normal subjects as those with BMIp25.0 kg/m 2 . Data on 989 subjects (501 men and 488 women) aged from X18 to p69 years without antihypertensive treatment, atrial fibrillation or diabetes were included for analysis. We consistently found that obese men had the expected increased heart rate compared to normal and overweight men, whereas women (normal, overweight and obese) had similar HRs. In addition, normal and obese women had similar diastolic blood pressures (BP), as opposed to obese men, who had raised diastolic BP. These results may indicate that different pathogenetic mechanisms may be involved in the relationship between obesity and hypertension in men and women.

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Nighttime blood pressure dipping: the role of the sympathetic nervous system

Cited by 266 publications

References 37 publications

Is Isolated Nocturnal Hypertension a Novel Clinical Entity?

Is Isolated Nocturnal Hypertension a Novel Clinical Entity?

Metabolic Syndrome as a Predictor of Non-Dipping Hypertension

Gender differences in ambulatory blood pressure monitoring profile in obese, overweight and normal subjects

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