Nocturnal Hypertension and Organ Damage in Dippers and Nondippers

Cuspidi, Cesare; Sala, Carla; Valerio, Cristiana; Negri, Francesca; Mancia, Giuseppe

doi:10.1038/ajh.2012.49

Cited by 65 publications

(54 citation statements)

References 33 publications

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“…Our data, in keeping with some previous cross-sectional studies conducted in hypertensive cohorts, 24,25 extend to a general population the notion that absolute nocturnal BP level rather than nocturnal BP fall from daytime values is independently related to new-onset LVH. In fact, nocturnal BP level but not the extent of nighttime BP fall may be regarded as a useful diagnostic parameter for identifying individuals exposed to a higher risk of incident LVH.…”

Section: Discussionsupporting

confidence: 56%

“…More importantly, a fully preserved BP fall at night in dipper hypertensives may not result in a normal nighttime BP profile because nocturnal hypertension may occur independently from the dipping status. 25,31 In the present study, we found that nocturnal SBP levels (ie, average nighttime, lowest SBP, and the extent of day-to-night SBP decline) contributed to explain the variance of baseline LV mass value and, more importantly, that the level of nighttime SBP, but not day-to-night SBP fall, was predictive of new-onset LVH during a 10-year follow-up period.…”

Section: Discussionmentioning

confidence: 70%

“…25 This observation was strengthened by the fact that (1) the study compared individuals with similar clinical/demographic characteristics and reproducible dipping/nondipping patterns, and (2) no correlation was found between LVMI and the magnitude of nocturnal BP fall in the entire study population.…”

Section: Discussionmentioning

confidence: 97%

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Nighttime Blood Pressure and New-Onset Left Ventricular Hypertrophy

et al. 2013

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Extensive echocardiographic investigations performed in the past 3 decades have shown that hypertensive heart disease includes a variety of anatomic and functional alterations, such as left ventricular hypertrophy (LVH), systolic/diastolic dysfunction, myocardial fibrosis, and left atrial and aortic dilatations. [1][2][3][4][5] Among these manifestations of cardiac damage, particular attention has been devoted to LVH because this phenotype has been reported to be a powerful, independent predictor of cardiovascular (CV) events and all-cause mortality either in the general population or in hypertensive cohorts. 6,7 Although the pathogenesis of hypertensive LVH is not fully understood, a consistent body of evidence indicates that the severity of pressure overload, as better reflected by out-of-office than by in-office blood pressure (BP) levels, in combination with nonhemodynamic variables, including genetic, ethnic, and humoral factors, plays a pivotal role in its development. 8,9 Nonetheless, numerous reports have also shown that circadian variations in BP correlate to LVH independently of 24-hour ambulatory BP monitoring (ABPM) values. Furthermore, earlier studies suggested that daytime BP, in particular BP values recorded during working hours, is more closely associated with LVH compared with nighttime BP. 10 More recently, however, numerous studies have shown that nighttime BP and nocturnal BP fall are stronger correlates of LVH than daytime or average 24-hour BP. 11,12Although a blunted decrease in nighttime BP (ie, nondipping status) has been associated with unhealthy conditions, including diabetes mellitus, metabolic syndrome, sleep apnea, cardiac or extracardiac organ damage, resistant hypertension, and an increased risk of CV morbidity and mortality, 13-15 this issue remains a source of debate. It is worthy of mention that a systematic review by Hansen et al 16 which included 25 856 hypertensive patients and 9641 individuals randomly recruited from the population revealed that nondipping status and increased night-to-day BP ratio were associated with higher all-cause mortality and CV events but added a marginal prognostic value over and beyond 24-hour BP.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 70%

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Nighttime Blood Pressure and New-Onset Left Ventricular Hypertrophy

et al. 2013

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“…However, this definition does not consider patients with normal awake ambulatory BP but with abnormally high asleep BP, which has been shown to be associated with subclinical target organ damage. 8,9 A classification based on normalcy of both daytime and nighttime values has been recently proposed. 10 Thus, true RH would be defined as an office BP X140 and/or 90 mm Hg and either daytime BP X135 and/or 85 mm Hg or nighttime BP X120 and/or 70 mm Hg, the remaining would be considered as having WCRH.…”

Section: Role Of Abpm In the Diagnosis Of Rhmentioning

confidence: 99%

Resistant hypertension: patient characteristics, risk factors, co-morbidities and outcomes

Oliveras

Sierra

2013

J Hum Hypertens

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Among the vast population of hypertensive subjects, between 10 and 15% do not achieve an adequate blood pressure (BP) control despite the use of at least three antihypertensive agents. This group, designated as having resistant hypertension (RH), represents one of the most important clinical challenges in hypertension evaluation and management. Resistant hypertensives are characterized by several clinical particularities, such as a longer history of hypertension, obesity and other accompanying factors, such as diabetes, left ventricular hypertrophy, albuminuria and renal dysfunction. In addition to other diagnostic and therapeutic maneuvers, such as excluding secondary hypertension, ensuring treatment adherence and optimizing therapeutic schemes, ambulatory BP monitoring (ABPM) is crucial in the clinical evaluation of patients with RH. ABPM distinguish between those with out-of-office BP elevation (true resistant hypertensives) and those having white-coat RH (WCRH; normalcy of 24-h BPs), the prevalence of the latter estimated in about one-third of the population with RH. True resistant hypertensives also exhibit more frequently other co-morbidities, more severe target organ damage and a worse cardiovascular prognosis, in comparison to those with WCRH. Some device-based therapies have recently been developed for treatment of RH. This requires a better characterization of a potential candidate population. A better knowledge of the clinical features of resistant hypertensive subjects, the confirmation of elevated BP values out of the doctor's office, and improvements in the search for secondary causes would help to select those candidates for newer therapies, once the pharmacological possibilities have been exhausted.

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“…One, whether the protective effect of nocturnal hypotension resides in the magnitude of the BP fall or in the absolute low night-time BP value is unclear, although recent observations that in subjects with nocturnal hypertension (mean night-time BP ≥120/70 mm Hg) the prevalence of organ damage does not majorly differ between dippers and nondippers suggest that the latter may be the case. 53 Two, although the prognostic value of ambulatory systolic BP has usually been found to be greater than that of ambulatory diastolic BP, 13,14,54 little information has been collected on the role, if any, of ambulatory pulse pressure, and in particular whether any predictive value should be ascribed to the pulse pressure reduction that systematically takes place from the day to the night-time. 55 Three, it also remains unclear whether different definitions of the day and night affect the prognostic impact of their BP values.…”

Section: Further Considerations and Data Limitationsmentioning

confidence: 99%

Clinical Value of Ambulatory Blood Pressure

Mancia

Verdecchia

2015

Circulation Research

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188

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This article reviews the clinical value of ambulatory blood pressure (BP) vis-à-vis the traditional BP measurements taken in the physician's office or in the hospital. Mention is initially made that longitudinal studies conducted in the general population or in hypertensive cohorts have shown that ambulatory BP provides a more accurate prediction of outcome than office BP. Namely, that (1) the risk of cardiovascular events increases in a less steep fashion with office than with 24-hour mean BP, (2) the 24-hour BP-dependent prediction is maintained after adjustment for office BP values, and (3) among individuals with normal office BP, those with increased ambulatory BP (masked hypertension) have an increased prevalence of organ damage, a more frequent unfavorable metabolic profile and a higher risk of new onset sustained hypertension, diabetes mellitus, and cardiovascular events than those with normal ambulatory BP. It is further mentioned, however, that more recently similar observations have been made for individuals with high office but normal ambulatory BP (white coat hypertension) suggesting a complementary role of out-of-office and office BP values in the determination of patients' prognosis. The evidence in favor of an independent prognostic value also of some within 24-hour BP phenomena (night BP reduction or absolute values, short-term BP variations, and morning BP surge) is then critically appraised for its elements of strength and weakness. Finally, whether the clinical advantages of ambulatory BP make this approach necessary for all patients with hypertension is discussed. The conclusion is that this is at present still premature because crucial evidence pro or against routine use of this approach in untreated and treated hypertensives is not yet available. It will be crucial for future studies to determine whether, compared with a treatment guided by office BP, a treatment tailored on ambulatory BP allows to improve prevention or regression of organ damage as well as protection from major cardiovascular complications to a degree that justifies the complexity and cost of the procedure.

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Nocturnal Hypertension and Organ Damage in Dippers and Nondippers

Cited by 65 publications

References 33 publications

Nighttime Blood Pressure and New-Onset Left Ventricular Hypertrophy

Nighttime Blood Pressure and New-Onset Left Ventricular Hypertrophy

Resistant hypertension: patient characteristics, risk factors, co-morbidities and outcomes

Clinical Value of Ambulatory Blood Pressure

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