Role of Insulin Resistance in Nondipper Essential Hypertensive Patients

Abstract

of atrial and brain natriuretic peptides (ANP and BNP) in patients with essential hypertension (7-9). Accumulating evidence suggests that insulin resistance plays an important role in the development of essential hypertension (10, 11). Therefore, we hypothesized that LVH with concomitant increase in plasma concentrations of ANP and BNP may occur more easily in nondipper essential hypertensive patients than in dippers, and that insulin resistance may play an essential role in these processes. In this study, we analyzed 24-h ambulatory blood pressure (ABP), echocardiographic findings, plasma ANP and BNP levels, and insulin resistance in untreated patients with essential hypertension.

Ausência de descenso noturno se associa a acidente vascular cerebral e infarto do miocárdio

“…is similar to those observed by Anan et al 12 , who emphasized the importance of the method chosen for the investigation of hypertensive patients.…”

“…After the analysis of sociodemographic factors, we pointed out in our sample the absence of association between ND and the remaining variables (age, SAH time, school degree, waist circumference, genre, race, smoking and sedentarism), which was confirmed by other studies 12,14,15,26 . Other authors observed that individuals without ND were older 16,18,19 and that this condition occurs preferentially in non-white people 19 .…”

“…ND attenuation was associated with the presence of other cardiovascular risk factors (obesity and lower HDL-c) and also with a higher frequency of lesion in target-organ. Studies on the prevalence of cardiovascular and cerebral events varies greatly in the specific literature (Table 5), reaching a frequency of 37.5 to 64.2% [11][12][13][14][15][16][17][18][19][20][21] under several factors' influence, like the definition of sleep and vigil periods 22 .…”

“…These authors showed a direct relation between higher BMI and higher mean pressure for ABMP, and 55% of the individuals with normal weight (normal BMI) presented ND, while only 35% of the obese individuals presented the same condition (p<0.05). Others, however, did not find such association 12,[14][15][16]19 . In our sample, after the logistic regression model, we observed that BMI was not correlated to a higher risk for stroke or MI in ND patients.…”

“…Despite the lower HDL-c in non-dipper patients, there was no correlation to higher risk of lesions in target-organs. Alterations found in the levels of uric acid 14,16 , serum creatinine 16,18 , glycemia 12,18 and triglycerides 15,16 in patients without ND make their interpretation difficult due to the differences found between the studied populations as well as to the influence of medications on these biochemical parameters. Though we observed a higher prevalence of diabetic patients in the Non-dipper Group (38.2 versus 28.3%), this value was not statistically significant, which opposes to the findings of Björklund et al 28 , who found higher frequency of individuals without ND in a diabetic subpopulation.…”