Associations between nondipping of nocturnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives

Hoshide, Satoshi; Hoshide, Yoko; Umeda, Yuji; Hashimoto, Toru; Kunii, Osamu; Ojima, Toshiyuki; Shimada, Kazuyuki

doi:10.1016/s0895-7061(03)00567-3

Cited by 227 publications

(164 citation statements)

References 26 publications

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“…The clinical consequences of this finding are unclear as we found no correlation between dipping and end-organ damage, measured as cardiac ventricular hypertrophy (LVMI). A non-dipping pattern is associated with cardiac left ventricular hypertrophy among adult normotensive subjects 6 and among children and adolescents with type 1 diabetes. 3 In this population of obese, non-diabetic adolescents, there was no indication that impaired dipping had a negative effect on LVM.…”

Section: Discussionmentioning

confidence: 99%

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Association between nocturnal blood pressure dipping and insulin metabolism in obese adolescents

Westerståhl

Marcus

2009

Int J Obes

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Objective: The purpose of this study was to analyze the relationship between insulin-glucose metabolism, nocturnal blood pressure (BP) dipping and cardiac left ventricular mass (LVM) in obese adolescents without diabetes. Methods: A cohort of 206 obese adolescents (mean age 15.4 years (s.d. 1.6), mean body mass index (BMI) 38 kg m -2 (s.d. 5.8), 53% girls) under clinical care were included in the study. Body fat was assessed by dual X-ray absorptiometry (DEXA). Blood samples were drawn for analyses of fasting insulin (fS-insulin), fasting glucose and glycosylated hemoglobin Alc. Homeostatic model assessment index (HOMA index) was calculated. Insulin sensitivity and acute insulin response (AIR) were calculated from the performed frequently sampled intravenous glucose tolerance test. An ambulatory BP measurement was performed and 24 h daytime and nighttime values were calculated. Non-dipping was defined as a nocturnal BP reduction of o10%. Ultrasound was used to measure heart LVM and LVM index (LVMI) was calculated (LVM Â height À2.7 ). Results: Systolic non-dipping was present in 50% (n ¼ 103) of the subjects. Systolic and diastolic dipping was negatively associated with measures of insulin metabolism (HOMA index, fS-insulin and AIR). These associations were present independently of gender, age, daytime BP or body mass index standard deviation score. Dipping (P ¼ 0.7-0.9) or measures of insulin-glucose metabolism (P ¼ 0.3-1.0) were not associated with LVMI in this population. Conclusion: Non-dipping is common among obese adolescents. We found a negative association between nocturnal BP fall (dipping) and measures of insulin metabolism independently of the degree of obesity or daytime BP level among severely obese, non-diabetic adolescents without diagnosed hypertension. Our findings suggest the importance of keeping the insulin levels under observation even in allegedly healthy obese adolescents in clinical care, as a part of the prevention of morbidity associated with obesity.

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Section: Discussionmentioning

confidence: 99%

“…4,5 In normotensive adults, failed nocturnal dipping is associated with cardiac hypertrophy. 6 Failed nocturnal dipping also increases the risk for all-cause mortality among adults. 7 The association between nocturnal dipping and morbidity among obese adolescents has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Association between nocturnal blood pressure dipping and insulin metabolism in obese adolescents

Westerståhl

Marcus

2009

Int J Obes

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“…In studies of individuals with untreated essential hypertension and similar 24 h BPs, a nondipping BP pattern was associated with significantly larger atrial dimensions (43,49), interventricular septum thickness and aortic root diameter (43), as well as left atrium passive and active emptying volumes and fractions (52). In addition, normotensive individuals classified as nondippers displayed a higher prevalence of relative wall thickness and concentric hypertrophy independent of 24 h BP levels than their dipping counterparts (51). Results suggest that even among normotensives, the absence of a nocturnal BP decrease may occur before a BP increase and be linked with a poorer cardiovascular prognosis.…”

Section: Cardiac Geometrymentioning

confidence: 97%

“…Cuspidi et al (15,18,43) (12,20,28,50,86), isolated systolic hypertension (42) and normotension (51). In addition, several researchers have discovered sex-specific cardiovascular adaptation due to diurnal BP variations among persons with essential hypertension.…”

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

115

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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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“…Non-dippers are reported to have increased risk for left ventricular hypertrophy [9], silent cerebral infarcts [10], and cardiovascular mortality [11]. The non-dipper status may contribute to an increased risk for cardiovascular events in patients with SAS.…”

Section: Introductionmentioning

confidence: 99%

Increased low-grade inflammation and plasminogen-activator inhibitor-1 level in nondippers with sleep apnea syndrome

Ishikawa¹,

Hoshide²,

Eguchi³

et al. 2008

Journal of Hypertension

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Objective-Patients with sleep apnea syndrome (SAS) have an increased risk of cardiovascular events and frequently show a non-dipper pattern (blunted nocturnal decline <10%) of systolic blood pressure (BP). We investigated neurohumoral activation and risk factors in relation to nocturnal BP dipping pattern and SAS.Methods-We conducted sleep polysomnography and ambulatory BP monitoring, and measured high-sensitivity C-reactive protein (hsCRP), tissue-type plasminogen activator inhibitor-1 (PAI-1), and neurohumoral factors in 121 outpatients with suspected SAS, who were classified in 4 groups depending on the presence or absence of dipping/non-dipping and SAS.Results-Non-dippers with SAS had higher hsCRP (overall P<0.001), PAI-1 (overall P=0.004), and aldosterone levels (overall P=0.010) than any of the other 3 groups. After adjustment for significant covariates such as age, sex, body mass index, waist circumference, smoking, alcohol drinking, aspirin use, presence of DM, and insulin, non-dippers with SAS still had a higher hsCRP level than non-dippers without SAS (geometric mean: 1.47 vs. 0.37 mg/L, P=0.001). In multiple linear regression analysis controlling for confounding factors that related with SAS, hsCRP was significantly correlated with 3% oxygen desaturation index (P=0.047). PAI-1 was also highest in the non-dippers with SAS, but this was not independent of obesity. PAI-1 was correlated with insulin (r=0.32, P=0.002) and hsCRP levels (r=0.26, P=0.005).Conclusion-Non-dipper status was associated with an increased hsCRP in patients who also had SAS, but not in those who did not, and hsCRP was closely affected by the desaturation level. PAI-1 is also increased in non-dippers with SAS, and is related to insulin and hsCRP.

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Associations between nondipping of nocturnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives

Cited by 227 publications

References 26 publications

Association between nocturnal blood pressure dipping and insulin metabolism in obese adolescents

Association between nocturnal blood pressure dipping and insulin metabolism in obese adolescents

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

Increased low-grade inflammation and plasminogen-activator inhibitor-1 level in nondippers with sleep apnea syndrome

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