Blunted nocturnal fall in blood pressure and left ventricular mass in elderly individuals with recently diagnosed isolated systolic hypertension

Cicconetti, P.; Morelli, Sergio; Ottaviani, Luigi; Chiarotti, Flavia; Serra, Caterina De; Marzio, Paolo De; Costarella, Marianna; Sgreccia, Alessandro; Ciotti, Veronica; Marigliano, Vincenzo

doi:10.1016/s0895-7061(03)01012-4

Cited by 34 publications

(21 citation statements)

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“…The normal variation in BP is a dipping pattern characterized by a 10% to 20% dip in BP from day to night (3,42). Individuals with a less than 10% reduction in BP during sleep are described as having a nondipping BP pattern (2,24,38).…”

Section: Resultsmentioning

confidence: 99%

“…Several studies involving subjects with uncomplicated essential hypertension have revealed an association between a nondipper BP profile and an increased risk of target organ damage at the cardiac, renal, vascular and cerebrovascular levels (6,9,10,15,18,27,28,(42)(43)(44)(45). Target organ damage has also been found to be linked with two additional abnormal BP patterns: reverse dipping (nocturnal rise in night-time BP) and extreme dipping (nocturnal fall in night-time BP of greater than 20%) (46).…”

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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

118

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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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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

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

Routledge

McFetridge-Durdle

Dean

2007

Canadian Journal of Cardiology

118

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“…Among the others, non-dippers also showed high baPWV, whereas no marked difference was observed between extreme dippers and dippers ( Table 1). The mechanism underlying the relationship between blunted nocturnal BP drop and MCI may thus differ somewhat with that of extreme dippers, that is, advanced arteriosclerosis and cerebral arterial remodeling in risers and non-dippers, 34 and cerebral hypoperfusion due to the nocturnal BP fall in extreme dippers. 28,35 Recently, excessive sympathetic activation was represented to be a factor potentially responsible for the day-night BP difference.…”

Section: Discussionmentioning

confidence: 99%

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

et al. 2009

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Mild cognitive impairment (MCI), a syndrome characteristic of the transition phase between normal cognitive function and dementia, has been shown to carry the risk of progression to dementia. Dysregulation of blood pressure (BP) is thought to be an indicator of cerebrovascular damage, including cognitive impairment. Here, we investigated the possible association of circadian BP variation with MCI in community-dwelling persons exhibiting no definitive dementia. Our study enrolled 144 persons (68 ± 7 years). Nocturnal BP profile was defined as dipper, with a 10-19% drop in nocturnal systolic BP; extreme dipper, X20% drop; non-dipper, 0-10% drop; and riser, any increase in nocturnal BP. MCI was assessed using the MCI screen, a cross-validated, staff-administered battery of tests. Subjects with MCI (n¼38) were significantly older (74±6, 67±6 years, Po0.001) and had higher frequency of apolipoprotein E e4 allele (36.8, 18.9%, P¼0.018). Although the ambulatory measured BP and the percent changes in nocturnal systolic BP (À10 ± 12% and À12 ± 8%, respectively; P¼0.291) did not differ between MCI subjects and normal controls, frequency of MCI was significantly higher in the extreme dippers (32.0%), non-dippers (30.0%) and risers (50.0%) than in dippers (13.2%, P¼0.018). Multiple logistic regression analysis identified a blunted nocturnal BP decline, non-dipping or increase in nocturnal BP and extreme drop in BP as potent determinants of MCI (odds ratio 3.062, P¼0.039), after adjustment for possible confounding factors, including apolipoprotein E e4 genotype. Abnormal nocturnal BP profile was found to be a strong indicator of MCI in otherwise apparently healthy community-dwelling elderly persons. Keywords: ambulatory blood pressure monitoring; mild cognitive impairment; nocturnal blood pressure INTRODUCTION Mild cognitive impairment (MCI) is a syndrome defined as cognitive decline greater than expected for an individual's age and education level that does not notably interfere with activities of daily life. 1 MCI is classified into four subtypes: amnestic MCI involving only memory impairment (single domain) or memory impairment along with deficits in another cognitive domain such as language function, visuospatial skills, or executive function (multiple domain) and non-amnestic MCI involving discrete cognitive impairments in single or multiple domains other than memory function. 2 MCI prevalence has been estimated to be between 6 and 10% based on community assessments, 3 a frequency about four times that of dementia. MCI also exhibits Alzheimer-type dementia-like neuropathology on autopsy, and at least half of those diagnosed with MCI, in particular amnestic MCI subtype, eventually progress into Alzheimer-type dementia (AD) with a smaller percentage progression to other forms of dementia,

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“…Individuals with this decline in nocturnal BP are known as "dippers", and those who experience a blunted decline in nocturnal BP are known as "non-dippers" [2]. Several studies involving subjects with uncomplicated essential hypertension have revealed an association between the non-dipper BP profile and increased risk of target organ damage at the cardiac, vascular and cerebrovascular levels [3,4].…”

Section: Introductionmentioning

confidence: 99%

The Relationship between Non-Dipper Blood Pressure and Thoracic Aortic Diameter in Metabolic Syndrome

Karaagac¹,

Vatansever²,

Tenekecioğlu³

et al. 2014

EAJM

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Objective: Non-dipper hypertension is associated with increased cardiovascular morbidity and mortality. The purpose of this study was to evaluate the association of non-dipping hypertension with aortic diameter in patients with metabolic syndrome. Materials and Methods:This study included 70 hypertensive patients with metabolic syndrome. These patients were evaluated with 24-h blood pressure Holter monitoring and divided into two groups of 35 patients each. Aortic diameter was measured by M-mode and two-dimensional echocardiography. These parameters were compared between the two groups. Results:In the dipper group, there were 26 female and 9 male patients with a mean age of 55±11 years. In the non-dipper group, there were 25 female and 10 male patients with a mean age of 56±11 years. No significant difference was found between the two groups in terms of basic characteristics. Non-dipper hypertensive patients had a higher thoracic aortic diameter value than dipper patients (35.6±2.4 and 33.23±1.1, p<0.01). Conclusion:These findings suggest that thoracic aortic diameter value is higher in patients with non-dipper hypertension.Key Words: Blood pressure, metabolic syndrome, aortic diameter, echocardiography, non-dipper Özet Amaç: Non-dipper hipertansiyon artmış kardiyovasküler mortalite ve morbidite ile ilişkilidir. Bu çalışmanın amacı metabolik sendromlu hastalarda aort çapı ile non-dipping hipertansiyon ilişkisini değerlen-dirmektir. Gereç ve Yöntem:Çalışmaya metabolik sendromlu 70 hipertansif hasta alındı. Bu hastaların 24 saat kan basıncı ölçümü holter ile değerlen-dirildi ve herbirinde 35 hasta olan iki gruba ayrıldı. Aort çapları M mod ve iki boyutlu ekokardiyografi ile değerlendirildi. Bu paramatreler iki gurup arasında karşılaştırıldı. Bulgular:Dipper gurupta yaş ortalaması 55±11 yıl olan 26 kadın, 9 erkek hasta vardı. Non-dipper gurupta yaş ortalaması 56±11 yıl olan 25 kadın, 10 erkek hasta vardı. Temel özellikler açısından iki gurup arasında anlamlı farklılık yoktu. Non-dipper gurupta torasik aort çapları dipper guruba göre yüksekti (35.6±2.4 and 33.23±1.1, p<0.01).Sonuç: Bu bulgular non-dipper hipertansiyon hastalarında torasik aort çaplarının yüksek olduğunu göstermiştir.Anahtar Kelimeler: Kan basıncı, metabolik sendrom, aort çapı, ekokardiyografi, non-dipper

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Blunted nocturnal fall in blood pressure and left ventricular mass in elderly individuals with recently diagnosed isolated systolic hypertension

Abstract: An association between blunted nocturnal SBP fall and increased LVM was observed in the early phases of ISH in the elderly. This finding may have important prognostic implications.

Cited by 34 publications

References 33 publications

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

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

Abnormal nocturnal blood pressure profile is associated with mild cognitive impairment in the elderly: the J-SHIPP study

The Relationship between Non-Dipper Blood Pressure and Thoracic Aortic Diameter in Metabolic Syndrome

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