Clinical Conditions and Predictive Markers of Non-Dipper Profile in Hypertensive Patients

Abstract

Hypertension remains one of the primary causes of premature cardiovascular mortality representing a major independent risk factor.The importance of ambulatory blood pressure monitoring in clinical evaluation of hypertensive patients, beyond diagnosis, is the identification of circadian dipping/non-dipping profile. The non-dipper pattern in hypertensive and normotensive patients is associated with significant target organ damage and worse outcomes, as an increased cardiovascular risk condition. Non-dipping pattern has been found to be associated with specific clinical conditions. Obesity, diabetes mellitus, metabolic syndrome, obstructive sleep apnea syndrome, chronic kidney disease, autonomic and baroreflex dysfunctions, salt sensitivity, hormonal changes, gender and age were extensively studied. Research efforts are focused on recognizing and exploring predictive markers of abnormal blood pressure circadian pattern. Previous studies acknowledge that red cell distribution width, mean platelet volume, fibrinogen level, C-reactive protein, serum uric acid and gamma-glutamyltransferase, are independently significant and positive associated to non-dipping pattern. Moreover, research on new biomarkers are conducted: Chitinase 3-Like-Protein 1, atrial and B-type natriuretic peptide, brain-derived neurotrophic factor, chemerin, sphingomyelin and the G972R polymorphism of the insulin receptor substrate-1 gene. This review summarizes the current knowledge of different clinical conditions and biomarkers associated with the non-dipper profile in hypertensive patients.

Clinical risk factors and predictive score for the non-dipper profile in hypertensive patients: a case-control study

“…Previous studies found that night-time BP was a stronger predictor of adverse cardiovascular outcomes than daytime BP [ 5 – 8 ]. Non-dippers were related to sleep disturbance, obstructive sleep apnea, obesity, high salt intake, orthostatic hypotension, autonomic dysfunction, chronic kidney disease, diabetic neuropathy, metabolic syndrome, and old age [ 7 – 9 ].…”

Shift Work and Heart Rate Variability Coherence: Pilot Study Among Nurses

“…A third possible interpretation is that a diminution in sleep period HRV coherence among the night workers may occur prior to the onset of other symptoms. If that is the case, reductions in sleep period HRV coherence may serve as an early indicator of autonomic dysregulation among night workers, which would be consistent with the role of reduced HRV as a risk indicator in other populations (Tilea et al 2018 ; Politano et al 2008 ; Tsuji et al 1996 ; Zhou et al 2016 ; Dekker et al 2000 ). The results of this pilot investigation also may have occurred by chance given the sample size.…”

The association between nondipper pattern and perioperative hypertension in patients with controlled hypertension

“…patients who are over 55 years [28]. The average age of our patients was greater than 55 years, and in such a population, higher incidences of autonomic dysfunction and enhanced sympathetic activity are also expected.…”

“…Enhanced sympathetic tonus and increased plasma norepinephrine levels in NDHT patients would lead to increased peripheral vascular resistance and excessive fluid collection in patients undergoing surgery. Circulating norepinephrine levels and peripheral vascular resistance are high in NDHT patients who are over 55 years [28]. The average age of our patients was greater than 55 years, and in such a population, higher incidences of autonomic dysfunction and enhanced sympathetic activity are also expected.…”