Disturbed circadian blood pressure rhythm and C-reactive protein in essential hypertension

Abstract

We investigated the effect of the diverse definition criteria of the dipping and non-dipping status on the assessed differences in inflammatory activation between dippers and non-dippers with essential hypertension. 269 consecutive subjects (188 males, aged 50 ± 7 years) with untreated stage I-II essential hypertension underwent ambulatory blood pressure (BP) monitoring and high-sensitivity C-reactive protein (hs-CRP) level determination. The population was classified into dippers and non-dippers based on the three following different definitions: true non-dippers (TND): non-dippers (nocturnal fall of systolic and diastolic BP of o10% of the daytime values, n ¼ 95) and dippers (the remaining subjects, n ¼ 174); true dippers and true non-dippers (TD-TND): non-dippers (nocturnal fall of systolic and diastolic BPo10%, n ¼ 95) and dippers (nocturnal fall of systolic and diastolic BPX10%, n ¼ 75); systolic nondippers (SND): non-dippers (nocturnal systolic BP fall of o10% of the daytime values, n ¼ 145) and dippers (the remaining subjects, n ¼ 124). Non-dippers compared to dippers in the TND, TD-TND and SND classification exhibited higher levels of log hs-CRP (by 0.11 mg l À1 , P ¼ 0.02; 0.13 mg l À1, P ¼ 0.03 and 0.14 mg l À1, P ¼ 0.02, respectively) and 24 h pulse pressure (PP) (by 4 mm Hg, P ¼ 0.006; by 5 mm Hg, P ¼ 0.003 and by 5 mm Hg, Po0.0001, respectively). Twenty-four hour PP and nocturnal systolic BP fall were independent predictors of log hs-CRP (Po0.05 for both) in multiple regression analysis. In conclusion, essential hypertensive nondippers compared to dippers exhibit higher hs-CRP values, irrespective of the dipping status definition. Furthermore, ambulatory PP and nocturnal systolic BP fall interrelate and participate in the inflammatory processes that accompany non-dipping state.

Subendocardial viability ratio as an index of impaired coronary flow reserve in hypertensives without significant coronary artery stenoses

“…7 Ambulatory BP was recorded over a working day (Monday through Friday) using the automatic Spacelabs units 90207 (Redmond, WA, USA). 8 …”

Association of nighttime hypertension with central arterial stiffness and urinary albumin excretion in dipper hypertensive subjects

“…7 In particular, only a limited number of studies have connected a blunted decrease in nighttime BP to arterial stiffness, 8 increased urinary albumin excretion 9 and increased levels of high sensitivity C-reactive protein (hs-CRP). 10 Nevertheless, a blunted nighttime BP decrease (referred to as 'nondipping status') should be distinguished from 'nighttime hypertension (NH)' , in which the absolute nighttime BP values lie above the upper normal BP limits for the nighttime period. Importantly, NH may be present even in subjects with a dipping pattern of circadian BP variation, depending on their daytime BP levels.…”

Targeting Nocturnal Hypertension in Type 2 Diabetes Mellitus

“…21,22 Both markers have been associated with nondipping, 23,24 and elevated levels of C-reactive protein have been demonstrated in subjects with nocturnal hypertension. 25 Fibrinogen was shown to be significantly reduced with BA of valsartan.…”