Diurnal blood pressure pattern and development of prehypertension or hypertension in young adults: the CARDIA study

Abstract

Nondippers (people whose sleep systolic blood pressure (SBP) fails to decrease >10% from daytime SBP) have increased risk of cardiovascular disease. The prevalence of nondipping in younger adults has not been well-studied, nor has its value for predicting hypertension. We examined the prevalence of nondipping in a sub-study of the Coronary Artery Risk Development in Young Adults (CARDIA) Study. We used Cox regression to estimate the hazard ratio (HR) conferred by nondipping for incident prehypertension or hypertension (preHTN/HTN) over 15 years. Of the 264 non-hypertensive participants at baseline, 118 (45%) were nondippers. Blacks were more likely than Whites to be nondippers (52% vs 33%, p=0.004). The incidence rate of preHTN/HTN was 29.2/1000 person-years among dippers and 36.2/1000 person-years among nondippers. Compared to those in the lowest quartile of nighttime to daytime SBP, those in the highest quartile were more likely to develop preHTN/HTN (HR 1.61; p =0.06), but this relationship was attenuated after adjustment (HR 1.34; p =0.27). Our results demonstrate that nondipping is common in young, nonhypertensive adults, and is more common in Blacks than Whites. Nondipping might predate a meaningful clinically detected increase in BP in some people, but more research in larger study samples is needed.Keywords diurnal blood pressure; blood pressure dipping; hypertension

Sleep efficiency and nocturnal hemodynamic dipping in young, normotensive adults

“…In addition, a longitudinal analysis from the Coronary Artery Risk Development in Young Adults (CARDIA) study demonstrated that blunted nocturnal blood pressure dipping in adolescents is associated with an increased risk of hypertension later in life (48). Given that the present study evaluated healthy young adults, our findings may be more informative for future risk of hypertension.…”

“…The primary finding of this study is that low sleep efficiency is significantly correlated to blunted SAP dipping, which is a known risk factor for future hypertension in young adults (48). In addition, low sleep efficiency was also associated with higher nocturnal heart rate and blunted heart rate dipping, which are clinically relevant indices of cardiovascular prognostic value that are often overlooked in this area of research (36).…”

“…The magnitude of blood pressure reduction at night varies among the population, and blunted nocturnal blood pressure dipping (i.e., a decrease Ͻ10%) is associated with increased risk of hypertension (48), heart failure (23), and mortality (14,24,46). While often overlooked, epidemiological studies also reported elevated heart rate to have prognostic value independent of blood pressure (15,18,19,36).…”

55 High-sensitivity cardiac troponin T and risk of hypertension

“…Based on our results, it is possible that these early BP aberrations cause myocardial damage, leading to elevated hs-cTNT, before clinically overt hypertension is recognized. Compatible with this hypothesis, it has been shown elsewhere that "non-dippers" (an abnormal diurnal BP pattern where sleep systolic BP fails to decrease >10% from daytime systolic BP and a known riskfactor for subsequent hypertension 6 ), are more likely to have prevalent detectable troponin levels by hs-cTNT assays 34 .…”

“…4 The onset of hypertension is an insidious process that typically occurs over many years and is often preceded by altered diurnal BP patterns and prehypertension. 5,6 While hypertension is diagnosed using defined BP thresholds, risks associated with elevated BP occur on a continuous spectrum. Indeed, even early, pre-hypertensive, BP abnormalities can induce structural heart changes 7 , potentially affording the opportunity both to detect persons at risk for overt hypertension and to initiate timely preventive strategies.…”