Metabolic Syndrome as a Predictor of Non-Dipping Hypertension

Abstract

Metabolic syndrome (MS) and nondipping hypertension both increase cardiovascular mortality. Although both clinical modalities share common pathophysiologic factors in their etiologies, previous studies did not find any association between them. We aimed to investigate the association between MS and non-dipping blood pressure by comparing different definitions of MS. One hundred-thirty-two consecutive patients (58 men) who underwent 24-hour ambulatory blood pressure monitoring were analyzed. MS was evaluated according to the currently used Adult Treatment Panel (ATP) III definition criteria, named MS-ATP III. In order to reveal the weights of risk contributing to MS, a new diagnostic scoring method (MS-Score) was used in comparison with MS-ATP III. Nocturnal non-dipping refers to a reduction in average systolic and/or diastolic blood pressure at night ( 10%) compared with daytime average values. Non-dipping pattern was found in 61.4% of patients. The frequency of MS according to MS-Score, but not MS ATP III, was significantly higher in patients with nondipping pattern than those without it ( p = 0.009). Although more prominent in the nighttime, MS-Score showed positive correlation with all systolic blood pressure results (r = 0.27, p = 0.002). Adjusted for baseline characteristics, high ( 27.5) MS-Score remained as an independent predictor of non-dipping pattern (OR 2.64, p = 0.038). Finally, high MS-Score, but not MS-ATP III, is a predictor of non-dipping pattern. Nighttime systolic blood pressure is higher in patients with high MS-Score. Therefore, patients with high MS-Score may be more prone to cardiovascular events than those with low MSScore.circadian blood pressure variation; hypertension; metabolic syndrome score; metabolic syndrome adult treatment panel III; non-dipping pattern

Non-dipping pattern in ambulatory blood pressure monitoring is associated with metabolic abnormalities in a random sample of middle-aged subjects

“…MetS is associated with an increased risk for developing diabetes. 28 Non-dipping blood pressure has been reported to be more common in subjects with the MetS in some earlier studies, 5,6,29 in addition to this study. Adiposity influences all the features of the MetS and the associations of non-dipping status with HDL-cholesterol, as well as with MetS as a cluster observed in our study were dependent on the amount of body fat.…”

“…A non-dipping pattern in ABPM has been reported to be more common in subjects with the MetS in some studies [4][5][6] although this relationship has not been detected in others. 7 In addition, an increase in the prevalence of non-dipping has been observed with the increasing number of MetS components.…”

“…7 In addition, an increase in the prevalence of non-dipping has been observed with the increasing number of MetS components. 8 Obesity and nocturnal volume-dependent hypertension have been postulated to be some of 5 the factors involved in the pathophysiology of non-dipping pattern in MetS. Earlier data have also provided evidence that there might be an inter-relationship between MetS, enhanced sodium sensitivity of the blood pressure and non-dipping pattern.…”

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

“…37 in addition, a higher occurrence of metabolic syndrome has been reported in non-dippers compared with dippers. 38 Accumulating evidence indicates that adipose tissue may produce aldosterone secretory factors that cause excessive adrenal aldosterone production. If true, a new paradigm is emerging that elevated levels of plasma aldosterone mediate several maladaptive changes that contribute to the pathogenesis of the metabolic syndrome and RHTN.…”

Serum uric acid, the endothelium and hypertension: an association revisited

“…It might therefore be expected that there would be an association between metabolic syndrome and non-dipping hypertension, but this has been shown not to be the case. 21,22 What further information can we extract? No information was supplied by Coutinho about the concomitant use of allopurinol in the patients studied.…”