Nocturnal blood pressure fall and metabolic syndrome score in hypertensive patients

Vyssoulis, Gregory P.; Karpanou, Eva A.; Kyvelou, Stella‐Maria; Adamopoulos, Dionysios; Deligeorgis, Alexandros D.; Spanos, Panagiotis; Pietri, P; Cokkinos, Dennis F.; Stefanadis, Christodoulos

doi:10.1097/mbp.0b013e3282cb5ad3

Cited by 23 publications

(19 citation statements)

References 30 publications

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“…One, we found that in our patients, the HOMA index and plasma insulin levels also were both inversely related to the magnitude of the nighttime BP fall, the inverse dipping pattern being thus associated with the highest HOMA index and plasma insulin values. This finding, which may depend on the fact that sympathetic activation frequently accompanies elevated levels of HOMA and thus the insulin resistance state, 34 is in line with evidence from previous studies that alterations in the dipping state are associated with insulin resistance, 38,39 possibly reflecting the multifold circulatory effects of insulin (ie, a vasomotor response, a central action, and an alteration in neural sympathetic drive). 40 Two, in previous studies, we have shown that the baroreflex ability to modulate MSNA is not altered in essential hypertension, in contrast to the baroreflex modulation of heart rate, which is impaired.…”

Section: Discussionsupporting

confidence: 89%

Adrenergic, Metabolic, and Reflex Abnormalities in Reverse and Extreme Dipper Hypertensives

et al. 2008

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Abstract-Limited information is available on whether and to what extent the different patterns of the nocturnal blood pressure profile reported in hypertension are characterized by differences in sympathetic drive that may relate to, and account for, the different day-night blood pressure changes. In 34 untreated middle-aged essential hypertensive dippers, 17 extreme dippers, 18 nondippers, and 10 reverse dippers, we assessed muscle sympathetic nerve traffic, heart rate, and beat-to-beat arterial blood pressure at rest and during baroreceptor deactivation and stimulation. Measurements were also performed in 17 age-matched dipper normotensives. All patients displayed reproducible blood pressure patterns at 2 different monitoring sessions. Key Words: reverse dipping Ⅲ extreme dipping Ⅲ ambulatory blood pressure Ⅲ sympathetic activity Ⅲ baroreflex Ⅲ hypertension U se of ambulatory blood pressure (BP) monitoring allowed identification of 4 different patterns of the nocturnal BP profile (ie, the dipping, nondipping, extreme dipping, and reverse dipping type), each with a prevalence that makes it a rather common phenomenon to be seen in clinical practice. 1-3 It also has been shown that these different BP patterns are associated with different rates of target organ damage and clinical outcome. 2-12 However, information is limited and contradictory on whether individuals with these different BP patterns display differences in the factors involved in cardiovascular control that may relate to and account for the different day-night BP changes. [13][14][15][16][17][18] This is particularly the case for a fundamental mechanism participating in day and night cardiovascular modulation such as the adrenergic nervous system. 19 The present study was aimed at addressing the above issue by using direct measurement of muscle sympathetic nerve activity (MSNA) via microneurography in untreated hypertensive patients whose belonging to the dipping, nondipping, extreme dipping, and reverse dipping pattern was confirmed by repeated ambulatory BP monitorings. Microneurographic measurements were coupled with assessment of baroreflex function and insulin sensitivity to determine the relative contribution of reflex and metabolic alterations to the sympathetic abnormalities. Methods PopulationOur study was performed from a population of males and females referred to the outpatient cardiovascular risk and hypertension clinic of our Hospital (San Gerardo, Monza). Inclusion criteria were: (1) an elevated office (Ͼ140/90 mm Hg) and 24-hour (Ͼ125/79 mm Hg) BP; (2) no obesity (body mass index Յ30 kg/m 2 ); (3) no history of smoking, excessive alcohol consumption, and major cardiovascular or noncardiovascular disease, including diabetes mellitus; (4) no use of antihypertensive and other cardiovascular or metabolic drugs; (5) no echocardiographic evidence of left ventricular hypertrophy, alteration in renal function, or ultrasonographic evidence of carotid artery thickening or plaques; (6) no evidence of disease or conditions responsible for second...

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Section: Discussionsupporting

confidence: 89%

Adrenergic, Metabolic, and Reflex Abnormalities in Reverse and Extreme Dipper Hypertensives

et al. 2008

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“…Some authors claimed that insulin resistance was associated with the nondipping and reverse dipping status. 7,25 A very important cause of cardiac remodelling in the reverse dippers and the nondippers might also be the renin-angiotensin-sympathetic interaction, 26 which is responsible for cardiomyocyte hypertrophy, myocardial fibrosis, apoptosis, endothelial dysfunction, vasoconstriction and increased nocturnal sodium retention. All these changes could result in functional and structural impairment of LV and RV equally.…”

Section: Discussionmentioning

confidence: 99%

To dip or not to dip? The unique relationship between different blood pressure patterns and cardiac function and structure

2011

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Dipping and nondipping blood pressure (BP) patterns are associated with different levels of target organ damage and cardiovascular risk. The aim of our investigation was to determine the relationship between different BP patterns (dipping, nondipping, extreme dipping and reverse dipping type) and cardiac structure, and function in hypertensive patients. This crosssectional study included 376 hypertensive patients. All subjects underwent 24-h ambulatory BP monitoring, and complete two-dimensional, pulsed and tissue Doppler echocardiography. Most of the parameters of the left ventricular (LV) diastolic function (E/A, e 0 /a 0 , E/e 0 ) significantly and progressively deteriorated from the extreme dippers to the dippers and nondippers, and finally to the reverse dippers. In contrast, LV structural parameters (IVS, RWT, LV mass index) showed a statistically important difference only by comparing the dippers and the extreme dippers with the rest of the patients. Simultaneously, the right ventricular (RV) structural parameter (RVT, right ventricular thickness), and most RV diastolic parameters significantly and progressively worsened from the extreme dippers, over the dippers and the nondippers, to the reverse dippers. Daytime and night time systolic BP, nocturnal systolic BP fall, and the nondipping and the reverse dipping status were independently associated with LV and RV structure, as well as with diastolic function. LV and RV structure, and diastolic function were significantly more impaired with the nondippers and the reverse dippers compared with others.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

2009

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A reduction in the blood pressure decline at night (o10% from daytime systolic blood pressure (SBP)) during 24-h ambulatory blood pressure monitoring (ABPM) ('non-dipping pattern') is associated with cardiovascular morbidity. Our aim was to evaluate whether ABPM characteristics are associated with metabolic abnormalities in subjects without known hypertension or type 2 diabetes mellitus (T2DM). This is a cross-sectional population-based study on middle-aged subjects (n¼462). Two distinct definitions of metabolic syndrome (MetS) were used: National Cholesterol Education Program-Third Adult Treatment Panel (NCEP-ATPIII) and International Diabetes Federation (IDF) criteria. Results suggested that subjects characterized by non-dipping in 24 h ABPM were more obese (P¼0.014). After adjustment for body mass index, age and sex, non-dippers had higher verylow-density lipoprotein (VLDL)-cholesterol (P¼0.003), total (P¼0.029)-and VLDL-triglycerides (P¼0.026) and oral glucose tolerance test 2 h blood glucose (P¼0.027) compared with dippers. Non-dipping status was more common among subjects with MetS (Pp0.01), impaired glucose tolerance (IGT) (Po0.05) and in those with the combination of IGT-T2DM (Pp0.01) than among those without these abnormalities. ABPM non-dipping status was an independent predictor of IGT in multivariate models (Po0.05). With respect to MetS components, high triglycerides (Pp0.005) and low high density lipoprotein-cholesterol (Po0.05) were associated with a non-dipping pattern. The percentage decline in blood pressure from day to night decreased with the number of metabolic abnormalities (P¼0.012). In conclusion, ABPM non-dipping status is an independent predictor of glucose intolerance. It is also associated with several other metabolic abnormalities. Whether non-dipping pattern is causally related to these metabolic aberrations remains to be explored in a future prospective follow-up of this cohort.

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Nocturnal blood pressure fall and metabolic syndrome score in hypertensive patients

Abstract: It seems that hypertensive patients have an increased prevalence of abnormal dipping patterns as the number of MS components rises.

Cited by 23 publications

References 30 publications

Adrenergic, Metabolic, and Reflex Abnormalities in Reverse and Extreme Dipper Hypertensives

Adrenergic, Metabolic, and Reflex Abnormalities in Reverse and Extreme Dipper Hypertensives

To dip or not to dip? The unique relationship between different blood pressure patterns and cardiac function and structure

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

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