Nocturnal dipping status and the association of morning blood pressure surge with subclinical target organ damage in untreated hypertensives

Abstract

The clinical practice of hypertension management involves decision making based on absolute blood pressure (BP) levels, typically referring to the 24-hour, daytime, and nocturnal averages, though complementary indicators such as diurnal BP changes, nocturnal dipping status, and BP variability are also considered. In recognition of the normal circadian evolution of BP, the commonly recommended cutoffs for distinguishing between normotension and hypertension are 135/85 and 120/70 mm Hg for daytime and nocturnal BP, AbstractThe authors aimed to investigate the association between sleep-through morning surge (MS) in blood pressure (BP) and subclinical target organ damage in untreated hypertensives with different nocturnal dipping status. This cross-sectional study included 1252 individuals who underwent anthropometric measurements, serum biochemistry evaluation, 24-hour ambulatory blood pressure monitoring, echocardiography, and carotid ultrasonography. Left ventricular mass index, left atrial dimension, and carotid intima-media thickness were evaluated. Participants were grouped according to nocturnal systolic BP dipping rate (388 dippers, 10%-20%; 674 nondippers, 0%-10%; 190 reverse dippers, <0%). Twenty-two extreme dippers were excluded. While reverse dippers exhibited the most severe signs of damage, only dippers showed significant and positive correlation between MS and hypertension-mediated organ damage (all P < .05), with significant area under the receiver operating characteristic curve for discriminating left ventricular hypertrophy (0.662), left atrial enlargement (0.604), and carotid intima-media thickening (left, 0.758; right, 0.726; all P < .05). MS showed significant association with subclinical organ damage on both logistic and multiple linear regression analysis adjusted for age, sex, body mass index, smoking status, and alcohol consumption status, as well as for the levels of fasting blood glucose, uric acid, serum creatinine, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol, even when 24-hour, daytime, nocturnal, and morning systolic BP were included (odds ratio >1 and P < .01 for all types of damage).Besides race, nocturnal dipping status might affect the role of MS in subclinical target organ damage, with a significant association only in dippers, independent of other systolic BP parameters. Dipping status might account for the discrepancies across previous reports.

Clinical and functional predictors that cause a decrease of indicators of morning blood pressure profile in antihypertensive telmisartan-based therapy

“…Recent studies indicate other adverse effects of morning hypertension. Gong changes did not depend on other BP indicators according to daily BP monitoring 5 . In patients with newly diagnosed AH who did not receive treatment, the relationship between BP variability and early systolic dysfunction of the left ventricle (LV) was found, even in cases with preserved LV ejection fraction (EF) 6 .…”

“…Increased morning BP surge is defined to be associated with various factors, including aging, AH, DM, alcohol intake, smoking and stress. A series of investigations have demonstrated higher all-cause and cardiovascular mortality, regardless of the presence or absence of morning hypertension 2,4,5,13 . It was observed that there is an increased risk of stroke by 11% per each 10 mm Hg of morning BP surge increase 13 .…”

Ambulatory blood pressure monitoring in children undergoing polysomnography

“…This is an important finding. The circadian variability of BP has been reported and exhibits a nocturnal dip with an early morning surge (Gong et al., 2019). Several studies have highlighted the importance of this morning surge in cardiovascular risk and end‐organ damage and even in normotensive patients an elevated morning surge is associated with increased risk of ventricular hypertrophy (Li et al., 2010; Xie et al., 2015; Ye et al., 2019).…”

Afternoon blood pressure increase on home blood pressure measurement: A forgotten entity?

“…Early morning is a high‐risk period in the day for the development of cardiovascular events, including stroke and ischemic heart disease 8,9 . Previous studies have reported that morning BP surge is associated with subclinical target organ damage 10 and that the surge is a strong predictor of stroke, coronary artery disease, and all‐cause mortality in hypertensive patients, as well as in the general population 11 . Nocturnal hypertension, defined as a nocturnal BP level of >120/70 mmHg as measured by ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM) with a riser and non‐dipper BP pattern, is also associated with higher cardiovascular risk 8,12 .…”