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

Abstract

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.

Nondipping Pattern and Carotid Atherosclerosis in a Middle-Aged Population: OPERA Study

“…20 These pathological modifications in risk factors may be reflected in the tendency for nondipping subjects to develop atherosclerosis. Recently it has been documented, that a higher BP variability during night-time independently correlated with a higher IMT.…”

Ambulatory Blood Pressure Monitoring in Diabetes and Obesity—A Review

“…There are other reports supporting the relationship between MS and a nondipping pattern [24, 28–30]. Additionally, nondipping status has been shown to be an independent predictor of glucose tolerance and several other metabolic abnormalities [31]. In contrast, other studies reported no difference in the ambulatory BP patterns between patients with and those without MS. With regard to the components of MS, glucose and abdominal obesity were two important components, but the number of components itself was also a determinant of the nondipping pattern.…”

Echocardiographic indices of left ventricular hypertrophy and diastolic function in hypertensive patients with preserved LVEF classified as dippers and non-dippers

“…Day-time and night-time blood pressure values and their changes due to treatment are related to each other [15], but the prognostic value of night-time blood pressure has been found superior [16]. Moreover, patients with a non-dipper circadian pattern of BP are at higher risk of micro- and macrovascular complications, such as cerebrovascular and cardiovascular complications, than individuals with a dipper circadian rhythm [17, 18]. Non-dipping of nocturnal BP seems to be a determinant of cardiac remodelling and LV diastolic dysfunction (LVDD) and may result in a cardiovascular risk independent of the increase in LVM in both hypertonic patients and in normotensives [19].…”