The current state of knowledge about the dipping and non-dipping hypertension

Dubielski, Zbigniew; Zamojski, Michał; Wiechecki, Bartosz; Możeńska, Olga; Petelczyc, Monika; Kosior, Dariusz A.

doi:10.5603/ah.2016.0007

Cited by 16 publications

(21 citation statements)

References 131 publications

(212 reference statements)

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“…While age reduces the role of trait anger, it appears to strengthen suppression of anger. Aging is associated with an improvement of anger management [55] and with the expression of the non-dipping pattern [56]. Probably, in people who present extreme dipping, this relationship is dissociated, and people express a maladaptive suppression of anger.…”

Section: Discussionmentioning

confidence: 99%

The Night Effect of Anger: Relationship with Nocturnal Blood Pressure Dipping

Casagrande

Favieri

Guarino

et al. 2020

IJERPH

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Introduction: The circadian pattern of blood pressure is characterized by a physiological drop occurring after sleep onset. The alteration of this phenomenon (non-dipping, extreme dipping, or reverse dipping) is associated with an increased cardiovascular risk. Besides altered autonomic and endocrine circadian rhythms, psychological aspects seem to play a role in this modification. However, the few studies that have analyzed the influence of psychological dimensions on the dipping phenomenon have reported inconsistent results. This study aimed to examine the relationship between anger expression and blood pressure (BP) dipping. Methods: We obtained 24 h ambulatory BP measurements from 151 participants and used them to define three groups according to their dipping status: Dippers (N = 65), Non-Dippers (N = 42), and Extreme Dippers (N = 44). Sociodemographic and anamnestic information was collected, and the State-Trait Anger Expression Inventory was used to assess anger. Results: Analysis of variance evidenced significant higher scores for Trait Anger Temperament and Anger Expression in Extreme Dippers than in both Dippers and Non-Dippers. However, after controlling for confounding variables, there was no significant relationship with trait anger, and only the result concerning the suppression of anger was confirmed. Conclusions: These findings suggest that the analysis of some psychological factors, such as anger, could be necessary to better understand differences in nocturnal BP alterations. Trait anger and suppression of anger may contribute to the description and classification of patients who exhibit a maladaptive dipping phenomenon. However, modifiable (i.e., cigarette consumption) and unmodifiable (i.e., age) risk factors appear to mediate this relationship. Although further studies are necessary to explore this association, these results highlight that some aspects of anger can represent risk factors or markers of maladaptive modulation of the dipping phenomenon. different declinations of BP dipping may occur. In some individuals, an excessive reduction of BP (Extreme Dipping), or an increase of the BP trend after sleep onset (Reverse Dipping) may be reported. Earlier studies mainly focused on the absence of dipping, highlighting that a non-dipping pattern is a significant predictor of a range of organ damage and cardiovascular events [3,7,8]. The increase of cardiovascular risk associated with Non-Dipping seems to be due to the difficulty in physiological recovering from the typical demand-driven elevations of blood pressure during the waking hours of the day [9] and it is characterized by a disruption of the circadian rhythm of the autonomic balance [10]. Accordingly, some studies suggested that Non-Dippers have a high sympathetic nervous system activity during wake time [11][12][13] and a lower parasympathetic nervous system activity throughout the sleep period [13,14].However, the exact causes of Non-Dipping are not fully clarified [15][16][17], and genetic, biological, environmental, and sociodemogra...

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Section: Discussionmentioning

confidence: 99%

The Night Effect of Anger: Relationship with Nocturnal Blood Pressure Dipping

Casagrande

Favieri

Guarino

et al. 2020

IJERPH

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“…Non-dipping blood profile is harmful for both normotensive and hypertensive patients. 7,9 There are multiple pathological mechanisms in both POTS and non-dipping HT. According to the literature, increased sympathetic activity, decreased parasympathetic activity, or a combination of both clinical situations might have a role in the development of POTS and non-dipping HT.…”

Section: Pots (-) N=232 Pots (+) N=39 Pmentioning

confidence: 99%

“…Increased sympathetic nervous system activity with or without impaired parasympathetic system activity may be some of the pathologic mechanisms responsible for the non-dipping pattern. 7,8 It was also shown that non-dipping pattern was related to an increased risk of end organ damage even in normotensive people. 9 There is a possibility that the same pathophysiological mechanisms may have a role in both POTS and non-dipping pattern.…”

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confidence: 99%

The Relation Between Non-dipping Blood Pressure Pattern and Postural Orthostatic Tachycardia Syndrome in Hypertensive Patients

Dönmez¹,

Caf²,

İçen³

et al. 2019

Turkiye Klinikleri J Cardiovasc Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Postural orthostatic tachycardia syndrome (POTS) is an orthostatic intolerance with a pathophysiology that is likely to be heterogeneous. Hypertensive patients with a non-dipping pattern have an increased cardiovascular risk. There is a possibility that the same pathophysiological mechanisms may have a role in both POTS and the non-dipping pattern. To our knowledge, there are some studies showing the relation between POTS and non-dipping pattern in normotensive patients. However, data about this relation in hypertensive patients is limited. Our aim was to investigate the relation between 24-hour ambulatory blood pressure monitoring (ABPM) parameters and POTS in our study. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : A total of 271 suitable patients were enrolled in our study. ABPM, Tilt table test, echocardiography, and laboratory tests were performed. R Re es su ul lt ts s: : The study included 39 (14.3%) patients with POTS. There were no differences in the demographic variables, drug therapies, and laboratory as well as echocardiography parameters in all patients. Day-time, night-time, and 24-hour mean systolic and diastolic blood pressures and frequency of non-dipping pattern were significantly higher in patients with POTS. Day-time mean systolic blood pressure and non-dipping pattern were determined as independent predictors for POTS in multivariate logistic regression analysis. C Co on nc cl lu us si io on n: : A relation was observed between POTS and non-dipping pattern in patients with hypertension, which needs further exploration in larger and detailed studies. Clinicians might be aware of POTS if their hypertensive patients complain of palpitations, lightheadedness, and fatigue in an upright position. K Ke ey yw wo or rd ds s: : Hypertension; postural orthostatic tachycardia syndrome; orthostatic intolerance; blood pressure monitoring; ambulatory Ö ÖZ ZE ET T A Am ma aç ç: : Postüral ortostatik taşikardi sendromu (POTS) bir ortostatik tolerans bozukluğudur. Bu sendromun patofizyolojisi muhtemelen heterojendir. Hipertansif hastalarda non-dipping patern varlığı kardiyovasküler riski artırmaktadır. Aynı patofizyolojik mekanizmaların, hem POTS hem de non-dipping paternde rol alması ihtimali mevcuttur. Bildiğimiz kadarıyla, normotansif hastalarda non-dipping patern ile POTS arasındaki ilişkiyi gösteren bazı yayınlar mevcuttur. Fakat hipertansif hastalarda bu ilişkiye dair veri kısıtlıdır. Amacımız hipertansif hastalarda 24 saatlik ambulatuvar kan basıncı ölçümleri (AKBÖ) ile POTS arasında bir ilişki olup olmadığını incelemekti. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : 271 hasta çalışmamıza dâhil edildi. Tüm hastalara AKBÖ, Tilt masa testi, ekokardiyografi ve laboratuvar testleri yapıldı. B Bu ul lg gu ul la ar r: : 39 (%14,3) hastada POTS saptandı. Demografik veriler, ilaç tedavileri, laboratuvar ve ekokardiyografi parametreleri tüm hastalarda benzerdi. Gündüz, gece ve 24 saatlik ortalama sistolik ve diyastolik kan basınçları ...

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“…Grassi et al provide evidence that in arterial hypertension is a close correlation between the sympathetic activation degree and the magnitude of nocturnal decrease in systolic or diastolic BP. [10,29] Orthostatic hypotension Orthostatic hypotension is a relatively common and multifactorial disorder, often secondary to autonomic dysfunction. BP variation related to posture was associated to non-dipper pattern in female gender taking at least 2 antihypertensive drugs.…”

Section: Autonomic Nervous Systemmentioning

confidence: 99%

Clinical Conditions and Predictive Markers of Non-Dipper Profile in Hypertensive Patients

Ţilea

Petra

Ardeleanu

et al. 2018

Acta Medica Marisiensis

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Hypertension remains one of the primary causes of premature cardiovascular mortality representing a major independent risk factor.The importance of ambulatory blood pressure monitoring in clinical evaluation of hypertensive patients, beyond diagnosis, is the identification of circadian dipping/non-dipping profile. The non-dipper pattern in hypertensive and normotensive patients is associated with significant target organ damage and worse outcomes, as an increased cardiovascular risk condition. Non-dipping pattern has been found to be associated with specific clinical conditions. Obesity, diabetes mellitus, metabolic syndrome, obstructive sleep apnea syndrome, chronic kidney disease, autonomic and baroreflex dysfunctions, salt sensitivity, hormonal changes, gender and age were extensively studied. Research efforts are focused on recognizing and exploring predictive markers of abnormal blood pressure circadian pattern. Previous studies acknowledge that red cell distribution width, mean platelet volume, fibrinogen level, C-reactive protein, serum uric acid and gamma-glutamyltransferase, are independently significant and positive associated to non-dipping pattern. Moreover, research on new biomarkers are conducted: Chitinase 3-Like-Protein 1, atrial and B-type natriuretic peptide, brain-derived neurotrophic factor, chemerin, sphingomyelin and the G972R polymorphism of the insulin receptor substrate-1 gene. This review summarizes the current knowledge of different clinical conditions and biomarkers associated with the non-dipper profile in hypertensive patients.

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The current state of knowledge about the dipping and non-dipping hypertension

Cited by 16 publications

References 131 publications

The Night Effect of Anger: Relationship with Nocturnal Blood Pressure Dipping

The Night Effect of Anger: Relationship with Nocturnal Blood Pressure Dipping

The Relation Between Non-dipping Blood Pressure Pattern and Postural Orthostatic Tachycardia Syndrome in Hypertensive Patients

Clinical Conditions and Predictive Markers of Non-Dipper Profile in Hypertensive Patients

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