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Published on: May 3, 2018
Impact of nocturnal fall in blood pressure on early cardiovascular changes in essential hypertension
C Cuspidi1, L Lonati, L Sampieri
1Istituto di Clinica Medica Generale e Terapia Medica and Centro di Fisiologia Clinica e Ipertensione, Università di Milano and Ospedale Maggiore, IRCCS, Italy.
Insights
A reduced night-time blood pressure fall (non-dipping) in early hypertension is not linked to increased cardiac or vascular damage. This finding suggests non-dipping is not a major factor in early essential hypertension cardiovascular changes.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Background:
- Essential hypertension is a common condition.
- Understanding early cardiovascular and vascular changes is crucial for effective management.
- The role of nocturnal blood pressure dipping patterns in early disease progression requires further investigation.
Purpose of the Study:
- To investigate the association between a blunted nocturnal blood pressure fall (non-dipping) and cardiac and vascular damage in newly diagnosed, untreated essential hypertension patients.
- To determine if non-dipping is a predictor of advanced cardiovascular changes in the early stages of hypertension.
Main Methods:
- 111 recently diagnosed, never-treated mild essential hypertension patients underwent 24-hour ambulatory blood pressure monitoring (ABPM).
- Echocardiography was used to assess cardiac structure (left ventricular mass index).
- Carotid ultrasonography evaluated vascular parameters (internal diameter, intima-media thickness, plaque prevalence).
Main Results:
- No significant differences in left ventricular mass index, carotid artery diameter, intima-media thickness, or plaque prevalence were observed between dippers (normal night-time fall) and non-dippers (blunted fall).
- The correlation between daytime/night-time blood pressure and cardiac/vascular measures did not differ between the groups.
- These findings held true when analyzing men and women separately.
Conclusions:
- A blunted reduction in night-time blood pressure (non-dipping) does not appear to be a significant factor in the development of cardiac and vascular damage during the early phase of essential hypertension.
- These results suggest that focusing on other factors may be more critical for preventing cardiovascular complications in newly diagnosed hypertensive patients.
Objective:
To evaluate in a selected population of subjects with a recent diagnosis of hypertension whether a blunted nocturnal fall in blood pressure is associated with more advanced cardiac and vascular damage.
Methods:
One hundred and eleven recently diagnosed and never-treated patients with mild essential hypertension underwent 24-h ambulatory blood pressure monitoring (ABPM), echocardiography and carotid ultrasonography.
Results:
The 78 patients with normal (> 10%) night-time fall in systolic blood pressure (SBP) and diastolic blood pressure (DBP) (dippers) were similar to the 33 patients with a small (< or = 10 %) fall (non-dippers) for age, sex, body surface area, smoking habit, clinic and 24-h blood pressure. There were no differences between dippers and non-dippers in left ventricular mass index (104 versus 105 g/m2), common carotid internal diameter (5.8 versus 5.9 mm), intima-media thickness (0.66 versus 0.64 mm) and carotid plaques prevalence (25 versus 29%). Furthermore, no differences were found in the correlation of daytime and night-time SBP and DBP with left ventricular mass and carotid wall thickness. When the 77 men and 34 women were analysed separately, similar results were obtained.
Conclusion:
These results suggest that a blunted reduction in night-time blood pressure does not play a major role in the development of cardiovascular changes during the early phase of essential hypertension.
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