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Published on: May 3, 2018
Circadian blood pressure variation: relationship between dipper status and measures of arterial stiffness
Paula Jerrard-Dunne1, Azra Mahmud, John Feely
1Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland. jerrardp@tcd.ie
Insights
Hypertension patients with a reverse-dipper blood pressure pattern show increased arterial stiffness. This finding suggests altered sympathetic tone at night may contribute to cardiovascular risk.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Physiology
Background:
- Hypertensive individuals with nondipping nocturnal blood pressure (BP) exhibit greater target organ damage and poorer cardiovascular outcomes.
- Arterial stiffness is a potential mediator of these adverse effects.
Purpose of the Study:
- To investigate the relationship between arterial stiffness and nocturnal BP dipping patterns in untreated hypertensive individuals.
- To identify specific dipping patterns associated with increased arterial stiffness.
Main Methods:
- Evaluated 314 untreated hypertensive patients (mean age 48 years, 55% male).
- Categorized BP dipping patterns: dipper (10-20% fall), extreme-dipper (>20%), nondipper (<10%), and reverse-dipper (0% fall).
- Measured aortic pulse wave velocity (PWV) and augmentation index.
Main Results:
- Reverse-dippers and extreme-dippers showed the highest PWV.
- Nondippers and reverse-dippers had significantly higher PWV compared to dippers, even after age and sex adjustment.
- Multivariate analysis confirmed significantly higher PWV in reverse-dippers compared to both dippers and nondippers, independent of measured risk factors.
Conclusions:
- A reverse-dipper BP pattern is associated with increased arterial stiffness (PWV).
- This association persists after adjusting for common cardiovascular risk factors.
- Reverse-dippers exhibit reduced heart rate variability and wider nocturnal pulse pressures, suggesting altered sympathetic activity as a potential mechanism.
Background:
Compared with dippers, hypertensive individuals with a nondipping nocturnal blood pressure (BP) profile have more target organ damage and a worse cardiovascular prognosis, potentially mediated through arterial stiffness.
Objective:
To examine arterial stiffness and dipping in a population of 314 untreated hypertensive individuals, mean age 48 +/- 8 years, 55% men.
Methods:
Dipping was defined as a 10-20% fall in nocturnal BP; extreme dipping as greater than 20%, nondipping as less than 10%, and reverse-dipping as 0% at most fall in nocturnal BP. Aortic pulse wave velocity (PWV) (Complior) and augmentation index (Sphygmocor) were measured.
Results:
Groups did not differ by age, gender, 24-h or daytime mean BP, body mass index, smoking, cholesterol, glucose, renin or aldosterone. The relationship between PWV and dipper-status was J-shaped, with extreme-dippers and reverse-dippers having the highest PWV. Nondippers and reverse-dippers had significantly higher age and sex-adjusted PWV compared with dippers. Following multivariate adjustment for age, gender, mean arterial pressure, heart rate and smoking, reverse-dippers had significantly higher PWV than either dippers or nondippers (P = 0.005 and P = 0.006, respectively). Dipper status was not associated with augmentation index.
Conclusions:
A reverse-dipper pattern, corresponding to the 95% percentile of the night: day BP ratio on ambulatory BP monitoring, identifies a population group with increased PWV. This difference could not be explained by the measured risk factors. Reverse-dippers had significantly less day: night variability in heart rate and wider pulse pressures at night than any of the other groups, suggesting altered sympathetic tone at night as a potential mechanism.
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