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Dippers versus non-dippers
P Verdecchia1, G Schillaci, C Porcellati
1R. Silvestrini General Hospital, Division of Medicine, Perugia, Italy.
Insights
Essential hypertension patients with a flattened 24-hour blood pressure profile (non-dippers) face increased cardiovascular risks. This classification, based on a less than 10% nocturnal blood pressure dip, affects approximately 35% of essential hypertension patients.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Physiology
Background:
- Essential hypertension is linked to cardiovascular complications like stroke and left ventricular hypertrophy.
- Patient outcomes are influenced by 24-hour blood pressure variability, specifically the day-night dipping pattern.
- Non-invasive ambulatory blood pressure monitoring (ABPM) is crucial for assessing this variability.
Purpose of the Study:
- To investigate the prevalence and clinical significance of the dipper and non-dipper classification in essential hypertension.
- To explore the relationship between blood pressure dipping status and cardiovascular complications, particularly left ventricular hypertrophy.
- To evaluate the impact of defining daytime and night-time hours on patient classification.
Main Methods:
- Utilized non-invasive ambulatory blood pressure monitoring (ABPM) in a cohort of essential hypertension patients.
- Defined daytime as 0600-2200 h and night-time as 2200-0600 h.
- Classified patients as non-dippers if nocturnal systolic and diastolic blood pressure reduction was less than 10% of daytime levels.
Main Results:
- Approximately 35% of essential hypertension patients were classified as non-dippers based on the defined criteria.
- Non-dipper status was associated with greater left ventricular mass in women, but not in men.
- Sleep monitoring indicated no significant disturbance affecting day-night blood pressure differences.
Conclusions:
- The non-dipper classification is prevalent in essential hypertension and may indicate increased cardiovascular risk, particularly left ventricular hypertrophy in women.
- Further research is needed to clarify the clinical significance of dipper/non-dipper status for risk stratification in hypertensive patients.
- Standardized definitions for diurnal blood pressure variation are essential for consistent patient classification and risk assessment.
Abstract:
Clinical studies with non-invasive ambulatory blood pressure monitoring have shown that some cardiovascular complications of essential hypertension (left ventricular hypertrophy, stroke) tend to be more frequent in patients whose 24-h blood pressure profile is flattened (non-dippers) and, consequently, suffer a longer duration of exposure to high blood pressure levels over the 24 h. The distribution of patients between dippers and non-dippers is conditioned by the limits of the blood pressure changes from day to night that are arbitrarily chosen to define these two groups, and by the time intervals defining daytime and night-time hours. Sleep does not seem to be disturbed by non-invasive monitoring to such an extent that the day-night blood pressure difference is affected. If daytime is defined as 0600-2200 h and night-time as 2200-0600 h, and those hypertensive patients with a nocturnal reduction in average daytime systolic and diastolic blood pressure of less than 10% are classed as non-dippers, the prevalence of non-dippers in essential hypertension appears to be about 35%. In these patients, left ventricular mass seems to be greater in non-dippers than in dippers among women, but not in men. The clinical significance of the dippers/non-dippers classification in the stratification of hypertensive patients of different levels of risk of cardiovascular complications needs further investigation.