Risk of atrial fibrillation in dipper and nondipper sustained hypertensive patients
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Updated: Jul 3, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Sante D Pierdomenico1, Domenico Lapenna, Franco Cuccurullo
1Department of Medicine and Aging Science, University Gabriele d'Annunzio, and Clinical Research Center, University Gabriele d'Annunzio Foundation, Chieti, Italy. pierdomenico@unich.it
Insights
Nondipper hypertensive patients have a doubled risk of developing atrial fibrillation (AF) compared to dippers. This finding highlights a potential factor contributing to the increased cardiovascular risk observed in nondipper hypertensive individuals.
Area of Science:
- Cardiology
- Hypertension Research
- Atrial Fibrillation Etiology
Background:
- Circadian blood pressure (BP) patterns, specifically the nocturnal BP dip, are crucial in cardiovascular risk assessment.
- The relationship between different circadian BP patterns in sustained hypertensive patients and the risk of new-onset atrial fibrillation (AF) remains underexplored.
Purpose of the Study:
- To investigate the incidence of new-onset AF in sustained hypertensive patients stratified by their circadian blood pressure (BP) patterns.
- To compare the risk of AF between 'dipper' and 'nondipping' sustained hypertensive individuals.
Main Methods:
- A cohort of 1141 patients aged >= 40 years with sustained hypertension underwent ambulatory BP monitoring.
- Patients were classified as dippers (night-time systolic BP fall >= 10%) or nondippers (night-time BP decline <10%).
- The occurrence of AF was monitored over a mean follow-up period of 6.1 years using Cox regression analysis.
Main Results:
- Atrial fibrillation (AF) occurred in 43 patients during follow-up.
- The AF incidence rate per 100 patient-years was significantly higher in nondippers (1.13) compared to dippers (0.38).
- After adjusting for covariates, nondippers exhibited a significantly higher risk of AF (Relative Risk [RR] 2.02; 95% Confidence Interval [CI] 1.08-3.79).
Conclusions:
- Sustained hypertensive patients with a nondipper BP pattern face a two-fold increased risk of developing atrial fibrillation (AF) compared to dippers.
- This elevated AF risk in nondippers may partially explain their previously documented higher cardiovascular risk.
- Circadian BP patterns are a significant independent predictor of AF in hypertensive individuals.
Objective:
The risk of atrial fibrillation (AF) in sustained hypertensive patients with different circadian blood pressure (BP) patterns is unknown. We investigated the risk of new onset AF in dipper and nondipper sustained hypertensive patients.
Methods:
The occurrence of AF was evaluated in 1141 patients aged > or = 40 years with sustained hypertension (clinic BP > or = 140 and/or 90 mmHg and daytime BP > or = 135 and/or 85 mmHg). Among these patients, 783 had night-time systolic BP fall > or = 10% (dippers) and 358 had night-time BP decline <10% (nondippers).
Results:
During the follow-up (6.1+/-3.2, range 0.5-12.9 years), AF occurred in 43 patients. The AF rate per 100 patient-years in dippers and nondippers was 0.38 and 1.13, respectively. AF free survival was significantly different between the groups (P=0.0002). After adjustment for other covariates, including left atrial enlargement or left ventricular hypertrophy (these variables were analyzed in separate models because of a strong association between them) and 24-h BP, Cox regression analysis showed that the risk of AF was significantly higher in nondippers than in dippers [nondippers vs. dippers, relative risk (RR) 2.02, 95% confidence interval (CI) 1.08-3.79, P=0.028 in the model including left atrial enlargement, and RR 1.97, 95% CI: 1.05-3.69, P=0.035 in the model including left ventricular hypertrophy].
Conclusion:
This study shows that nondipper sustained hypertensive patients have a two-fold greater risk of developing AF than dipper ones. This aspect could partly contribute to explain the higher cardiovascular risk previously observed in nondipper hypertensive patients.
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