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Blunted nocturnal fall of blood pressure in isolated clinical hypertension

N Turfaner1, Y Karter, A Curgunlu

  • 1Istanbul University, Cerrahpasa Medical Faculty, Department of Family Medicine, Istanbul, Turkey. nurver@istanbul.edu.tr

Swiss Medical Weekly
|March 31, 2009
PubMed

Insights

Isolated clinical hypertension (ICH) patients who do not experience a normal drop in blood pressure at night (nondippers) show reduced arterial compliance and increased target organ damage. This highlights the importance of monitoring diurnal blood pressure variations in managing hypertension.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Vascular Biology

Background:

  • Isolated clinical hypertension (ICH) is characterized by elevated clinic blood pressure with normal ambulatory daytime readings.
  • Diurnal blood pressure variations, specifically the 'dipping' pattern, are crucial indicators of cardiovascular health.
  • Understanding the link between diurnal blood pressure patterns and target organ damage in ICH is vital for risk stratification.

Purpose of the Study:

  • To investigate the relationship between diurnal blood pressure variations and target organ damage in patients with isolated clinical hypertension (ICH).
  • To compare vascular, cardiac, and renal parameters between 'dipper' and 'nondipper' patients with ICH.

Main Methods:

  • Ninety patients with ICH were categorized into dippers and nondippers based on 24-hour ambulatory blood pressure monitoring.
  • Vascular parameters including intima-media thickness (IMT), distensibility coefficient (DC), and compliance coefficient (CC) were assessed using ultrasound.
  • Cardiac function (left ventricular mass index, e/a ratio), renal function (GFR, UAE), and retinal changes were evaluated using echocardiography, laboratory tests, and fundoscopy.

Main Results:

  • Nondippers exhibited significantly higher IMT and lower arterial compliance (DC and CC) compared to dippers.
  • While left ventricular mass index was elevated in both groups, the e/a ratio showed significant differences between dippers and nondippers.
  • Nondipper ICH patients had a higher prevalence of microalbuminuria and reduced glomerular filtration rate (GFR <90 mL/min/1.73 m2).

Conclusions:

  • Nondipping status in isolated clinical hypertension is associated with reduced arterial compliance.
  • The findings suggest a greater global risk load for target organ damage in nondipper ICH patients.
  • Monitoring diurnal blood pressure patterns is essential for identifying ICH patients at higher risk for complications.
Abstract

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