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Published on: May 17, 2016
Dipping pattern of nocturnal blood pressure in patients with hypertension
1Hypertension and Cardiovascular Rehabilitation Unit, University of Leuven, U.Z. Gasthuisberg, Herestraat 49, Leuven B-3000, Belgium. robert.fagard@uz.kuleuven.ac.be
Insights
Reverse dipping, a blood pressure pattern, is linked to a worse prognosis in hypertension patients. Extreme dippers show lower mortality, while reverse dippers face higher cardiovascular event risks.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Epidemiology
Background:
- Ambulatory blood pressure monitoring categorizes hypertensive patients into four dipping patterns: extreme dippers, dippers, nondippers, and reverse dippers, based on the night-day blood pressure ratio.
- The prognostic significance of these distinct blood pressure dipping patterns requires further elucidation.
Purpose of the Study:
- To evaluate the prognostic implications of the four blood pressure dipping categories in patients with hypertension.
- To synthesize evidence from meta-analyses of individual patient data and population-based studies.
Main Methods:
- Analysis of a large meta-analysis of individual patient data, adjusting for confounders and 24-hour blood pressure.
- Comprehensive meta-analysis of population-based studies.
Main Results:
- In hypertensive patients without baseline cardiovascular disease, extreme dippers had lower mortality than dippers, and reverse dippers had a higher incidence of cardiovascular events.
- Reverse dippers exhibited the worst prognosis, both in patients with and without baseline cardiovascular disease.
- Population-based studies confirmed higher cardiovascular event incidence and mortality in reverse dippers compared to dippers.
Conclusions:
- Reverse dipping is unequivocally associated with a worse prognosis in hypertensive individuals.
- Prognosis appears similar between extreme dippers and dippers, though some studies suggest variations.
- Nondippers may have a slightly worse prognosis, while extreme dippers' prognosis can be variable.
Abstract:
Four dipping categories have been described, based on the night-day blood pressure ratio from 24-h ambulatory blood pressure recordings: extreme dippers (night-day blood pressure ratio < or = 0.8), dippers (0.8 < ratio < or = 0.9), nondippers (0.9 < ratio < or = 1.0) and reverse dippers (ratio > 1.0). The main purpose of this article is to discuss the prognostic significance of these four dipping categories in hypertension, mainly based on a large meta-analysis of individual patient data. In hypertensive patients without cardiovascular disease at baseline and with statistical adjustment for confounders and 24-h blood pressure, mortality was lower in extreme dippers than in dippers, whereas the incidence of cardiovascular events was higher in reverse dippers. The worst prognosis for reverse dippers was also observed in hypertensive patients with major cardiovascular disease at baseline. Higher incidences of cardiovascular events and mortality were also found in reverse dippers in comparison with dippers in a comprehensive meta-analysis of population-based studies but outcome was not significantly different between extreme dippers and dippers. Based on these findings, there appears to be little doubt that reverse dipping is associated with a worse prognosis. Some studies suggest that prognosis is similar in nondippers and extreme dippers in comparison with dippers, but other studies suggest a somewhat worse prognosis in nondippers, or a better or worse prognosis in extreme dippers.
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