Stress, menopausal status and nocturnal blood pressure dipping patterns among hypertensive women

A less than 10% decline in blood pressure during the night is known as a nondipping blood pressure (BP) pattern. Nondipping BP has been shown to be associated with target organ damage and poorer cardiovascular outcomes. Additionally, some evidence suggests that hyper-tensive nondipping women are at greater risk for target organ damage than hypertensive nondipping men.

To determine whether stress, demographics, menopausal status or sleep quality are associated with nondipping BP among hyperten-sive women.

A cross-sectional study design was used to describe the rela-tionship between stress and dipping status among a sample of hypertensive women and to describe the sample by age, ethnicity, marital status, meno-pausal status, current medications and sleep quality.

The study sample consisted of 47 women (mean [+/- SD] age 57+/-13.9 years) with essential or office hypertension who underwent 24 h ambulatory BP monitoring, and completed stress and sleep quality measurements. Thirty-one women (66%) were classified as dippers and 16 (34%) were classified as nondippers. Nondippers were older (P=0.04), postmenopausal (P=0.003) and had lower stress scores (P=0.02) than their dipper counterparts. Postmenopausal status sig-nificantly predicted nondipping (OR 16; 95% CI 1.9 to 136.4).

These findings were of interest given that some women had a nondipping BP pattern and significantly lower stress scores. It is pos-sible that there are fundamentally different physiological mechanisms that explain this nondipping phenomenon. In the future, the identification of specific hemodynamic mechanisms associated with nondipping could potentially influence the choice of antihypertensive treatment regimens for nondipper hypertensive patients.