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Extreme Dipping: Always Means Nocturnal Hypotension?
Cesare Cuspidi1,2, Giovanni Caffi1, Raffaella Dell'Oro1
1Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
American Journal of Hypertension
|May 4, 2019
Summary
Extreme dipping (ED) blood pressure patterns are not always linked to nocturnal hypotension. Many patients with ED have normal or high nighttime blood pressure, challenging previous assumptions about cardiovascular risk.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- Nocturnal hypotension is a suspected contributor to cardiovascular risk in extreme dipping (ED) blood pressure patterns.
- Prevalence data for nocturnal hypotension in ED patients is lacking.
Purpose of the Study:
- To determine the prevalence of nocturnal hypotension in patients with the extreme dipping (ED) blood pressure pattern.
- To investigate the association between antihypertensive treatment and nocturnal hypotension in ED patients.
Main Methods:
- Analysis of a large database of 24-hour ambulatory blood pressure recordings from 7,074 patients.
- Identification of patients with extreme dipping (ED) pattern (nighttime BP reduction ≥ 20%).
- Assessment of nocturnal hypotension and hypertension prevalence based on defined criteria.
Main Results:
- 4.5% of patients (339/7,074) exhibited an ED pattern.
- Prevalence of nocturnal hypotension in ED patients ranged from 9.1% to 45.0% based on criteria.
- Nocturnal hypertension (≥ 120/70 mm Hg) was present in 19.5% of ED patients.
- Treated hypertensive patients were more likely to have nocturnal hypotension and less likely to have nocturnal hypertension compared to untreated patients.
Conclusions:
- Extreme dipping (ED) is not invariably associated with nocturnal hypotension.
- A significant proportion of ED patients exhibit normal or elevated nocturnal blood pressure.
- Findings suggest a more complex relationship between ED patterns and nocturnal blood pressure profiles.
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