Non-Dipping Blood Pressure in Pediatric Hypertension: A Narrative Review

Ambulatory blood pressure monitoring (ABPM) provides a unique opportunity to assess day-night blood pressure (BP) variability. Individuals whose night-time BP is 10-20% lower than the subsequent daytime BP values are defined as dippers, whereas those with a nocturnal BP decrease of <10% are considered non-dippers. A non-dipping (ND) pattern has been shown to occur in a substantial proportion of adults with hypertension and is influenced by age, sex, ethnicity, and comorbidities. More importantly, the ND pattern has been reported to adversely affect hypertension-mediated organ damage (HMOD) and cardiovascular prognosis, due to a greater nighttime pressure overload that promotes more severe cardiovascular damage. Notably, current evidence on alterations in circadian BP rhythm in children and adolescents with hypertension remains scarce. Therefore, this narrative review aimed to analyze the available literature on this important topic and to provide updated, comprehensive information on the prevalence of the ND pattern and its association with cardiac and extracardiac HMOD markers. The prevalence of ND patterns (based on data from 16 studies) ranged from 35% to 72% (mean 59%). Regarding the association between ND and HMOD, particularly echocardiographic left ventricular hypertrophy, results have been mixed, leaving uncertainty about whether a blunted nocturnal BP decline in pediatric hypertension contributes to HMOD. Thus, large prospective studies are needed to improve definitions of the clinical significance of alterations in BP circadian rhythm in children and adolescents with hypertension, focusing on methodological issues not yet fully addressed, such as the use of pediatric diagnostic criteria and the reproducibility of the ND pattern over time.