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"Non-dipping" related to cardiovascular events in essential hypertensive patients
R Zweiker1, B Eber, M Schumacher
1Division of Cardiology, University of Graz, Austria.
Insights
Essential hypertension patients with non-dipping blood pressure patterns face a higher risk of cardiovascular events. Monitoring circadian blood pressure profiles is crucial for better prognosis in hypertensive individuals.
Area of Science:
- Cardiology
- Hypertension Research
- Circadian Rhythms
Background:
- Approximately one-third of essential hypertension patients exhibit an impaired circadian blood pressure pattern, known as non-dipping.
- Non-dipping, characterized by a lack of normal nocturnal blood pressure fall, is linked to increased end-organ damage, including left ventricular hypertrophy.
Purpose of the Study:
- To investigate whether the non-dipping phenomenon in blood pressure can worsen the prognosis for individuals with essential hypertension.
Main Methods:
- 116 consecutive hypertensive patients underwent ambulatory blood pressure monitoring (ABPM).
- Patients were categorized into two groups: dippers (n=87) and non-dippers (n=29).
- A follow-up of approximately 31 months assessed cardiovascular events.
Main Results:
- Non-dippers showed a significantly higher incidence of major cardiovascular events compared to dippers (p < 0.001).
- Cardiovascular events in non-dippers included deaths (myocardial infarction, apoplexy) and transient ischemic attacks.
- No significant differences were observed in sex, mean 24-hour systolic blood pressure, or heart rate between groups.
Conclusions:
- Non-dipping of blood pressure in essential hypertension is associated with an increased risk of cardiovascular events.
- Careful monitoring of the circadian blood pressure profile is recommended for hypertensive patients.
- The non-dipping pattern may serve as a significant indicator of poor prognosis.
Abstract:
About 1 third of all patients with essential hypertension reveal an impaired circadian pattern of blood pressure. This phenomenon called "non-dipping" (i.e. a lack of the normal nocturnal fall in blood pressure) is related to a higher incidence of end-organ damage such as left ventricular hypertrophy. It is the purpose of this study to evaluate, whether or not non-dipping of blood pressure may worsen the prognosis of hypertensive subjects. 116 consecutive hypertensives underwent an ambulatory blood pressure monitoring (ABPM) using the Spacelabs 2000 device. 2 groups were established: Group I (n = 87) were "dippers", group II (n = 29) "non-dippers" showing a diminished or even lack of nocturnal fall in blood pressure. No difference was seen concerning sex, mean 24-hour systolic blood pressure, systolic and diastolic causal blood pressure and heart rate. However, a significant difference in age and mean 24-hour diastolic blood pressure could be observed. In a follow-up investigation after approximately 31 months all patients and/or their physicians were contacted concerning cardiovascular events during the time since the ABPM was performed. In Group I only 1 transient ischemic attack occurred, but in group II 4 patients showed major cardiovascular events: 3 deaths occurred (2 of which caused by myocardial infarction, 1 by apoplexy), while 1 suffered from a transient ischemic attack (p < 0.001). Thus, in essential hypertension non-dipping of blood pressure is associated with an increased occurrence of cardiovascular events, and, therefore, the circadian blood pressure profile should be carefully monitored.