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Nocturnal hypertension and cardiovascular risk: consequences for diagnosis and treatment
Insights
New blood pressure guidelines identify "nondippers" at higher cardiovascular risk. Addressing sleep-related breathing disorders and nocturnal hypertension is crucial for effective treatment and improved patient outcomes.
Area of Science:
- Cardiology
- Sleep Medicine
- Pharmacology
Background:
- Ambulatory 24-hour blood pressure monitoring reveals distinct circadian patterns, classifying individuals as
- dippers
- or
- nondippers
- (lacking a normal nighttime blood pressure drop).
- Nondipping status is increasingly linked to essential hypertension and elevated risk of cardiovascular complications, including myocardial infarction and cerebrovascular events.
- Sleep-related breathing disorders (SRBD) are associated with increased cardiovascular risk, potentially causing significant blood pressure elevations during REM sleep.
Purpose of the Study:
- To investigate the diagnostic and therapeutic implications of altered circadian blood pressure profiles, particularly in nondippers.
- To evaluate the impact of sleep-related breathing disorders on 24-hour blood pressure patterns and cardiovascular risk.
- To assess the efficacy of antihypertensive therapy in managing both daytime and nighttime blood pressure, including nocturnal hypertension.
Main Methods:
- Utilized ambulatory noninvasive 24-hour blood pressure monitoring to classify patients into dipper and nondipper categories.
- Examined the correlation between nondipping patterns, sleep-related breathing disorders (SRBD), and cardiovascular risk factors in a general practice population.
- Employed a new protocol for 24-hour blood pressure assessment under standardized load, incorporating nocturnal hypertension evaluation.
Main Results:
- A high incidence (40/112) of nondippers was observed in a group of snoring, obese middle-aged men with daytime fatigue, suggesting a link to SRBD.
- Antihypertensive drug therapy aims to reduce blood pressure during both day and night, across wakefulness and sleep stages.
- The angiotensin-converting enzyme (ACE) inhibitor cilazapril demonstrated a significant 24-hour mean blood pressure reduction of 10.0 mm Hg compared to placebo (4.3 mm Hg).
Conclusions:
- Altered circadian blood pressure profiles, especially in nondippers, necessitate consideration of nocturnal breathing patterns and daytime symptoms related to SRBD.
- Effective antihypertensive strategies must address 24-hour blood pressure control, including nocturnal hypertension.
- Cilazapril shows promise in managing hypertension by significantly reducing 24-hour blood pressure, offering a potential therapeutic option for nondippers and those with SRBD.
Abstract:
General use of ambulatory noninvasive 24-h blood pressure monitoring in many patients has shown that new criteria for arterial hypertension are useful. A classification of circadian blood pressure in "dippers" and "nondippers" (no physiologic drop of blood pressure) needs to be specified. An altered circadian blood pressure profile, like that in nondippers, was used as a diagnostic criterion for secondary hypertension. Recent epidemiologic studies in patients with essential hypertension have shown that nondippers are at higher risk for cardiovascular complications such as myocardial infarction and cerebrovascular insult. The studies also revealed that sleep-related breathing disorders (SRBD) are characterized by increased cardiovascular risk. Increases in blood pressure caused by SRBD could be documented, with the highest amount occurring during REM sleep. A study performed in a general practice showed a high incidence (40/112) of nondippers in a group of snoring middle-aged men with obesity and daytime fatigue. This indicates diagnostic and therapeutic consequences for the control of 24-h blood pressure, including nocturnal breathing pattern and daytime symptoms due to SRBD. The goal of antihypertensive drug therapy is to reduce blood pressure significantly during the day and during the night in different stages of wakefulness and sleep. A new protocol was designed to investigate blood pressure over 24 h under a standardized load, including nocturnal hypertension. The angiotensin-converting enzyme (ACE) inhibitor cilazapril was used in this test procedure and showed a significant and clinically relevant mean blood pressure reduction of 10.0 mm Hg (versus placebo 4.3 mm Hg) over 24 h.