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Determinants and consequences of the diurnal rhythm of blood pressure
1Cardiovascular Center, New York Hospital--Cornell University Medical Center, New York 10021.
Insights
Blood pressure (BP) dipping patterns, not just levels, may impact cardiovascular health. Non-dippers, lacking a normal nighttime BP drop, show increased target organ damage, suggesting prognostic importance.
Area of Science:
- Cardiology
- Hypertension Research
- Chronobiology
Background:
- Diurnal blood pressure (BP) rhythms are influenced by external and internal factors.
- Non-dippers exhibit a blunted nocturnal BP fall, linked to increased left ventricular hypertrophy (LVH).
- Higher average 24-hour BP in non-dippers may explain observed target organ damage.
Purpose of the Study:
- To investigate the prognostic significance of BP diurnal patterns beyond average BP levels.
- To explore the relationship between BP variability and cardiovascular event incidence.
- To determine if BP pattern analysis is crucial for understanding cardiovascular pathology.
Main Methods:
- Analysis of 24-hour ambulatory BP monitoring data.
- Comparison of cardiovascular outcomes between dippers and non-dippers.
- Assessment of target organ damage, specifically left ventricular hypertrophy (LVH).
Main Results:
- Non-dippers demonstrate a higher prevalence of left ventricular hypertrophy (LVH) compared to dippers.
- A diminished nocturnal BP fall is associated with increased target organ damage.
- The prognostic value of BP patterns, independent of BP levels, is suggested but requires further proof.
Conclusions:
- The diurnal BP pattern, particularly the nocturnal dip, may hold independent prognostic significance for cardiovascular events.
- Understanding BP variability is crucial for assessing cardiovascular risk.
- Further research is needed to confirm the predictive value of BP patterns and refine analytical methods.
Abstract:
The diurnal rhythm of blood pressure (BP) is influenced by both extrinsic and intrinsic factors, with the former usually being of greater significance. Non-dippers, in whom the normal nocturnal fall of pressure is diminished, have been reported to show more target organ damage (left ventricular hypertrophy (LVH)) than dippers, which may be explained by a higher average 24 h BP. Whether or not the pattern of BP (as opposed to the level) also is prognostically important is probable but unproven, given the known morning surge of the incidence of many acute cardiovascular events. The pathological significance of different diurnal patterns of BP change may depend both on the method of analysis and on the outcome measure used.