Extreme Dippers Research Articles

Study of 154 patients with ambulatory blood pressure monitoring (ABPM)

Introduction: Blood pressure is a risk factor for stroke, coronary heart disease, heart failure, peripheral arterial disease and renal failure. Blood pressure (BP) has a circadian pattern, the measure of continuous ambulatory blood pressure for 24 h should be an indispensable method on clinical practice. Objective: To study demographic data and the results of the ABPM, conducted in our environment, as well as the pattern of ABPM, BP control and the treatment received by the patients. Material and methods: We analyzed 154 studies of ABPM, conducted in the La Mancha Centro Hospital service area, between June 2009 and November 2011. The results were analyzed using SPSS computer system 18. Results: We have measured the age and sex of patients, the reason for requesting the test, the pattern of BP, if target BP figures were achieved, and the number of drugs patients were being treated with. The average age was 61.13 years (standard deviation 13.061, minimum 20 years, maximum 84). 58.4% of the patients were female and 41.6% male. The reasons why the test was requested were: suspected untreated hypertension (3.2% of cases), suspected white coat BP (5.8%), study the circadian pattern (27.3%), high-risk hypertension (7.1%), refractory hypertension (1.3%) and efficacy of treatment (51.9%). The most frequent reason why the test was requested, was to evaluate the efficacy of treatment. Regarding the circadian pattern of blood pressure, the most common pattern was the Dipper (40.9% of cases), followed in order of frequency by the non-dipper pattern (36.4%), Riser (12.3%) and extreme dippers (10.4%). Regarding the treatment that followed our patients: 26% had any treatment, 26% followed treatment with two drugs, 21.4% with three drugs, 16% followed monotherapy and 10.4% of patients were being treated with 4 or more drugs. We also analyzed the mean BP figures: 44.2% of the patients had BP within the control objective, 30.5% had not achieved this goal, 20.1% of the patients were not hypertensive and 5.2% were confirmed to be. We studied patients who were not treated (40/154), and in 33 of them we observed that they were hypertensive and 8 were diagnosed with hypertension. As for patients that required three or more drugs (46/154), 26 had poor control, and despite the therapy they did not reach target values. Conclusions: The patients with ABPM in our area had an average age of 61.13 years, 58.4% were female and 41.6% male. The most common reason why the test was requested was the efficacy of treatment (51.9% of cases). The most frequent pattern presented was Dipper (49.9%). 44.2% of the patients had BP values well controlled. Only 16% of the patients followed monotherapy. There were 25% of untreated patients, 8 of them was confirmed to have hypertension. With ambulatory blood pressure monitoring for 24 h, we can obtain data regarding average values of BP and circadian pattern that clinical measurement of BP cannot demonstrate.

Effect of telmisartan vs. ramipril on ‘dipping’ status and blood pressure variability: pooled analysis of the PRISMA studies

A retrospective pooled analysis of the 'Prospective, Randomized Investigation of the Safety and Efficacy of MICARDIS vs. Ramipril Using ABPM' studies conducted in Europe and South Africa (PRISMA I) and in the United States of America and Canada (PRISMA II) was carried out to investigate the effects of telmisartan and ramipril on dipper status (extreme dippers, dippers, non-dippers, risers/reverse dippers), and blood pressure (BP) variability in 1279 patients (with normal sleeping patterns and valid 24-h ambulatory BP monitoring recordings at baseline and end point). After 14 weeks' treatment, telmisartan had a greater systolic BP (SBP) reduction and higher smoothness index in all four dipper groups compared with ramipril. In addition, the tendency toward dipping was significantly higher in patients treated with) telmisartan than ramipril (P=0.032; odds ratio for telmisartan vs. ramipril: 1.27 (95% confidence interval: 1.102-1.58)). In patients with an early morning SBP surge 35 mm Hg, telmisartan treatment was associated with significantly greater reductions from baseline in the night-time low mean, early morning mean and early morning SBP surge compared with ramipril (P=0.026, P<0.0001 and P=0.0006, respectively). In this retrospective analysis, telmisartan was shown to normalize the circadian BP pattern to a dipper profile in a larger proportion of patients than ramipril, and reduce early-morning SBP surge in high-risk patients, indicative of a cardioprotective effect. These findings need to be confirmed in long-term prospective trials and observational studies.

Extreme dipping predicts less calcified coronary arteries

Extreme dipping predicts less calcified coronary arteries

Hipertrofia ventricular izquierda y variación circadiana de la presión arterial

Background and objectivesMultiple studies support the prognostic role of both ambulatory blood pressure (BP) monitoring and left ventricular hypertrophy (LVH) in patients with hypertension. Consequently, we evaluated the correlation between certain ambulatory BP monitoring parameters and left ventricular mass (LVM) measured by echocardiography in a sample of hypertensive patients. Material and methodsA cross sectional, retrospective study was performed in 405 patients (53.8% women; mean age, 55.5 years), diagnosed with essential hypertension and referred to the Hypertension and Vascular Risk Unit by their primary care centers between 1 January, 1998 and 31 August, 1999. All patients underwent clinical and biological evaluation (using a standardized protocol), echocardiography, and 24-hour ambulatory BP monitoring (SaceLabs 90207). ResultsAmbulatory BP monitoring revealed poor BP control in 320 patients (79%); the mean dip in systolic BP was 10.6±0.9%. The dipper pattern was observed in 43.8%, the extreme dipper pattern in 13.4%, the non-dipper pattern in 30.2%, and the riser pattern in 12.6%. Left ventricular hypertrophy was identified in 248 patients (61.23%). An increase in ambulatory nocturnal BP was associated with an increase in LVM (p<0.0001) and a statistically significant negative correlation was observed between the drop in BP and the increase in LVM (P<.0001). ConclusionAn increase in LVM was associated with nocturnal hypertension and a decrease in the nocturnal drop in BP.

Primary non-alcoholic fatty liver disease in hypertensive patients

Non-alcoholic fatty liver disease (NAFLD) is considered the most common liver disease affecting 15-25% of the general population. The aim of this study was to investigate the prevalence of NAFLD and the relationship between insulin sensitivity and NAFLD in grade III high and very high cardiovascular additional risk essential hypertensive patients according to the circadian blood pressure (BP) rhythm. This four-year prospective study was conducted at the Department of Internal Medicine at Cluj-Napoca's Diagnosis and Treatment Centre in Romania. The study included grade III essential hypertensive patients. Hypertensive patients were divided into four groups according to the diurnal index (DI) from ABPM monitoring: dipper (D), non-dipper (ND), reverse-dipper (RD), and extreme-dipper (ED). All hypertensive patients underwent 24 ABPM, blood tests and abdominal ultrasonography for the diagnosis of fatty liver disease. Thirty-five hypertensive patients were included in the study, with 31.42% ND, 11.43% RD, 8.57% ED and 48.57% D. The prevalence of NAFLD was significantly higher in ND, RD and ED when compared to D. When compared to the dipper group of hypertensive patients a statistically significantly higher level of plasma insulin was observed: in non-dipper [86.3±17.9pmol/l vs. 62.2±203pmol/l, p<0.05], in reverse dipper [88.3±18.6pmol/l vs. 62.2±20.3pmol/l] and in extreme-dippers [86.7±16.88pmol/l vs. 62.2±20.3 pmol/l, p<0.05]. The altered dipping status (ND, RD, ED) of hypertension associated with a higher insulin resistance could be the pathogenetic link between the NAFLD and altered blood pressure status. Altered BP status could be a marker of NAFLD in hypertensive patients.

Nocturnal dipping is preserved in children with sleep disordered breathing regardless of its severity

Sleep disordered breathing (SDB) in adults has been associated with a loss of nocturnal dipping in blood pressure (BP) and heart rate, however, there have been limited studies in children. We measured BP non-invasively and continuously overnight in 105 children aged 7-12 with a range of severities of SDB and 36 non-snoring controls to examine nocturnal dipping profiles. Children with SDB were divided into three severity groups according to their obstructive apnea hypopnea index. Nocturnal dipping profiles across sleep stages were described both as a proportion of children exhibiting a ≥10% fall in systolic arterial pressure (SAP) and heart rate (HR) from wake to sleep and according to SAP sleep/SAP wake ratio as extreme dippers (ratio ≤ 0.8), dippers (ratio < 0.8 and ≤0.9), non-dippers (ratio < 0.9 and ≤1.0), and reverse dippers (ratio > 1.0). The mean fall in BP between wake and NREM 1/2, SWS, and REM sleep was not different between the groups and there were no differences between the dipping profiles of children in each group. SDB did not alter nocturnal dipping patterns of BP and HR compared to controls, a finding which may suggest that these young children have not been exposed to the effects of SDB long enough or that SDB severity was not great enough to affect nocturnal dipping profiles. However, further studies are required to determine if the elevated BP previously reported in this group of children will have long-term effects on the cardiovascular system.

AB0833 The clinical significance sympathetic overactivity in patients with systemic sclerosis: Reverse dipper pattern of blood pressure and ADMA

BackgroundSystemic sclerosis (SSc) is a multisystem disorder characterized by extensive vascular damage, with early generalized microangiopathy and fibrosis of the skin and internal organs. SSc is characterized by parasympathetic impairment...

A two-for-one bargain: using cilnidipine to treat hypertension and its comorbidities.

A two-for-one bargain: using cilnidipine to treat hypertension and its comorbidities.

Ambulatory Blood Pressure in Stroke and Cognitive Dysfunction

We have reviewed the most relevant data regarding ABPM and brain damage, with specific reference to first and recurrent stroke, silent structural brain lesions such as lacunar infarcts and white matter lesions, and cognitive impairment. Only two large studies have evaluated the usefulness of ABPM in relation to antihypertensive treatment in primary stroke prevention. In the Syst-Eur trial, drug treatment reduced ABPM and office BP more than placebo in patients with sustained isolated systolic hypertension (ISH). In contrast, in those patients with white-coat hypertension (WCH) changes in ABPM between the treatment groups were not significantly different. Patients with WCH had a lower incidence of stroke (p < 0.05) during follow-up than patients with sustained ISH, suggesting that WCH is a benign condition. In the HYVET trial 50 % of the very elderly patients included with office systolic BP > 160 mmHg had WCH. However, a significant 30 % stroke reduction was observed in treated patients including those with WCH, indicating that WCH may not be a benign condition in the elderly. In the acute stroke setting, where treatment of hypertension is not routinely recommended due to the lack of evidence and the differing results of the very few available trials, ABPM data shows that sustained high BP during the first 24 h after acute stroke is related to the formation of cerebral edema and a poorer functional status. On the other hand, even when nondipping status was initially related to a poorer prognosis, data indicate that patients with very-large nocturnal dipping, the so-called "extreme dippers", are those with the worse outcomes after stroke. The association between different ABPM parameters (circadian pattern, short-term variability) and poorer performance scores in cognitive function tests have been reported, especially in elderly hypertensives. Unfortunately most of these studies were cross-sectional and the associations do not establish causality.

Blood pressure variability: Epidemiological and clinical issues

Blood pressure variability (BPV) is a classical physiological phenomenon. This paper describes major epidemiological and clinical issues of BPV which may be important to understand the background of this interesting feature. In healthy subjects, BPV is a measure of hemodynamic condition and refl ects function of autonomic nervous system. BP fl uctuations result from the complex interaction between environmental stimulation, genetic factors and cardiovascular control mechanisms. Abnormal BPV is recognized in persons with a blurred dipping pattern (i.e. extreme dipping, non-dipping, reverse-dipping, morning surge of BP) or increased variations of day-time or night-time BP (high BP lability). Inappropriate BPV worsens the outcome, including increase in all-cause and cardiac mortality and incidence of cardiovascular events, and advance in target organ damage. Abnormal BPV may be softened or removed with suitable time-dependent administration of anti-hypertensive agents, especially those acting on the renin-angiotensin system.

Relationship Between Stroke Subtypes and Morning Surge or Dipping Pattern

HomeHypertensionVol. 61, No. 2Relationship Between Stroke Subtypes and Morning Surge or Dipping Pattern Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBRelationship Between Stroke Subtypes and Morning Surge or Dipping Pattern Miki Hosaka Kei Asayama Yutaka Imai Takayoshi Ohkubo Miki HosakaMiki Hosaka Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan Search for more papers by this author Kei AsayamaKei Asayama Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan, Department of Cardiovascular Diseases Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, University of Leuven, Leuven, Belgium Search for more papers by this author Yutaka ImaiYutaka Imai Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan Search for more papers by this author Takayoshi OhkuboTakayoshi Ohkubo Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan, Department of Health Science, Shiga University of Medical Science, Otsu, Japan Search for more papers by this author Originally published24 Dec 2012https://doi.org/10.1161/HYPERTENSIONAHA.111.00247Hypertension. 2013;61:e21Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2012: Previous Version 1 To the Editor:We read with interest the article by Verdecchia et al1 demonstrating that a blunted morning ambulatory blood pressure surge (MABPS) was an independent predictor of cardiovascular disease in the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study.1 Furthermore, cardiovascular risk was increased in reverse dippers and nondippers.1Kario2 reported that a high MABPS was a risk for stroke in their cohort of elderly hypertensive individuals who were older than those in the PIUMA study (72.2 versus 50.8 years). This might have resulted in the higher threshold of the top decile of MABPS among their patients (55 versus 44 mm Hg). However, Verdecchia et al1 further reported that the risk of cardiovascular events declined with higher levels of MABPS, regardless of age.In the International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome (IDACO; mean age, 53.0 years) study, the top decile of MABPS (≥37.0 mm Hg) was independently associated with cardiovascular risk only when the nocturnal decline of blood pressure was simultaneously included (P=0.01).3 The Ohasama study (mean age, 61.1 years) indicated that nondippers and risers had a significantly higher risk for cerebral infarction compared with dippers and extreme dippers (relative hazard, 1.59; P=0.04). An MABPS was not associated with cerebral infarction (P for trend=0.94), whereas an MABPS and a large nocturnal decline in blood pressure were associated with cerebral hemorrhage (P≤0.04), and the threshold for a high MABPS was similar to that in the PIUMA study (25.0 versus 27.5 mm Hg).4Exaggerated MABPS is likely to be a risk for cardiovascular disease in a specific population, but not in the general population. Nevertheless, the associations of each stroke subtype with MABPS or dipping pattern would be different. Therefore, we would like to understand the association of stroke subtypes with MABPS and the dipping pattern among the PIUMA patients. We would also like to know the association between cardiovascular risk and MABPS when the degree of nocturnal decline in blood pressure is simultaneously included as in the IDACO stuy.Miki HosakaDepartment of Planning for Drug Developmentand Clinical EvaluationTohoku University Graduate School of Pharmaceutical SciencesSendai, JapanKei AsayamaDepartment of Planning for Drug Developmentand Clinical EvaluationTohoku University Graduate School of Pharmaceutical SciencesSendai, JapanDepartment of Cardiovascular Diseases Studies Coordinating CentreDivision of Hypertension and Cardiovascular RehabilitationUniversity of LeuvenLeuven, BelgiumYutaka ImaiDepartment of Planning for Drug Developmentand Clinical EvaluationTohoku University Graduate School of Pharmaceutical SciencesSendai, JapanTakayoshi OhkuboDepartment of Planning for Drug Developmentand Clinical EvaluationTohoku University Graduate School of Pharmaceutical SciencesSendai, JapanDepartment of Health ScienceShiga University of Medical ScienceOtsu, JapanDisclosuresNone.FootnotesLetters to the Editor will be published, if suitable, as space permits. They should not exceed 500 words (typed double-spaced) plus 5 references in length and may be subject to editing or abridgment.

The circadian rhythm of arterial blood pressure in Alzheimer disease (AD) patients without hypertension

Objectives. The circadian rhythm (CR) of arterial blood pressure (ABP) in Alzheimer disease (AD) patients was examined in a case–control clinical study. Methods. This study was constructed using the case–control method and investigates non-hypertensive AD patients, compared with normotensive controls from a primary care setting. Twenty-four-hour ABP was measured with an automatic oscillometric device and recorded every 30 min throughout the day and night. Extreme dipper, dipper, non-dipper and reverse-dipper patterns were defined as those individuals with > 20%, 10–20%, < 10% and no fall in nocturnal ABP relative to daytime values. Results. There were significant differences in ABP dipper status between cases and controls (cases – 16.15%, 60.00%, 17.70% and 6.15% vs controls – 3.19%, 31.9 2%, 42.02% and 22.88% for reverse dipper, non-dipper, dipper and extreme dipper, respectively, df = 3, χ2 = 56.76, p < 0.001). Compared with normal controls, AD patients had significantly higher 24-h mean blood pressure, 24-h mean systolic blood pressure (SBP), night mean SBP, night mean pulse pressure (PP) and 24-h mean PP. There were no significant differences in 24-h mean diastolic blood pressure (DBP), daytime mean DBP or night-time mean DBP, and no significant differences in daytime mean SBP. Conclusions. The circadian rhythm of ABP in AD patents differed from normal controls, perhaps from higher night SBP in AD patents.

Circadian variability and nocturnal dipping pattern in blood pressure in young normotensive subjects

Blood pressure variability (BPV) is one of the recognized risk factors for different types of cardiovascular diseases (CVDs). Several physiological, behavioral and ethnic factors are known to modulate blood pressure (BP). Such studies on the population of southeast India are altogether absent. It is worthwhile, therefore, to examine the circadian variability in systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) and nocturnal dipping pattern in BP in apparently healthy human subjects as a function of gender. Sixty females and 40 males voluntarily participated in the study. All subjects wore an Ambulatory Blood Pressure Monitor (ABPM, TM 2430) for two to four consecutive days. SBP, DBP and HR was measured every 15 and 30 minutes between 07:00–22:00 and 22:00–07:00 hrs, respectively. In addition, double product (DP) and mean arterial pressure (MAP) were also computed. Data were analyzed using A&D, Cosinor and Spectre software. Prevalence of extreme dipper, dipper and non-dipper was 13%, 63% and 24%, respectively. A statistically significant circadian rhythm was validated in all studied variables, irrespective of gender and dipping pattern in BP. However, the rhythm detection ratio was low among non-dippers. Chi-square test revealed a statistically significant association of the frequency of prominent periods of SBP and MAP with nocturnal dipping categories. Further, significant differences for the circadian Mesors of SBP, DBP, HR, DP and MAP and acrophase of DBP and MAP were noticed between males and females. Dipping pattern produced a significant effect on the rhythm characteristics of all the studied variables. On the basis of our findings we can conclude that variability in BP may be associated with factor gender to some extent, whereas nocturnal dipping in BP is independent of gender. Interestingly in the present study about 24% subjects are non-dippers, which may be an indication of higher risk of CVDs among individuals belonging to younger generation of this region. However, further extensive study is desirable to strengthen the above conjecture.

1071 Gender differences in 24-hour blood pressure regulation in hypertensive patients with coronary atherosclerosis confirmed in angiography

Introduction: More and more evidence indicate that gender plays important role in hypertension and coronary atherosclerosis pathogenesis. The aim of our study was to assess 24-hour blood pressure profile in hypertensive men and women with established coronary atherosclerosis. Methods: We enrolled 891 patients with hypertension and coronary atherosclerosis confirmed in coronary angiography (at least one coronary stenosis ≥70%), divided into two groups: women, n = 276, mean age 66.4 ± 8.4 and men, n = 615, mean age 62.5 ± 9.5. Reverse dipper, Dipper, Non-dipper and Extreme dipper profiles were defined according to night fall of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results: Higher values of only DBP were observed in men in comparison to women as follows: 24-h (72.7 ± 8.3 mmHg vs. 68.5 ± 8.1 mmHg, p < 0.01), daytime (75.4 ± 8.6 mmHg vs. 71.4 ± 8.6 mmHg, p < 0.01) and nighttime (68.2 ± 9.0 mmHg vs. 63.7 ± 8.4 mmHg, p < 0.01). Our study revealed higher mean nocturnal/diurnal ratio (nighttime/daytime BP values) in men than women only for DBP (0.91 ± 0.06 vs. 0.89 ± 0.07, p < 0.02). There was lower prevalence of dippers in men than in women (39.7% vs. 47.8%, p < 0.02). The most common profiles were as follows: in men – non-dipper (43.2%) and in women – dipper (47.8%). The men group and the women group did not differ in treatment of hypertension (assessed either as number of antihypertensive agents or prevalence of using particular groups of antihypertensive drugs). Conclusion: Gender influences blood pressure regulation in patients with hypertension and coronary atherosclerosis. Dipper profile is more characteristic for women than for men.

Do Extreme Dippers Have a Lower Cardiovascular Risk Than Dippers?

We have recently read with interest the article by Verdecchia et al1 concerning the relationship between day-night blood pressure (BP) dip. During a mean follow-up period of 8.44 years, extreme dippers had a lower rate of cardiovascular CV events (0.57 [95% CI, 0.36–0.88]) than dippers (0.76 [95% CI, 0.63–0.92]). These data were apparently discrepant with the results of some previous large studies. Kario et al2 have revealed that an excessive decline of nighttime BP values may contribute to heart and central nervous system ischemic episodes. This fact may …

Response to Do Extreme Dippers Have a Lower Cardiovascular Risk Than Dippers?

We read with interest the letter by Sobiczewski and Wirtwein.1 We are aware of the potential relation between low levels of blood pressure (BP) at night and central nervous system ischemia. Sobiczewski and Wirtwein1 mention a study by Kario et al2 in which the prevalence of lacunae detected by MRI was 69% in a group of 16 subjects categorized as extreme dippers, 32% in a group of 38 dippers, and 63% in a group of 46 nondippers. Other reports suggest that such association may not apply to younger or mildly aged individuals. For example, in a study by Kohara et al,3 a J-shaped relation between nighttime BP and lacunar lesions by MRI was only evident in subjects aged …

Response to Is the Atherosclerotic Risk of Extreme Dipping in Youth Partly Explained by Exaggerated Morning Surge?

We thank Dr Kario1 for raising the interesting question of whether the exaggerated morning blood pressure (BP) surge might explain the relationship between extreme dipping and future coronary artery calcium. To examine whether this might be the case, we created a morning BP variable defined as the average of the ambulatory BP between the hours of 7:00 am and 9:00 am (we had previously eliminated daytime sleepers by detailed diary analysis). We calculated morning …

Is the Atherosclerotic Risk of Extreme Dipping in Youth Partly Explained by Exaggerated Morning Surge?

To the Editor: I have read the article by Viera et al1 demonstrating that disrupted circadian rhythm of blood pressure (BP) in youth was a predictor of coronary calcium levels in younger adults. The study is of great interest because, although an association between normotensive nondippers and advanced target organ damage is expected,2 the risk of extreme dipping was unexpected in younger subjects. In 1999, we first demonstrated a U curve-shaped association between nocturnal BP …

White Coat Hypertension, relationship of stages of hypertension with end organ damage and diurnal variation of blood pressure in newly diagnosed hypertensive patients

Introduction - Systemic hypertension is a disease attributable for various cardiovascular events. White coat hypertension is under diagnosed in Nepal and is usually treated as hypertension. However its prevalence in Nepal is not known. The relationship of stages of hypertension and diurnal variation of blood pressure with end organ damage is a current topic of research however such studies haven’t been done in Nepal. Methods - A Cross-sectional, Descriptive study including 80 patients was conducted over a period of 1 year from February 2008 to March 2010 at B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan. Results - The prevalence of white coat hypertension was 9%. Considering stage one (JNC 7) patients only it was 17%. There was statistically significant association between rise in blood pressure and proteinuria (p=&lt;0.001). There was also significant relationship between the ECG and Fundoscopic changes with the rise in blood pressure (p value 0.003 and 0.041 respectively). There were 47% non-dippers, 44% dippers, 8% extreme dippers and 1% raisers with significant variations between active and resting blood pressure. Conclusion - The prevalence of White Coat Hypertension among stage one hypertensives was 17%. There is strong relationship between the rise in blood pressure and end organ damage. Majority of patients with pre?hypertension (JNC 7) showed micro-albuminuria. There was a significant variation between active and resting blood pressure. DOI: http://dx.doi.org/10.3126/jaim.v1i2.6504 Journal of Advances in Internal Medicine 2012;01(02):56-9

1311 NONALCOHOLIC FATTY LIVER DISEASE IS NOT MORE FREQUENT AMONG HYPERTENSIVES AND NON-DIPPERS

Arterial hypertension (AH) and nonalcoholic fatty liver disease (NAFLD) are both components of the metabolic syndrome although their concurrence is uncertain. Normal variation of blood pressure (BP) is characterized by a nighttime dip of 10–20%. The association of non-dipping status and NAFLD is also controversial. The aims of our study were to investigate the possible association of NAFLD and insulin resistance to AH and the effect of the dipping profile. Patients and Methods: 186 consecutive patients, referred to the Hypertensive Unit were included. Exclusion criteria: alcohol >40gr/d and >20gr/d for men and women, respectively, diabetes mellitus, viral or autoimmune hepatitis, cholestatic and druginduced liver disease. AH was defined as mean 24-hour ambulatory BP values >130/80mmHg. Dippers and non-dippers were defined according to whether nighttime BP drop was ≥ or < 10%, respectively. Body mass index (BMI), waist/hip ratio and blood results were evaluated. 24-hour BP monitoring, cardiac and abdominal ultrasounds were also performed. Results: 173 patients were eligible for analysis (82 with AH), mean age: 54.3±10.1 years (mean±SD). Patients with and without steatosis on ultrasound differed with respect to BMI (30.0±5.2 vs 25.6±3.8 kg/m, p < 0.0001), waist/hip ratio (103.1±13.2 vs 87.1±11.7 cm, p =0.002), triglycerides (135.9±62.4 vs 98.7±58.2mg%, p = 0.028), HOMA-IR (3.5±3.0 vs 1.5±0.8, p = 0.0004) and gGT (25.8±18.4 vs 16.0±7.7 IU/L, p = 0.025) whereas the frequency of hypertension was not different (52 vs 37%, p = 0.061). Characteristics of NAFLD were not different among hyperand normotensives. Among hypertensives, no differences were identified in the distribution of study parameters between dippers (N=48) and non-dippers (N=34). A more detailed analysis, after exclusion of reverse and extreme dippers, did not alter the results. Conclusions: 1. There is a trend for patients with steatosis to have AH (p =0.061) 2. All parameters related to NAFLD did not differ among patients with and without AH 3. Dipping status in patients with AH does not seem to be associated to NAFLD.