Non-dipper Hypertensive Patients Research Articles

Blood Pressure Patterns and Hepatosteatosis: Cardiometabolic Risk Assessment in Dipper and Non-Dipper Phenotypes.

Background/Objectives: Non-dipper hypertension (HT), a condition in which blood pressure does not drop sufficiently at night compared to daytime, is considered a serious condition that increases the risk of cardiovascular disease, stroke, and organ damage. This study aimed to examine the relationship between dipper and non-dipper blood pressure patterns, hepatosteatosis, and biochemical markers in hypertensive and normotensive individuals. Methods: Demographic, biochemical, and hepatic ultrasonography data from 142 patients who underwent 24 h ambulatory blood pressure measurement (ABPM) were evaluated retrospectively and cross-sectionally in this study. Patients were categorized into four groups based on ABPM results: non-dipper normotensive (NDN), dipper normotensive (DN), non-dipper hypertensive (NDH), and dipper hypertensive (DH). Results: The study results indicate that NDH individuals had markedly elevated levels of hepatosteatosis and uric acid compared with DH and normotensive persons (p < 0.001). The grade of hepatosteatosis showed significant discriminatory capacity in differentiating between dipper and non-dipper hypertensive patients, with an AUC of 0.861, specificity of 94%, and sensitivity of 66%. Individuals with hypertension exhibiting a non-dipper pattern demonstrate a greater prevalence of hepatosteatosis and elevated uric acid levels. Conclusions: The study findings show non-dipper patterns have a higher risk for cardiometabolic diseases. This indicates that not only blood pressure, but also metabolic disorders should be closely monitored and treated in the management of non-dipper HT.

Osteoprotegerin is associated with subclinical left ventricular systolic dysfunction in non-dipper hypertensive patients: a 2D speckle tracking echocardiographic study.

Past studies have shown that non-dipper hypertensive patients have more frequent subclinical left ventricular (LV) systolic dysfunction compared to dippers. Many different parameters have been examined to predict subclinical LV dysfunction. The role of osteoprotegerin (OPG) in the pathogenesis of heart failure and LV systolic dysfunction through different mechanisms had well described. In the present study, we hypothesized that increased OPG levels could predict subclinical LV systolic dysfunction in non-dipper hypertensive patients. Hypertensive patients were divided into two groups according to the results of ambulatory blood pressure (BP) monitoring. Non-dipper patients were subsequently divided into two further groups (normal LV function and impaired LV function) according to LV global longitudinal strain (GLS). A total of 103 hypertensive patients (51 dippers, 52 non-dippers) were included in the study. In the non-dipper group, LV GLS was normal in 21 patients and impaired in 31 patients. Based on the results of the multivariate logistic regression test, it was determined that OPG levels (OR: 2.413, 95% CI: 1.284-4.535, P = 0.006) and LVMI (OR: 1.086, 95% CI: 1.013-1.165, P = 0.021) were independently associated with impaired GLS. Higher OPG values were associated with subclinical LV systolic dysfunction in non-dipper hypertensive patients. It could be used for the early diagnosis of subclinical LV systolic dysfunction, which would allow for strategies to be designed to reduce the cardiovascular event rate in this patient population.

The platelet-to-lymphocyte ratio as an indirect outcome predictor in primary hypertension: a retrospective study.

Nondipper hypertensive patients have higher levels of platelet-to-lymphocyte ratio, a new studied inflammatory biomarker in primary hypertension. Furthermore, these patients have a higher risk of cardiovascular morbidity and mortality. This study aimed to assess the relationship between platelet-to-lymphocyte ratio and hypertensive pattern (dipper vs nondipper) and the association between the hypertensive pattern and major adverse cardiovascular events. A retrospective analysis was performed. One hundred fifty-three patients were included and classified as dipper or nondipper according to 24-hour ambulatory blood pressure measurements. Platelet-to-lymphocyte ratio was calculated based on complete blood count data. The dipper group included 109 patients, and the nondipper group included 44 patients. Nondipper patients have 2.11 more risk of presenting a higher platelet-to-lymphocyte ratio than dipper individuals (odds ratio [OR] = 2.11; 95% CI, 1.220-3.664; P = .007). Nondipper patients also registered earlier cardiovascular events, such as acute myocardial infarction and stroke (P < .001). Nondipper hypertensive individuals registered higher levels of platelet-to-lymphocyte ratio and earlier cardiovascular events than dipper patients. Therefore, platelet-to-lymphocyte ratio could be used as an indirect predictor of cardiovascular risk in primary hypertension and contribute to optimize preventive strategies.

Assessment of Oxidative Stress Markers in Hypertensive Patients under the Use of Renin-Angiotensin-Aldosterone Blockers.

As in other fields, chronotherapy applied to arterial hypertension (AHT) may have implications on oxidative stress. We compared the levels of some redox markers between hypertensive patients with morning and bedtime use of renin-angiotensin-aldosterone system (RAAS) blockers. This was an observational study that included patients older than 18 years with a diagnosis of essential AHT. Blood pressure (BP) figures were measured using twenty-four-hour ambulatory BP monitoring (24-h ABPM). Lipid peroxidation and protein oxidation were assessed using the thiobarbituric acid reactive substances (TBARS) and reduced thiols assays. We recruited 70 patients with a median age of 54 years, of whom 38 (54%) were women. In hypertensive patients with bedtime use of RAAS blockers, reduced thiol levels showed a positive correlation with nocturnal diastolic BP decrease. TBARS levels were associated with bedtime use of RAAS blockers in dipper and non-dipper hypertensive patients. In non-dipper patients, bedtime use of RAAS blockers was also associated with a decrease in nocturnal diastolic BP. Chronotherapy applied to bedtime use of some BP-lowering drugs in hypertensive patients may be linked to a better redox profile.

The relationship between nondipper hypertension and triglyceride glucose index.

Nondipper hypertensive patients have an increased incidence of damage to end organs, including the brain, heart, and kidney, and a worse cardiovascular prognosis. The triglyceride glucose (TyG) index is a reliable indicator of insulin resistance (IR) and is closely related to the traditional risk factors of cardiovascular disease. To the best of our knowledge, whether there is a relationship between the TyG index and impaired diurnal blood pressure (BP) has not been investigated. This study aimed to compare the TyG index between normotensive, nondipper, and dipper hypertensive patients. A total of 1037 patients grouped according to the results of ambulatory BP monitoring were included, with group 1 including dipper hypertensive ( n = 368), group 2 including nondipper hypertensive ( n = 496), and group 3 including normotensive control ( n = 173) patients. In both the univariate and multivariate logistic regression analyses, TyG index [odds ratio (OR), 4.656; 95% confidence interval (CI), 3.014-7.193; P < 0.001], age (OR, 1.011; 95% CI, 1.002-1.021; P = 0.018), and glomerular filtration rate (GFR) (OR, 0.979; 95% CI, 0.971-0.987; P < 0.001) were independent predictors of nondipper hypertension (HT). In the ROC analysis, a TyG index cutoff value of at least 4.74 predicted nondipper hypertensive patients with a sensitivity of 59.7%, and a specificity of 59.9% [area under the curve = 0.647 (0.614-0.680); 95% CI; P < 0.001]. We showed that TyG index, age, and GFR are independent predictors in patients with nondipper HT. TyG index, a simple, cost-effective, and rapid tool can predict the nondipper pattern in essential HT.

Systemic Immune-Inflammation Index: A Novel Predictor for Non-dipper Hypertension.

IntroductionThe non-dipper hypertension (HT) pattern is associated with more end-organ damage and cardiovascular events than is dipper HT. Inflammation is widely established to play a role in the pathophysiology of HT. Recently, a new inflammatory and prognostic marker called the systemic immune-inflammation index (SII) has emerged. Our goal is to determine whether there is a relationship between non-dipper HT and SII.MethodsOur study is a single-center retrospective and ninety-one patients with HT were included. All patients were analyzed with simultaneous 24-hour ambulatory blood pressure monitoring and laboratory parameters. Thirty-five patients had dipper HT while 56 patients had non-dipper HT. SII was calculated according to neutrophil, platelet, and lymphocyte counts.ResultsThe median age was 48 (45-61 interquartile range (IQR)) in the non-dipper HT group, whereas it was 54 (44-64 IQR) in the dipper HT group. Although the neutrophil level, neutrophil-lymphocyte ratio, platelet lymphocyte ratio, SII, sleeping systolic blood pressure (BP), and sleeping diastolic BP were higher (p=0.020, p=0.041, p=0.046, p=0.019, p<0.001, and p=0.001, respectively) in the non-dipper HT group, the lymphocyte level was lower (p=0.040). A multivariate logistic regression model shows that SII (odds ratio (OR)=1.023, 95% confidence interval (CI)=1.002-1.112, p=0.012) may be an independent predictor of non-dipper HT.ConclusionOur study showed that the SII level was higher in the non-dipper HT patient group than in the dipper HT group. Furthermore, SII was an independent predictor of non-dipper HT. The high SII value in hypertension patients can be used as an early warning parameter to identify non-dipper HT patients.

CORRELATION OF CAROTID INTIMA-MEDIA THICKNESS AND PULSE WAVE VELOCITY WITH HEMATOCRIT, PLATELET COUNT AND FIBRINOGEN LEVELS IN DIPPER AND NON-DIPPER HYPERTENSIVE PATIENTS

Objective: Carotid intima-media thickness (IMT) and pulse wave velocity (PWV) are the two most widely recognized methods for the assessment of arterial stiffness. The aim of this study was to verify whether there is a correlation between them and some blood parameters in dipper and non-dipper hypertensive patients. Design and method: This was a cross-sectional study that included patients with arterial hypertension (AHT) who were greater than 18 years old. Demographic and epidemiological variables were collected. Blood pressure (BP) parameters were assessed by office BP measurements and 24-hour ambulatory BP monitoring (24 h ABPM). We collected blood samples for biochemistry, blood count and coagulation variables. Individuals were divided into two groups: dipper and non-dipper patients. Quantitative normally distributed variables were nalysed using the Student’s t-test while non-normally distributed variables were nalysed using the Mann–Whitney U-test. A Chi-square test was used for categorical variables to test differences between groups. This study was approved by the center Ethics Committee of Clinical Research, and it adhered to the ethical standards that were outlined in the Declaration of Helsinki. All subjects provided informed consent. Results: There were 563 patients (47% women) with a mean age of 54 years who were included in this study. One third of patients suffered from diabetes and two out of three had plasma lipid abnormalities. There were differences in age, frequency of diabetes, dyslipidemia and antihypertensive therapy between dipper and non-dipper patients. After an adjustment for those variables, we observed a relevant correlation of PTC (Pearson correlation coefficient [r] -0.215, P = 0.002) and hematocrit (r 0.215 P = 0.002) with IMT in patients with a dipper profile while individuals with a non-dipper BP pattern showed a correlation of PWV with PTC (r -0.149, P = 0.031) and fibrinogen levels (r 0.238, P = 0.031). Uric acid levels were correlated with IMT in both groups of patients. Conclusions: It seems that some blood parameters could be linked to the development of arterial stiffness in both dipper and non-dipper patients. This was a preliminary retrospective, single-center study that could open the door to the investigation of new analytical indices in arterial stiffness.

Evening versus morning administration of drug therapy for hypertension: A meta-analysis of randomized controlled trials

Studies have suggested that different administration times may lead to different antihypertensive effects. This systematic review was designed to evaluate the effectiveness of evening versus morning drug administration for hypertension. Eight databases were searched to identify randomized controlled trials (RCTs) from database inception to August 2021. The RCTs compared the effects of evening and morning dosing on cardiovascular disease events, adverse events and reduction of blood pressure (BP) in hypertensive. Two reviewers independently extracted data and assessed trial quality. Meta-analysis was performed using Stata 12.0 software. A total of 36 RCTs were included and analysed. The results showed that, compared with the morning administration, evening administration of hypertensives could decrease cardiovascular disease events (risk ratio=0.39, 95% confidence interval (CI)=0.25 to 0.60), 24 h/48 h mean systolic BP (SBP) (mean differences (MD) =-3.39, 95% CI=-4.57 to -2.22), 24 h/48 h mean diastolic BP (DBP) (MD=-1.12, 95% CI=-1.70 to -0.53), nocturnal mean SBP (MD=-6.70, 95% CI=-8.35 to -5.05) and nocturnal mean DBP (MD=-3.54, 95% CI= -4.46 to -2.63), while diurnal mean SBP (MD=-0.53, 95% CI=-1.72 to 0.65) and diurnal mean DBP (MD=-0.31, 95% CI=-1.04– 0.42) showed no difference between two groups. This meta-analysis indicated that evening administration was superior to morning administration in reducing asleep BP and the risk of cardiovascular disease events, especially for patients with essential hypertension, patients with renal hypertension and the non-dipper hypertensive patients. More evidence is needed to support this conclusion.

Plasma catestatin importance and correlation in patients with dipper and non-dipper hypertension patients

Catestatin (CST) is a metabolite of chromogranin A, a soluble protein in catecholamine storage vesicles acting as a feedback inhibitor of catecholamine secretion. This study aims to investigate the correlation of catestatin with dipper and non-dipper status in hypertensive patients. Hypertensive (n=355) and healthy subjects (n=129) were randomly selected at an outpatient clinic. Blood pressure and heart rate were measured according to relevant guidelines. Plasma catestatin level, plasma glucose, lipid levels were measured. An ambulatory blood pressure monitor was performed to determine the dipping patterns in hypertensive subjects. Univariate and multivariate analyses were conducted to assess factors affecting catestatin levels. Left ventricular mass was higher among hypertensives compared with healthy controls (178±47 g versus 213±52 g in healthy controls and hypertensives, p&lt;0.05), but there was no significant difference between the two hypertensive groups 205±43 g versus 228±77 g in dippers versus non-dippers, p=0.54). Average systolic blood pressure (SBP) and the percentage of systolic blood pressure dipping were statistically significantly negative correlated with CST (r=-0.316, p&lt;0.05 for systolic dipping%, r=-0.283, p&lt;0.05 for ASBP). In multivariate analysis for the prediction of catestatin levels, systolic dipping % and mean SBP were found to be independent predictors of plasma catestatin level. Plasma catestatin levels were lower among hypertensives compared to healthy controls and modest inverse correlations between catestatin and dipping percentage of systolic blood pressure and also between catestatin and average systolic blood pressure were noted. In hypertensive subjects, lower plasma catestatin levels may alert clinicians to the non-dipping status of the blood pressure.

Effect of CPAP treatment on BP in resistant hypertensive patients according to the BP dipping pattern and the presence of nocturnal hypertension.

High heterogeneity in the blood pressure (BP) response to continuous positive airway pressure (CPAP) exists in patients with resistant hypertension (RH). Only nondipper normotensive and hypertensive patients exhibited BP reductions when treated with CPAP; the baseline BP dipping pattern has been proposed as a predictor of BP response to CPAP but has never been explored in patients with RH. This study aimed to assess the effect of CPAP on BP in subjects with RH with respect to BP dipping pattern or nocturnal hypertension. This is an ancillary study of the SARAH study. RH subjects with an apnea/hypopnea index (AHI) ≥ 15/h and who received CPAP treatment for 1 year were included. Subjects underwent a sleep study and ambulatory BP monitoring (ABPM) at baseline and at the 1-year follow-up. Eighty-nine RH subjects were included. The subjects were mainly male (77.5%) and obese, with a mean age of 66 years (25th-75th percentile; 59.0; 70.0) and an AHI of 32.7/h (25th-75th percentile; 25.0; 54.7). A total of 68.5% of participants were nondippers, and 71.9% had nocturnal hypertension. After 1 year of CPAP, no significant differences in ABPM parameters were observed between dippers and nondippers. According to nighttime BP, subjects with nocturnal normotension did not show significant changes in ABPM parameters, while nocturnal hypertensive subjects achieved a significant reduction in mean nighttime BP of -4.38 mmHg (-7.10 to -1.66). The adjusted difference between groups was 3.04 (-2.25 to 8.34), which was not significant. This study shows that the BP response to CPAP in patients with RH does not differ according to the BP dipping pattern (dipper and nondipper) and suggests a differential response according to the presence of nocturnal hypertension (ClinicalTrials.gov: NCT03002558).

Heart rate turbulence measurements in patients with dipper and non-dipper hypertension: the effects of autonomic functions

Hypertensive patients have shown autonomic dysfunction that is closely associated with the measurements of heart rate variability (HRV) and heart rate turbulence (HRT). We aimed to show the alterations of HRV and HRT measurements in patients with both dipper and non-dipper hypertension. This was a retrospective study consisting of one hundred and twenty-three participants (mean age ± SD, 55.7 ± 14.8 years; range, 18–90 years). The participants were divided into two groups: Group1: The patients with dipper hypertension, Group2: The patients with non-dipper hypertension. Two cardiologists performed HRV and HRT using 24-h electrocardiography (ECG) Holter and ambulatory blood pressure monitoring (ABPM) of patients. The results indicated that patients in group 2 had higher low frequency power/high frequency power ratio (LF/HF), lower high frequency power (HF) , root mean square of standard deviation (RMSSD) values than group 1 (p = 0.007, p = 0.008, and p = 0.002, respectively). Group 2 also showed higher heart rate turbulence onset (HRTTO) and lower heart rate turbulence slope (HRTTS) values than Group 1 (p = 0.004, p = 0.001, respectively). We performed multivariate analysis and observed that HRTTS and HRTTO have statistically significant associations with the presence of dipper or non-dipper hypertension [F = 7.755, p = 0.001], LF/HF [F = 7.868, p = 0.001], and HF [F = 4.081, p = 0.020]. This study shows a statistically significant difference in HRT measurements between dipper and non-dipper hypertensive patients. Deteriorated autonomic circadian rhythm and autonomic functions may contribute to these results.

The pattern of systemic inflammation index in normotensive non-dipper and dipper hypertensive patients

Objective: Continuous inflammation at the level of the vascular endothelium plays an important role in the formation of hypertension. Diurnal blood pressure (BP) variation also is a risk factor for hypertensive target organ damage. This study planned to evaluate these inflammation processes in normotensive and hypertensive patients. Methods: This study is observational cross-sectional cohort in-design. 151 patients with a prediagnosis of hypertension included. The patients were divided into three groups (group 1: dipper normotensive, group 2: non-dipper normotensive, group 3: dipper-hypertensive) based on the results of ambulatory blood pressure monitoring. The groups were compared in terms of systemic inflammation index (SII; platelet count×neutrophil count/lymphocyte count), neutrophil to lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and other inflammation processes. Results: There was a significant difference between the three groups in terms of mean platelet volume (MPV) and red blood cell distribution width (RDW) levels (p=0.001 and p&amp;lt;0.001, respectively). A statistically significant difference was found between the groups in terms of NLR, PLR, systemic inflammation index, lymphocyte-monocyte ratio (LMR). In subgroup analysis, NLR and systemic inflammation index were similar in group 2 and group 3, but higher than in group 1 in both groups. LMR was similar in group 2 and group 3 but lower than in group 1. In subgroup analysis PLR levels were similar in group 2 and group 3 but higher than group 1 in both groups. Conclusion: This study showed that normotensive non-dipper patients had inflammation as much as dipper hypertensive patients according to measurement of MPV, RDW systemic inflammation index, PLR, NLR levels.

Dosing Time Matters? Nighttime vs. Daytime Administration of Nifedipine Gastrointestinal Therapeutic System (GITS) or Amlodipine on Non-dipper Hypertension: A Randomized Controlled Trial of NARRAS.

Background: Non-dipper hypertension is often characterized by a blunted decrease of nocturnal blood pressure (BP) and is associated with increased risk of target organ damage and cardiovascular (CV) events, while the optimal treatment strategy is yet to be established. This trial was designed to evaluate whether nocturnal BP reduction and arterial stiffness improvement differ from antihypertensive agents and time of administration.Methods: Young and middle-aged adults (18–65 years) with non-dipper hypertension were randomly assigned to nifedipine GITS (gastrointestinal therapeutic system) 30 mg or amlodipine besylate 5 mg once daily for 8 weeks, either taken in the morning or at night. Dose was doubled at 4-week if BP is not at goal. Twenty-four hour ambulatory BP monitoring (ABPM) and arterial stiffness were evaluated before and after 8 weeks of pharmacotherapy. The primary efficacy measure was the average nighttime systolic BP reduction.Results: A total of 98 non-dipper hypertensive patients (mean age 46.3 years) were randomized during Dec, 2016 and Dec, 2020, of whom 72 (73%) patients completed all ABPM and follow-up evaluations. Nighttime systolic BP significantly reduced at 8 weeks vs. baseline with nifedipine GITS or amlodipine, irrespective of dosing at nighttime (−9.9 vs −9.9 mmHg, P > 0.05) or daytime (−11.5 vs. −10.9 mmHg, P > 0.05). No difference was seen between these two agents, when combining the data of nighttime and daytime dosing together (−10.8 vs. −10.5 mmHg, respectively, P = 0.898). Daytime, 24-h systolic BP, diastolic BP at different time and pulse wave velocity reduced significantly and comparably, and recovery of dipping rhythm were similar among groups.Conclusion: Nighttime dosing of long-acting antihypertensive preparations, nifedipine GITS or amlodipine demonstrated similar effects on nocturnal BP reduction, dipping rhythm restoration and arterial elasticity improvement in younger subjects with non-dipper hypertension. These effects were comparable with morning dosing.

Evaluation of global left ventricular systolic function in dipper and newly diagnosed nondipper hypertensive patients

Abstract Objective Nondipper hypertension has been associated with enhanced target organ damage and adverse cardiovascular outcomes. The effect of dipper and non-dipper status on cardiac target organ damage has not been comprehensively investigated by two-dimensional strain echocardiography. We aimed to investigate myocardial deformational strain parameters in dipper and non-dipper untreated hypertensive patients. Material and methods We included 42 newly diagnosed hypertensive patients without previous history of cardiovascular disease and coexisting chronic disease. Study population consisted of two groups of patients, 23 dipper patients and 19 non dipper patients. Global longitudinal strain (GLS), radial strain and circumferential strain analysis were measured by two-dimensional (2-D) speckle tracking method. Results The study population included 42 patients (15 male) with a mean age of 54.5±9 years. The assessment of LV systolic function by GLS showed decreased values in nondippers compared with dippers (−18.13±2.07 vs. −13.7±1.95; p=0.001). But no significant intergroup differences were observed in circumferential and radial strain. The analysis showed that night-time mean arterial pressure (MAP), night-time systolic and diastolic blood pressures (BP), 24-hr SBP, dipping rate and nocturnal reduction rate of MAP were the parameters that correlated with GLS. Only dipping rate was independently associated with left ventricular GLS. Conclusion An isolated non-dipper BP was found to cause impaired LV systolic function detected by myocardial strain. Funding Acknowledgement Type of funding sources: None. Figure 1

Diurnal Blood Pressure and Heart Rate Variability in Hypertensive Patients with Cerebral Small Vessel Disease: A Case-Control Study

Whether autonomic dysfunction contributes to cerebral small vessel disease (CSVD) remains unclear. This study aimed to explore the relationship between CSVD and blood pressure variability (BPV) and heart rate variability (HRV). This case-control study recruited 50 patients with CSVD and 50 non-CSVD hypertensive age- and gender-matched controls. All participants completed a 24-h ambulatory electrocardiogram recording and ambulatory BP monitoring (ABPM). Differences in HRV and BPV between the two groups were examined. BPV indices assessed by ABPM included mean systolic BP (SBP), mean diastolic BP (DBP), coefficient of variation and weighted standard deviation of SBP and DBP. CSVD patients had significant higher 24-h mean systolic BP (SBP), 24-h mean diastolic BP (DBP), daytime mean SBP, nocturnal mean SBP, and nocturnal mean DBP (P < .05 for all). CSVD patients had a significant lower nocturnal SBP fall rate compared with controls (median: 1.0 versus 6.2, respectively; P < .001) and were more likely to be non-dippers and reverse dippers. There were no differences in HRV variables between the two groups. Five logistic models were built to explore the correlations between BPV indices and CSVD. BPV indices were separately entered into the logistic regression models, together with hyperlipidemia, ischemic stroke history, current use of anti-hypertensive agents, and serum blood urea nitrogen. In models 1-3, 24-h mean SBP and nocturnal mean SBP and DBP were significantly correlated with CSVD (r2 = 0.308-0.340). In model 4, the nocturnal SBP fall rate was negatively correlated with CSVD (odds ratio [OR] = 0.871, 95% confidence interval [CI] = 0.804-0.943; P = .001), with r2 = 0.415 fitting the model. In model 5, the pattern of SBP dipping was significantly associated with CSVD, with non-dipper (OR = 8.389, 95%CI = 1.489-47.254; P = .016) and reverse dipper (OR = 27.008, 95%CI = 3.709-196.660; P = .001) having the highest risks of CSVD (r2 = 0.413). Lower nocturnal SBP fall rate is associated with CSVD. Non-dipper and reverse dipper hypertensive patients have a higher risk of CSVD.

Yeni Tanı Dipper ve Non-dipper Hipertansif Hastalarda Strain Analiz Metoduyla Sol Ventrikül Global Sistolik Fonksiyonlarının Değerlendirilmesi

Objective: Non-dipper hypertension has been associated with enhanced target organ damage and adverse cardiovascular outcomes. The effect of dipper and non-dipper status on cardiac target organ damage has not been comprehensively investigated by two-dimensional (2D) strain echocardiography. We aimed to investigate myocardial deformational strain parameters in dipper and non-dipper untreated hypertensive patients. Material and Methods: We included 42 newly diagnosed hypertensive patients without a previous history of cardiovascular disease and coexisting chronic disease. Study population consisted of two groups of patients, 23 dipper patients and 19 non-dipper patients. Global longitudinal strain (GLS), radial strain and circumferential strain analysis were measured by 2D speckle tracking method. Results: The study population included 42 patients (15 male) with a mean age of 54.5±9 years. The assessment of left ventricular (LV) systolic function by GLS showed decreased values in non-dippers compared with dippers (-18.13±2.07 vs. -13.7±1.95; p=0.001). But no significant intergroup differences were observed in circumferential and radial strain. The analysis showed that night-time mean arterial pressure (MAP), nighttime systolic and diastolic blood pressures, 24-hr systolic blood pressure, dipping rate and nocturnal reduction rate of MAP were the parameters that correlated with GLS. Only dipping rate was independently associated with LV GLS. Conclusion: An isolated non-dipper BP was found to cause impaired LV systolic function detected by myocardial strain.

Relation between nocturnal decline in blood pressure and choroidal thickness: a comparative analysis in dipper vs. non-dipper hypertensive patients.

To compare choroidal thickness (ChT) and echocardiographical changes in patients with dipper and non-dipper systemic arterial hypertension (HT). Patients with HT were evaluated in two groups according to the 24-hour ambulatory BP monitoring. Compared to day-time values, those whose night-time SBP decreased ≥10% were defined as dippers, and those whose SBP decreased <10% were defined as non-dippers. Transthoracic echocardiography was conducted in all patients. ChT and central macular thickness were measured with spectral-domain optical coherence tomography. ChT was obtained at the subfoveal, 1500 µm nasal and temporal to the fovea. Thirty non-dipper (18 females and 12 males) and 23 dipper (16 females and seven males) hypertensive patients were recruited. Sex distribution and the mean age were similar between the groups (P = 0.472; P = 0.12). Disease duration was longer in the non-dipper group (8 ± 3.39 vs. 4.96 ± 1.19 years, P = 0.001). The non-dipper group had lower ChT in subfoveal and temporal locations (P = 0.02 and 0.03, respectively) and higher left atrial volume index (LAVI) and pulmonary valve maximum flow (PV-max; P < 0.001). The night-time SBP was negatively correlated with ChT (P = 0.048) and positive correlated with LAVI and PV-max (P < 0.05). However those correlations were not significant when were controlled by the possible confounding factors as disease duration, age and gender. Non-dipper HT patients may have thinner choroid than dippers due to longer duration of HT and higher ambulatory BP levels.

A comparative study for the effects of nifedipine GITS and amlodipine besylate administrated in daytime or at nighttime on recovery of blood pressure rhythm and arterial stiffness in the young and middle-aged subjects with non-dipper hypertension (NARRAS): Design and rationale.

Hypertensive patients with a blunted or absent nocturnal blood pressure (BP) drop (non-dipper) are associated with arterial stiffening and additional cardiovascular risk. Non-dipper hypertension is prevalent in young and middle-aged adults; but the optimal antihypertensive strategy remains unclear. There is a need to explore the effects of different antihypertensive agents and time of administration on recovery of dipper rhythm and arterial stiffness in this population. NARRAS is a randomised controlled trial (RCT), designed to evaluate the effects of long-acting antihypertensive agents administrated in daytime or at nighttime on BP rhythm restoration and arterial stiffness in young and middle-aged non-dipper hypertensive patients. Participants will be randomly assigned to nifedipine GITS (gastrointestinal therapeutic system) 30mg or amlodipine besylate 5mg once daily, either taken in the morning or at night. Subjects will be divided into the following groups: group A. nifedipine administrated in the morning (N-M); B. nifedipine at night (N-N); C. amlodipine in the morning (A-M); D. amlodipine at night (A-N). If BP is not at goal during 4week's visit, dosage of antihypertensive agents will be doubled. BP is measured via 24-hour ambulatory BP monitoring (ABPM) and arterial stiffness is examined before and after 8weeks of pharmaceutical intervention. The primary endpoint is the difference of average nighttime systolic BP reduction between nifedipine GITS and amlodipine. The second endpoint is the percentage of restoration of a dipper rhythm at 8weeks. The potential of nighttime dosing on arterial stiffness is also investigated. A sample size of 120 will have 80% power to detect a 3mmHg nighttime systolic BP difference between 2 drugs determined with ABPM. NARRAS study is the first RCT to evaluate the effects of nifedipine GITS and amlodipine besylate on restoration of dipping rhythm and arterial elasticity, either administrated in the morning or evening, in younger non-dipper hypertensive subjects. The findings of NARRAS are likely to be potential to facilitate new therapeutic strategies for this condition. NARRAS was registered in clinicaltrials.gov, NCT02940548.

The Prevalence of Obstructive Sleep Apnea Syndrome in Non-Dipper Hypertension Patients

The Prevalence of Obstructive Sleep Apnea Syndrome in Non-Dipper Hypertension Patients

The Effects of Nocturnal Blood Pressure Paterns and Autonomic Alterations on Erectile Functions in Patients with Hypertension.

Hypertension (HT) is known to be of the main risk factors for erectile dysfunction (ED). But non-dipping (<%10 drop in the night) of HT is not investigated truly. The aim of this study was to test the hypothesis that the non-dipper hypertensive patients are more prone to develop erectile dysfunction. This was a cross-sectional clinical study. 70 HT patients diagnosed by Ambulatory blood pressure monitoring (ABPM) were classified into 3 groups (No ED, mild to moderate and severe) according to their International Index of Erectile Function (IIEF) scores. All three groups were compared for their dipping status by ABPM, heart rate variability (HRV) by holter monitoring. In our study non-dipper hypertensives had statistically more erectile dysfunction (P=0.004). Also severe ED patients with non-dipping pattern had decreased dipping blood pressure levels then those of ED(-) patients with non-dipping HT (P= .003)(Daytime Systolic/Nighttime Diastolic Blood Pressure= 0.8 ± 0.07 / 3.90 ± 1.5, respectively). LF/HF daytime/ nighttime in holter reflecting sympathetic overactivity (P< .001). Autonomic dysfunction especially sympathetic overactivity is associated with both non dipping pattern of HT and erectile dysfunction as a common pathologic pathway, besides there might be an association between ED and non dipping HT.