The effects of nocturnal dipping on cardiovascular outcomes and proteinuria in essential hypertensive patients

• Authors: Yusuf Selcoki , Burak Uz , Nuket Baybek , Ali Akcay , Beyhan Eryonucu
• Languages of publication: EN

Abstracts

EN

Individuals who do not have a 10% to 20% reduction in blood pressure (BP) during the night are known as ‘nondippers’. Non-dipping patterns in hypertensive patients have been shown to be associated with an excess of target organ damage and other adverse outcomes. The present study was designed to investigate the relationship between nocturnal BP pattern, defined on the basis of the ambulatory blood pressure monitoring (ABPM) recording, and cardiac and renal target organ damage in a population of at least one year treated essential hypertensive subjects. The present analysis involved 123 patients with treated essential hypertension attending the outpatient clinic of our centre. Each patient was subjected to the following procedures: blood sampling for routine blood chemistry, spot urine for proteinuria, 24-hour periods of ABPM, and echocardiography. In the ABPM period, a dipping pattern was observed in 65 of the 123 patients, and a non-dipping pattern in 58 patients. Body mass index was higher in the non-dippers (26 ± 4 versus 28 ± 4, p<0.05). The proteinuria in spot urine was significantly higher in the non-dippers (10 ± 6 versus 24 ± 48, p<0.03). Left ventricular mass, interventricular septum thickness, posterior wall thickness and left ventricular systolic diameter were significantly higher in the non-dippers compared to the dippers. Left ventricular diastolic function was similar in non-dipper cases, except E-wave deceleration time. In treated essential hypertensives the blunted or absent nocturnal fall in blood pressure can be a strong predictor of cardiac and renal events. Hypertensive patients should be evaluated by ambulatory blood pressure monitoring. To prevent patients at risk for morbidity and mortality casualities as a result of hypertension, patients should be evaluated by ambulatory blood pressure monitoring. This method can be utilized for exacting future follow-ups with the patient.

Keywords

EN

Non-dipping; Essential hypertension; Target organ damage

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2008
• Volume: 3
• Issue: 3
• Pages: 279-286

Dates

published

1 - 9 - 2008

online

10 - 7 - 2008

Contributors

author

Yusuf Selcoki

• Department of Cardiology, Fatih University, School of Medicine, Ankara, Turkey

author

Burak Uz

• Department of Internal Medicine, Fatih University, School of Medicine, Ankara, Turkey

author

Nuket Baybek

• Department of Nephrology, Fatih University, School of Medicine, Ankara, Turkey

author

Ali Akcay

• Department of Nephrology, Fatih University, School of Medicine, Ankara, Turkey

author

Beyhan Eryonucu

• Department of Cardiology, Fatih University, School of Medicine, Ankara, Turkey

References

• [1] Palatini P., Too much of a good thing? A critique of overemphasis of the use of ambulatory blood pressure monitoring in clinical practice, J. Hypertens., 2002, 20, 1917–1923 http://dx.doi.org/10.1097/00004872-200210000-00003[Crossref]
• [2] Parati G., Mancia G., Ambulatory blood pressure monitoring in clinical practice, J. Hypertens., 2002, 20, 1925–1927 http://dx.doi.org/10.1097/00004872-200210000-00004[Crossref]
• [3] Cicconetti P., Morelli S., De Serra C., Ciotti V., Chiarotti F., de Marle M.G., et al., Left ventricular mass in dippers and nondippers with newly diagnosed hypertension, Angiology, 2003, 54, 661–669 http://dx.doi.org/10.1177/000331970305400605[Crossref]
• [4] Staessen J.A., Bieniaszewski L., O’Brien E., Gosse P., Hayashi H., Imai Y., et al., Nocturnal blood pressure fall on ambulatory monitoring in a large international database, The ‘Ad Hoc’ working group. Hypertension, 1997, 29, 30–39 [Crossref]
• [5] Verdecchia P., Schillaci G., Guerrieri M., Gatteschi C., Benemio G., Boldrini F., et al., Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension, Circulation, 1990, 81, 528–536 [Crossref]
• [6] Pierdomenico S.D., Lapenna D., Guglielmini L.D., Costantini F., Romano F., Schiavone C., et al., Arterial disease in dipper and nondipper hypertensive patients, Am. J. Hypertens., 1997, 10, 511–518 http://dx.doi.org/10.1016/S0895-7061(96)00493-1[Crossref]
• [7] Bianchi S., Bigazzi R., Baldari G., Sgherri G., Campese V.M., Diurnal variations of blood pressure and microalbuminuria in essential hypertension, Am J Hypertens 1994, 7, 23–29 [PubMed]
• [8] Shimada K., Kawamoto A., Matsubayashi K., Nishinaga M., Kimura S., Ozawa T., Diurnal blood pressure variations and silent cerebrovascular damage in elderly patients with hypertension, J. Hypertens., 1992, 10, 875–878
• [9] Verdecchia P., Porcellati C., Schillaci G., Borgioni C., Ciucci A., Battistelli M., et al., Ambulatory blood pressure, An independent predictor of prognosis in essential hypertension, Hypertension, 1994, 24, 793–801 [Crossref]
• [10] Erdogan D., Gullu H., Caliskan M., Yildirim I., Baycan S., Ciftci O., et al., The influence of circadian blood pressure changes on aortic distensibility and left ventricular diastolic function in hypertensive individuals, Int. J. Card. Imaging, 2006, 22, 157–165 http://dx.doi.org/10.1007/s10554-005-9007-1[Crossref]
• [11] Cuspidi C., Michev I., Meani S., Valerio C., Bertazzoli G., Magrini F., et al., Non-dipper treated hypertensive patients do not have increased cardiac structural alterations, Card. Ultrasound., 2003, 14,1–1 http://dx.doi.org/10.1186/1476-7120-1-1[Crossref]
• [12] Salvetti M., Muiesan M.L., Rizzoni D., Bettoni G., Monteduro C., Corbellini C., et al., Night time blood pressure and cardiovascular structure in a middle-aged general population in northern Italy: the Vobarno Study, J. Hum. Hypertens., 2001, 15, 879–85 http://dx.doi.org/10.1038/sj.jhh.1001286[Crossref]
• [13] Grandi A.M., Broggi R., Jessula A., Laurita E., Cassinerio E., Piperno F., et al., Relation of extent of nocturnal blood pressure decrease to cardiovascular remodeling in never-treated patients with essential hypertension, Am. J. Cardiol., 2002, 89, 1193–1196 http://dx.doi.org/10.1016/S0002-9149(02)02303-2[Crossref]
• [14] Cuspidi C., Michev I., Meani S., Severgnini B., Fusi V., Corti C., et al., Reduced nocturnal fall in blood pressure, assessed by two ambulatory blood pressure monitorings and cardiac alterations in early phases of untreated essential hypertension, J. Hum. Hypertens., 2003, 17, 245–251 http://dx.doi.org/10.1038/sj.jhh.1001546[Crossref]
• [15] Cuspidi C., Lonati L., Sampieri L., Macca G., Valagussa L., Zaro T., et al., Impact of nocturnal fall in blood pressure on early cardiovascular changes in essential hypertension, J. Hypertens., 1999, 17, 1339–1344 http://dx.doi.org/10.1097/00004872-199917090-00015[Crossref]
• [16] Cicconetti P., Ciotti V., Monteforte G., Moise A., Chiarotti F., Piccirillo G., et al., Circadian blood pressure pattern and cognitive function in newly diagnosed older hypertensives, Blood Press., 2003, 12, 168–74 http://dx.doi.org/10.1080/08037050301801[Crossref]
• [17] Cuspidi C., Macca G., Sampieri L., Fusi V., Severgnini B., Michev I., et al., Target organ damage and non-dipping pattern defined by two sessions of ambulatory blood pressure monitoring in recently diagnosed essential hypertensive patients, J. Hypertens., 2001, 19, 1539–1545 http://dx.doi.org/10.1097/00004872-200109000-00004[Crossref]
• [18] Sherwood A., Steffen P.R., Blumenthal J.A., Kuhn C., Hinderliter A.L., Nighttime blood pressure dipping: the role of the sympathetic nervous system, Am. J. Hypertens., 2002, 15, 111–118 http://dx.doi.org/10.1016/S0895-7061(01)02251-8[Crossref]
• [19] Nakano Y., Oshima T., Ozono R., Higashi Y., Sasaki S., Matsumoto T., et al., Non-dipper phenomenon in essential hypertension is related to blunted nocturnal rise and fall of sympatho-vagal nervous activity and progress in retinopathy, Auton Neurosci. 2001, 88, 181–186 http://dx.doi.org/10.1016/S1566-0702(01)00238-7[Crossref]
• [20] Routledge F., McFetridge-Durdle J., Nondipping blood pressure patterns among individuals with essential hypertension: a review of the literature, Eur. J. Cardiovasc. Nurs., 2007, 6, 9–26 http://dx.doi.org/10.1016/j.ejcnurse.2006.05.001[Crossref]
• [21] Verdecchia P., Porcellati C., Schillaci G., Borgioni C., Ciucci A., Battistelli M., et al., Ambulatory blood pressure, An independent predictor of prognosis in essential hypertension [published erratum appears in Hypertension 25:462]. Hypertension 1994, 24, 793–801
• [22] Sahn D.J., DeMaria A., Kisslo J., Weyman A., Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements, Circulation, 1978, 58, 1072–1083 [Crossref]
• [23] Devereux R.B., Reichek N., Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method, Circulation, 1977, 55, 613–618 [Crossref]
• [24] Appleton C.P., Galloway J.M., Gonzalez M.S., Gaballa M., Basnight M.A., Estimation of left ventricular filling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease. Additional value of analyzing left atrial size, left atrial ejection fraction and the difference in duration of pulmonary venous and mitral flow velocity at atrial contraction, J. Am. Coll. Cardiol., 1993, 22, 1972–1982 http://dx.doi.org/10.1016/0735-1097(93)90787-2[Crossref]
• [25] Izzedine H., Launay-Vacher V., Deray G., Abnormal blood pressure circadian rhythm: a target organ damage?, Int. J. Cardiol., 2006, 107, 343–349 http://dx.doi.org/10.1016/j.ijcard.2005.03.046[Crossref]
• [26] O’Brien E., Sheridan J., O’Malley K., Dippers and non-dippers, Lancet, 1988, 397 [Crossref]
• [27] Bjorklund K., Lind L., Andren B., Lithell H., The majority of nondipping men do not have increased cardiovascular risk: a population-based study, J. Hypertens., 2002, 20, 1501–1506 http://dx.doi.org/10.1097/00004872-200208000-00011[Crossref]
• [28] Pickering T.G., James G.D., Determinants and consequences of the diurnal rhythm of blood pressure, Am. J. Hypertens., 1993, 6, 166–169
• [29] Pickering T.G., Sleep, circadian rhythmas and cardiovascular disease, Cardiovasc Rev. Reports, 1980, 1, 37–47
• [30] Leary A.C., Donnan P.T., MacDonald T.M., Murphy M.B., Physical activity is an independent predictor of the diurnal variation in blood pressure, J. Hypertens., 2000, 18, 405–410 http://dx.doi.org/10.1097/00004872-200018040-00008[Crossref]
• [31] Hermida R.C., Calvo C., Ayala D.E., Mojon A., Lopez J.E., Relationship between physical activity and blood pressure in dipper and non-dipper hypertensive patients, J. Hypertens., 2002, 20, 1097–1104 http://dx.doi.org/10.1097/00004872-200206000-00020[Crossref]
• [32] Mancia G., Zanchetti A., Cardiovascular regulation during sleep, In Oren J, Barnes CD (editors): Physiology in sleep. New York Academic Press, 1980, pp 1–55
• [33] Oh J.K., Appleton C.P., Hatle L.K., Nishimura R.A., Seward J.B., Tajik A.J., The noninvasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiography, J. Am. Soc. Echocardiogr., 1997, 10, 246–270 http://dx.doi.org/10.1016/S0894-7317(97)70062-2[Crossref]
• [34] Levy D., Garrison R.J., Savage D.D., Kannel W.B., Castelli W.P., Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study, N. Engl. J. Med., 1990, 322, 1561–1566 http://dx.doi.org/10.1056/NEJM199005313222203[Crossref]
• [35] Aydin M., Ozeren A., Bilge M., Atmaca H., Unalacak M., Dursun A., Elbey M.A., Left ventricular diastolic function and circadian variation of blood pressure in essential hypertension, Tex. Heart Inst. J., 2005, 32, 28–34
• [36] Verdecchia P., Angeli F., Gattobigio R., Guerrieri M., Benemio G., Porcellati C., Does the reduction in systolic blood pressure alone explain the regression of left ventricular hypertrophy?, J. Hum. Hypertens., 2004, 18, 23–28 http://dx.doi.org/10.1038/sj.jhh.1001797[Crossref]
• [37] Ferrara A.L., Pasanisi F., Crivaro M., Guida L., Palmieri V., Gaeta I., Iannuzzi R., Celentano A., Cardiovascular abnormalities in never treated hypertensives according to nondipper status, Am. J. Hypertens., 1998, 11, 1352–1357 http://dx.doi.org/10.1016/S0895-7061(98)00164-2[Crossref]
• [38] Schulte K.L., Lederwald K., Meyer-Sabellik M., Van Gemmeren D., Lenz T., Gotzen R., Relationship between ambulatory blood pressure, forearm vascular resistance and left ventricular mass in hypertensive and normotensive subjects, Am. J. Hypertens., 1993, 6, 786–793
• [39] Timio M., Venanzi S., Lolli S., Lippi G., Verdura C., Monarca C., Guerrini E., Non-dipper hypertensive patients and progressive renal insufficiency, Clin. Nephrol., 1995, 43, 382–387
• [40] Uzu T., Takeji M., Yamauchi A., Kimura G., Circadian rhythm and postural change in natriuresis in nondipper type of essential hypertension, J. Hum. Hypertens., 2001, 15, 323–327 http://dx.doi.org/10.1038/sj.jhh.1001185[Crossref]
• [41] Uzu T., Kimura G., Diuretics shift circadian rhythm of blood pressure from nondipper to dipper in essential hypertension, Circulation, 1999, 100, 1635–1638 [Crossref]
• [42] Musialik D., Kosicka T., Skoluda A., Boruczkowska A., Trojnarska O., Tykarski A., Twenty-four hour ambulatory blood pressure monitoring in young and elderly hypertensive subjects, J. Hum. Hypertens., 1998, 12, 641–642 http://dx.doi.org/10.1038/sj.jhh.1000682[Crossref]
• [43] Mann S.J., James G.D., Wang R.S., Pickering T.G., Elevation of ambulatory systolic blood pressure in hypertensive smokers. A case control study, JAMA, 1991, 265, 2226–2228 http://dx.doi.org/10.1001/jama.265.17.2226[Crossref]
• [44] Harshfield G.A., Alpert B.S., Willey E.S., Somes G.W., Murphy J.K., Dupaul L.M., Race and gender influence ambulatory blood pressure patterns of adolescents, Hypertension, 1989, 14, 598–603 [Crossref]
• [45] Cuspidi C., Meani S., Salerno M., Valerio C., Fusi V., Severgnini B., Lonati L., Magrini F., Zanchetti A., Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure, Journal of Hypertension., 2004 22, 273–280 http://dx.doi.org/10.1097/00004872-200402000-00010[Crossref]

Identifiers

DOI

10.2478/s11536-008-0009-y