Refractory hypertension focus on nighttime blood pressure and nondipping

Refractory hypertension focus on nighttime blood pressure and nondipping In the past decades, a growing number of investigations, performed in different clinical settings, has been devoted to circadian variations in blood pressure (BP) and to nocturnal BP levels with the aim to clarify their associations with demographic/clinical variables, conventional risk factors, subclinical organ damage, and incident cardiovascular disease. In particular, two lines of clinical research have investigated this issue focusing on the nondipping status and nocturnal hypertension.Although nondipping status, as opposed to the dipping status, is commonly regarded as a clinical trait characterized by more advanced organ damage and a worse cardiovascular prognosis, this issue is still largely debated. This is because a number of studies have failed to show differences in intermediate end points such as cardiac and extracardiac target organ damage and hard outcomes between nondippers and dippers after adjustment for several confounders including average 24‐hour BP values. Moreover, it should be noted that a full preserved BP fall at night (ie, dipping status) may not necessarily result in a normal nighttime BP profile, as defined by the cutoff limits (ie, <120/70 mm Hg) recommended by authoritative hypertension guidelines. This means that dipping status and nocturnal normotension may be dissociated and represent different ambulatory BP phenotypes as shown http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Clinical Hypertension Wiley

Refractory hypertension focus on nighttime blood pressure and nondipping

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
Copyright © 2018 Wiley Periodicals, Inc.
ISSN
1524-6175
eISSN
1751-7176
D.O.I.
10.1111/jch.13196
Publisher site
See Article on Publisher Site

Abstract

In the past decades, a growing number of investigations, performed in different clinical settings, has been devoted to circadian variations in blood pressure (BP) and to nocturnal BP levels with the aim to clarify their associations with demographic/clinical variables, conventional risk factors, subclinical organ damage, and incident cardiovascular disease. In particular, two lines of clinical research have investigated this issue focusing on the nondipping status and nocturnal hypertension.Although nondipping status, as opposed to the dipping status, is commonly regarded as a clinical trait characterized by more advanced organ damage and a worse cardiovascular prognosis, this issue is still largely debated. This is because a number of studies have failed to show differences in intermediate end points such as cardiac and extracardiac target organ damage and hard outcomes between nondippers and dippers after adjustment for several confounders including average 24‐hour BP values. Moreover, it should be noted that a full preserved BP fall at night (ie, dipping status) may not necessarily result in a normal nighttime BP profile, as defined by the cutoff limits (ie, <120/70 mm Hg) recommended by authoritative hypertension guidelines. This means that dipping status and nocturnal normotension may be dissociated and represent different ambulatory BP phenotypes as shown

Journal

Journal of Clinical HypertensionWiley

Published: Jan 1, 2018

References

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