Non-dipper phenomenon in essential hypertension is related to blunted nocturnal rise and fall of sympatho-vagal nervous activity and progress in retinopathy
Introduction
Non-dippers (O'Brien et al., 1988) with persistently high blood pressure (BP) levels over 24 h have been characterized with increased risk of all target organ damages and cardiovascular morbid events Verdecchia et al., 1993, Shimoda et al., 1992, Verdecchia et al., 1994 compared with dippers, with appropriate nocturnal BP fall. As have been proven by past studies, the nocturnal decline in blood pressure is diminished in diseases that cause expansion of fluid volume, such as primary aldosteronism (Tanaka et al., 1983), toxemia of pregnancy (Rath et al., 1990) and renal failure (Baumgart et al., 1991). However, the mechanism of the blunted nocturnal decline of BP and of worse target organ damage in non-dipper essential hypertension has not been fully clarified. In terms of heart rate variability, some recent studies have reported that alteration in autonomic nervous activity influenced the abnormal patterns of diurnal BP variation Kohara et al., 1995a, Kohara et al., 1995b, Kario et al., 1997. A relationship between autonomic nervous function and target organ damages has also been reported Kohara et al., 1995a, Kohara et al., 1995b, Petretta et al., 1995, Mandawat et al., 1995.
We investigated the relationship among heart rate variability, nocturnal change of blood pressure and the severity of cardiac and extracardiac target organ damages to identify the independent predictors for these target organ damages as a result of essential hypertension.
Section snippets
Subjects and protocol
We studied 52 Japanese inpatients with essential hypertension (24 men and 28 women; mean age, 49±3 years). Hypertension was defined as a systolic blood pressure (SBP) >140 mm Hg and/or a diastolic blood pressure (DBP) >90 mm Hg on at least three different occasions at the outpatient clinic; and all the hypertensive patients were followed up in the First Department of Internal Medicine in our hospital before admission. The subjects had never been medicated with anti-hypertensive agents even in
Clinical characteristics and target organ damages of hypertension in dipper and non-dipper hypertensive patients
A dipper pattern was observed in 34 patients and a non-dipper pattern was observed in 18 patients of the total subjects. The clinical characteristics and target organ damages of the patients with dipper and non-dipper essential hypertension are shown in Table 1. The sex, age, BMI, duration of hypertension, urinary excretion of NE, PRA and PAC were similar in the two groups. Plasma norepinephrine was higher in the non-dipper group than in the dipper group. The LVMI was significantly higher and
Discussions
The clinical importance of the fact that the blunted nocturnal decline in blood pressure is associated with the progression of target organ damages is well established Verdecchia et al., 1993, Shimoda et al., 1992, Verdecchia et al., 1994, Rizzoni et al., 1992. The mechanisms responsible for a non-dipper phenomenon and the relationship between non-dipper phenomenon and target organ damages have not been fully clarified. Little discussion has been done about the hypothesis that autonomic nervous
Acknowledgements
This research was supported in part by a grant-in-aid for Scientific Research (11470518) from the Ministry of Education, Science and Culture, Japan.
References (25)
- et al.
Left ventricular mass index negatively correlates with heart rate variability in essential hypertension
Am. J. Hypertens.
(1995) - et al.
Dippers and non-dippers
Lancet
(1988) - et al.
Power spectral analysis of heart rate fluctuation: a quantitative probe of beat to beat cardiovascular control
Science
(1981) - et al.
Blood pressure elevation during the night in chronic renal failure, hemodialysis and after renal transplantation
Nephron
(1991) - et al.
Relation of concentric left ventricular hypertrophy and extracardiac target organ damage to supranormal left ventricular performance in established essential hypertension
Am. J. Cardiol.
(1988) - et al.
Cardioreparative effects of lisinopril in rats with genetic hypertension and left ventricular hypertension
Circulation
(1991) Effects of physiologic and pharmacologic adrenergic stimulation on heart rate variability
J. Am. Coll. Cardiol.
(1995)- et al.
Echocardiographic determination of left ventricular mass in man: anatomic validation of the method
Circulation
(1977) - et al.
Nocturnal decline in blood pressure is attenuated by NaCl loading in salt-sensitive patients with essential hypertension. Noninvasive 24 hour ambulatory blood pressure monitoring
Hypertension
(1997) - et al.
Autonomic nervous system dysfunction in elderly hypertensive patients with diurnal blood pressure variation: relation to silent cerebrovascular disease
Hypertension
(1997)
Some different type of essential hypertension: their course and prognosis
Am. J. Med. Sci.
Autonomic nervous function in non-dipper essential hypertensive subject. Evaluation by power spectral analysis of heart rate variability
Hypertension
Cited by (99)
Difficulty initiating sleep in patients with heart failure: Impact of left atrial pressure
2022, Journal of CardiologyCitation Excerpt :Because the univariate analysis showed that patients with HF and a longer SL had less beta blocker use, insufficiently suppressed sympathetic nerve activity might have increased systolic blood pressure before sleeping and led to difficulty initiating sleep. The lack of a nocturnal dipping of blood pressure is associated with a cardiovascular risk [22] and has been reported to involve sympathetic nerve activation [23]. A previous study showed an association between poor sleep quality and a non-dipper nocturnal blood pressure pattern [24].
Nondipping heart rate: A neglected cardiovascular risk factor based on autonomic imbalance?
2018, Autonomic Neuroscience: Basic and ClinicalRelationship between nocturnal blood pressure profiles and the presence and severity of hypertensive retinopathy
2018, Revista Portuguesa de CardiologiaRetinal microvascular damage and nocturnal hypertension: Therapeutic targets to bear in mind
2018, Revista Portuguesa de CardiologiaAssociation between non-dipping blood pressure pattern and different glucometabolic profile during oral glucose tolerance test
2024, Internal and Emergency Medicine