Risers and extreme-dippers of nocturnal blood pressure in hypertension: antihypertensive strategy for nocturnal blood pressure.
There is increasing evidence that disruption of diurnal blood pressure (BP) variation is a risk factor for hypertensive target organ damage and cardiovascular events. Especially, the risers (extreme non-dippers), who exhibit a nocturnal BP increase compared with daytime BP, have the worst cardiovascular prognosis, both for stroke and cardiac events. On the other hand, extreme-dippers (with marked nocturnal BP falls) are at risk for non-fatal ischemic stroke and silent myocardial ischemia, particularly extreme-dippers complicated with atherosclerotic arterial stenosis and excessive BP reduction due to antihypertensive medication. Extreme-dipping status of nocturnal BP is closely associated with excessive morning BP surge and orthostatic hypertension. Hypertensive patients who have these conditions and exhibit marked BP variations are likely to have silent cerebral infarct and to be at high-risk with regard to future stroke. Individualized antihypertensive medication targeting disrupted diurnal BP variation might thus be beneficial for such high-risk hypertensive patients.
Kario
Kazuomi
K
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical School, Kawachi, Tochigi, Japan. kkario@jichi.ac.jp
Shimada
Kazuyuki
K
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control; D002940:Circadian Rhythm; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D007564:Japan; D008297:Male; D012307:Risk Factors
D000959:Antihypertensive Agents