Nocturnal non-dipping pattern in untreated hypertensives at different cardiovascular risk according to the 2003 ESH/ESC guidelines.
OBJECTIVE
To evaluate in a large population of untreated, uncomplicated essential hypertensives the relationship between alterations in nocturnal blood pressure (BP) profile, i.e. non-dipping pattern, and total cardiovascular risk.


METHODS
A total of 580 consecutive patients with grade 1 or 2 hypertension, referred to our outpatient clinic, underwent the following procedures: (i) clinical and routine laboratory examinations; (ii) 24-h ambulatory BP monitoring; (iii) 24-h collection for microalbuminuria; (iv) echocardiography; and (v) carotid ultrasonography. Cardiovascular risk was assessed according to the stratification scheme suggested by the 2003 ESH/ESC guidelines.


RESULTS
According to this classification, 16.2% of the 580 patients were considered at low added risk, 42.4% at medium added risk and 41.4% at high added risk; 38.5% of the overall population was classified in the high-risk stratum because of at least one manifestation of target organ damage (TOD) and 6.3% for the presence of three or more risk factors. The prevalence rates of a non-dipping pattern (decrease in BP at night < or = 10% compared with the average daytime values) were 28.5% in low-risk, 32.6% in medium-risk and 42.2% in high-risk patients, respectively. CONCLUSIONS. Our findings show that the prevalence of a non-dipping profile is significantly greater in patients stratified at high compared with those at low and medium added risk.
Cuspidi
Cesare
C
Istituto di Medicina Cardiovascolare, Università di Milano, and Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Ospedale Maggiore Policlinico IRCCS, Milano, Italy. dhipertensione@libero.it
Meani
Stefano
S
Valerio
Cristiana
C
Fusi
Veronica
V
Zanchetti
Alberto
A
D000328:Adult; D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D002940:Circadian Rhythm; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000453:epidemiology* / Q000652:urine; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000652:urine; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors