Causes and mechanisms of nondipping hypertension.
Growing evidence indicates that nondippers have worsened cardiovascular outcomes than dippers. Ambulatory blood pressure monitoring with a lack of nocturnal BP fall (nondipping) have also been shown to be more closely associated with target organ damage and worsened cardiovascular outcome than in patients with essential hypertension with dipping pattern. The underlying pathogenetic mechanisms potentially linking nondipping with cardiovascular disease are not fully understood. There are multiple possible underlying pathophysiologic mechanisms in the impaired BP decline during the night. Extrinsic and intrinsic factors including abnormal neurohormonal regulation, lack of physical activity, nutritional factors such as increased dietary sodium intake, and smoking of tobacco have been implicated for blunted circadian rhythm of BP. Certain diseases such as diabetes and chronic renal diseases also affect the circadian BP rhythm. Currently, the clinical importance of nondipping is known well; however, the relationship between certain disease states and nondipping has not been fully explained yet. This paper will attempt to address to clarify the underlying basis for nondipping and the specific associations with various disease states.
Department of Internal Medicine, Section of Nephrology, Fatih University School of Medicine, Ankara, Turkey. mkanbay@fatih.edu.tr
Mehmet
M
Kanbay
Faruk
F
Turgut
Mehtap Erkmen
ME
Uyar
Ali
A
Akcay
Adrian
A
Covic
D000375:Aging / Q000502:physiology; D001341:Autonomic Nervous System / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D021081:Chronobiology Disorders / Q000503:physiopathology*; D002940:Circadian Rhythm / Q000502:physiology; D048909:Diabetes Complications / Q000503:physiopathology; D005260:Female; D006728:Hormones / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000503:physiopathology; D053158:Nocturia / Q000150:complications / Q000503:physiopathology; D009765:Obesity / Q000150:complications / Q000503:physiopathology; D011470:Prostatic Hyperplasia / Q000150:complications / Q000503:physiopathology; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000503:physiopathology; D012982:Sodium, Dietary / Q000009:adverse effects
D006728:Hormones; D012982:Sodium, Dietary