title: Nocturnal blood pressure in untreated essential hypertensives.
abstract: AIM. Prevalence, correlates and reproducibility of nocturnal hypertension (NH) as defined by fixed cut-off limits in uncomplicated essential hypertension are poorly defined. Therefore, we assessed such issue in a cohort of 658 untreated hypertensives. METHODS. All subjects underwent procedures including cardiac and carotid ultrasonography, 24-h urine collection for microalbuminuria, ambulatory blood pressure monitoring (ABPM), over two 24-h periods within 4 weeks. NH was defined according to current guidelines (i.e. night-time blood pressure, BP ? 120/70 mmHg) and non-dipping status as a reduction in average systolic (SBP) and diastolic BP (DBP) at night lower than 10% compared with daytime values. RESULTS. A total of 477 subjects showed NH during the first and second ABPM period; 62 subjects had normal nocturnal BP (NN) in both ABPM sessions. Finally, 119 subjects changed their pattern from one ABPM session to the other. Overall, 72.5% of subjects had reproducible NH, 18% variable pattern (VP) and 9.5% reproducible NN. In the same group, figures of reproducible non-dipping, variable dipping and reproducible dipping pattern were 24%, 24% and 52%, respectively. Among NH patients, 56% of whom were dippers, subclinical cardiac organ damage was more pronounced than in their NN counterparts. CONCLUSIONS. In uncomplicated essential hypertensives, NH is a more frequent pattern than non-dipping; NH is associated with organ damage, independently of dipping/non-dipping status. This suggests that options aimed at restoring a blunted nocturnal BP fall may be insufficient to prevent cardiovascular complications unless night-time BP values are fully normalized.
authors.affiliation: Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Italy. cesare.cuspidi@unimib.it
authors.forename: Cesare
authors.initials: C
authors.lastname: Cuspidi
authors.forename: Carla
authors.initials: C
authors.lastname: Sala
authors.forename: Cristiana
authors.initials: C
authors.lastname: Valerio
authors.forename: Francesca
authors.initials: F
authors.lastname: Negri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002940:Circadian Rhythm; D015331:Cohort Studies; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D007558:Italy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013599:Systole