title: Nondipping pattern and carotid atherosclerosis: a systematic review and meta-analysis.
abstract: Evidence on the association of nondipping pattern with carotid atherosclerosis is scarce. We performed a meta-analysis in order to provide comprehensive information on subclinical carotid alterations in nondipping as compared with dipping individuals. A computerized search was performed using PubMed, OVID, EMBASE and Cochrane library databases from 1 January 1990 up to 31 March 2015. Full articles providing data on carotid intima-media thickness (IMT) and plaque in nondipping and dipping individuals, as assessed by ultrasonography, were analyzed. A total of 2753 adult individuals (1003 nondipping and 1750 dipping) included in 13 studies were considered. Common carotid IMT was higher in nondipping than in dipping individuals [807 ± 36  μm vs. 746 ± 28  μm, standard means difference, SMD: 0.37 ± 0.09, confidence interval (CI): 0.19-0.56, P < 0.01]. From data on plaque prevalence provided by five studies, the odds ratio for carotid plaques resulted 67% higher in nondipping (95% CI: 1.26-2.21, P < 0.01) than in dipping individuals. Our findings support an association between nondipping pattern and increased risk of subclinical carotid alterations. In a practical perspective, the present meta-analysis reinforces the view that an effective blood pressure control over the entire 24-h period, in particular at night, may prevent the progression of vascular damage associated with nondipping phenotype.
authors.affiliation: aDepartment of Health Science, University of Milano-Bicocca bIstituto Auxologico Italiano cDepartment of Clinical Sciences and Community Health, University of Milano dFondazione Ospedale Maggiore Policlinico di Milano, Milano eUniversity Clinical Hospital Centre 'Dragisa Misovic', Belgrade, Serbia fIstituto di Ricerche a Carattere Scientifico Multimedica, Sesto San Giovanni, Milan, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Cuspidi
authors.forename: Carla
authors.initials: C
authors.lastname: Sala
authors.forename: Marijana
authors.initials: M
authors.lastname: Tadic
authors.forename: Elisa
authors.initials: E
authors.lastname: Gherbesi
authors.forename: Guido
authors.initials: G
authors.lastname: Grassi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D002940:Circadian Rhythm / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015995:Prevalence; D012306:Risk