Target organ damage and non-dipping pattern defined by two sessions of ambulatory blood pressure monitoring in recently diagnosed essential hypertensive patients

Cesare Cuspidi, Giuseppe Macca, Lorena Sampieri, Veronica Fusi, Barbara Severgnini, Iassen Michev, Maurizio Salerno, Fabio Magrini, Alberto Zanchetti

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate in a selected population of patients with a recent diagnosis of hypertension whether a reduced nocturnal fall in blood pressure, confirmed by two 24 h ambulatory blood pressure monitoring (ABPM) sessions is associated with more prominent target organ damage (TOD). Methods: The study was structured in two phases: in the first, 141 consecutive, recently diagnosed, never-treated essential hypertensives underwent 24 h ABPM twice within 3 weeks; in the second phase, 118 of these patients showing reproducible dipping or non-dipping patterns underwent the following procedures: (1) routine blood chemistry, (2) 24 h urinary collection for microalbuminuria, (3) amydriatic photography of ocular fundi, (4) echocardiography and (5) carotid ultrasonography. Results: The 92 patients with (>10%) night-time fall in systolic blood pressure (SBP) and diastolic blood pressure (DBP) (dippers) in both monitoring sessions were similar for age, gender, body surface area, smoking habit, clinic BP, 24 h and 48 h BP to the 26 patients with a ≤10% nocturnal fall (non-dippers) in both sessions. The prevalence of left ventricular hypertrophy (LVH) (defined by two criteria: (1) LV mass index ≥ 125 g/m2 in both genders; (2) LV mass index ≥ 120 and 100 g/m2 in men and women, respectively) and that of carotid intima-media (IM) thickening (IM thickness ≥ 0.8 mm) were significantly higher in non-dippers than in dippers (23 versus 5%, P <0.01; 50 versus 22%, P <0.05; and 38 versus 18%, P <0.05, respectively). There were no differences among the two groups in the prevalence of retinal changes and microalbuminuria. The strength of the association of LV mass index with night-time BP was slightly but significantly greater than that with daytime BP. Conclusions: This study suggests that a blunted reduction in nocturnal BP, persisting over time, may play a pivotal role in the development of some expressions of TOD, such as LVH and IM thickening, during the early phase of essential hypertension, despite similar clinic BP, 24 h and 48 h BP levels observed in non-dippers and dippers.

Original languageEnglish
Pages (from-to)1539-1545
Number of pages7
JournalJournal of Hypertension
Volume19
Issue number9
DOIs
Publication statusPublished - 2001

Keywords

  • Carotid thickening
  • Hypertension
  • Left ventricular hypertrophy
  • Non-dipping pattern

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology

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