Undiagnosed sleep-disordered breathing among male nondippers with essential hypertension

Francesco Portaluppi, Federica Provini, Pietro Cortelli, Giuseppe Plazzi, Nino Bertozzi, Roberto Manfredini, Carmelo Fersini, Elio Lugaresi

Research output: Contribution to journalArticlepeer-review


Objective. A blunting of the nocturnal fall in arterial blood pressure is found in a minority of patients (nondippers) with essential hypertension. We tested whether sleep-disordered breathing (snoring and apnea or hypopnea) might explain such a finding for male patients, among whom its prevalence is much higher. Setting and patients. We studied 100 new cases of hypertension in men, observed consecutively by a local group of general practitioners and diagnosed essential hypertensives in a referral clinic. By using 24 h ambulatory blood pressure monitoring with a SpaceLabs 90207 device, 15 patients were classified initially nondippers (daytime ambulatory blood pressure ≤ 136/87 mmHg; night-time decrease by <10% of the daytime mean), but only 11 were confirmed to be nondippers by continuous blood pressure monitoring with a Finapres device. Ten dippers matched by age, body mass index and mean 24 h blood pressure were used as controls. Main outcome measures. Parameters of nocturnal polysomnography. Results. During polysomnography, the nondippers exhibited a blunting of the sleep-related fall in blood pressure and an increased variability in blood pressure associated with sleep-disordered breathing (heavy snoring for all, with an apnea or hypopnea index > 10 in 10 cases). Six of the control patients breathed normally and four snored nonapneically. There was a normal fall in nocturnal blood pressure in all 10 cases. Conclusions. The nondipper condition appears to be associated with undiagnosed apneic snoring for an unselected population of previously untreated male subjects with a diagnosis of essential hypertension. Ambulatory blood pressure monitoring of such patients is of limited diagnostic value.

Original languageEnglish
Pages (from-to)1227-1233
Number of pages7
JournalJournal of Hypertension
Issue number11
Publication statusPublished - 1997


  • Blood pressure
  • Circadian rhythm
  • Hypertension
  • Polysomnography
  • Sleep apnea
  • Snoring

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology


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