Family Med Medical News about hypertension;nocturnal blood pressure

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Fagard RH et al. – Findings show that a reverse dipping pattern is associated with worse prognosis in hypertensive pts.

Methods

Review of the dipping pattern of nocturnal blood pressure in hypertensive pts
Assessment of prognostic significance of 4 dipping categories in hypertension
Large meta-analysis of individual pt data
Dipping categories based on night–day blood pressure ratio from 24-hr ambulatory blood pressure recordings
Extreme dippers: night–day blood pressure ratio ≤0.8
Dippers: 0.8 < ratio ≤0.9
Nondippers: 0.9 < ratio ≤1.0
Reverse dippers: ratio > 1.0

Results

In hypertensive pts without cardiovascular disease at baseline and with statistical adjustment for confounders and 24-hr blood pressure, mortality is lower in extreme dippers vs dippers
Incidence of cardiovascular events higher in reverse dippers
Worst prognosis for reverse dippers in hypertensive pts with major cardiovascular disease at baseline
Higher incidences of cardiovascular events and mortality in reverse dippers vs with dippers in comprehensive meta-analysis of population-based studies
Outcome not significantly different between extreme dippers vs dippers

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