Dippers versus non-dippers.
Clinical studies with non-invasive ambulatory blood pressure monitoring have shown that some cardiovascular complications of essential hypertension (left ventricular hypertrophy, stroke) tend to be more frequent in patients whose 24-h blood pressure profile is flattened (non-dippers) and, consequently, suffer a longer duration of exposure to high blood pressure levels over the 24 h. The distribution of patients between dippers and non-dippers is conditioned by the limits of the blood pressure changes from day to night that are arbitrarily chosen to define these two groups, and by the time intervals defining daytime and night-time hours. Sleep does not seem to be disturbed by non-invasive monitoring to such an extent that the day-night blood pressure difference is affected. If daytime is defined as 0600-2200 h and night-time as 2200-0600 h, and those hypertensive patients with a nocturnal reduction in average daytime systolic and diastolic blood pressure of less than 10% are classed as non-dippers, the prevalence of non-dippers in essential hypertension appears to be about 35%. In these patients, left ventricular mass seems to be greater in non-dippers than in dippers among women, but not in men. The clinical significance of the dippers/non-dippers classification in the stratification of hypertensive patients of different levels of risk of cardiovascular complications needs further investigation.
Managing the Non-Dippers: Possible? Worth It? | Medscape
George Bakris, MD; Mahboob Rahman, MD
April 24, 2012
By George Bakris, MD; Mahboob Rahman, MD | Disclosures | April 24, 2012
George Bakris, MD: Hello. I’m Dr. George Bakris, Professor of Medicine and Director of the Hypertensive Diseases Center at the University of Chicago Pritzker School of Medicine. I am joined today by Dr. Mahboob Rahman, Associate Professor at Case Western Reserve University in the Division of Nephrology and Hypertension. Today we are going to be talking about nocturnal blood pressure — its importance, its relevance, and whether we can convert people who are non-dippers to dipping status. If we can, what does that mean for prognosis? Mahboob, good morning.
Mahboob Rahman, MD: Good morning.
Dr. Bakris: Let’s start off by defining a non-dipper.
Dr. Rahman: “Non-dipper” is a term that is used to describe a change in blood pressure that happens during the daytime compared with the nighttime. This is a concept that has been around for quite a long time, ever since the advent of ambulatory blood pressure monitoring. It has been known for years that blood pressure at night is typically lower than blood pressure during the day. There is a somewhat arbitrary cut-off of about 10%. If your blood pressure declines less than 10% during the night compared with what it was during the day, you are defined as a non-dipper.
Dr. Bakris: In other words, the only way you can make that determination is by doing 24-hour ambulatory monitoring.
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