Nocturnal blood pressure in untreated essential hypertensives.

Aim. Prevalence, correlates and reproducibility of nocturnal hypertension (NH) as defined by fixed cut-off limits in uncomplicated essential hypertension are poorly defined. Therefore, we assessed such issue in a cohort of 658 untreated hypertensives. Methods. All subjects underwent procedures including cardiac and carotid ultrasonography, 24-h urine collection for microalbuminuria, ambulatory blood pressure monitoring (ABPM), over two 24-h periods within 4 weeks. NH was defined according to current guidelines (i.e. night-time blood pressure, BP 65 120/70 mmHg) and non-dipping status as a reduction in average systolic (SBP) and diastolic BP (DBP) at night lower than 10% compared with daytime values. Results. A total of 477 subjects showed NH during the first and second ABPM period; 62 subjects had normal nocturnal BP (NN) in both ABPM sessions. Finally, 119 subjects changed their pattern from one ABPM session to the other. Overall, 72.5% of subjects had reproducible NH, 18% variable pattern (VP) and 9.5% reproducible NN. In the same group, figures of reproducible non-dipping, variable dipping and reproducible dipping pattern were 24%, 24% and 52%, respectively. Among NH patients, 56% of whom were dippers, subclinical cardiac organ damage was more pronounced than in their NN counterparts. Conclusions. In uncomplicated essential hypertensives, NH is a more frequent pattern than non-dipping; NH is associated with organ damage, independently of dipping/non-dipping status. This suggests that options aimed at restoring a blunted nocturnal BP fall may be insufficient to prevent cardiovascular complications unless night-time BP values are fully normalize

Left ventricular hypertrophy and abdominal aorta size in essential hypertension

AIM: To investigate the association between subclinical organ damage and abdominal aortic diameter in a large cohort of uncomplicated essential hypertensive patients. Methods: Subclinical markers of organ damage (i.e. left ventricular mass, carotid intima-media thickness and plaques, microalbuminuria and retinal changes) and abdominal aortic diameter (ultrasonography) were assessed in 2430 (mean age 53 \ub1 13 years) untreated and treated hypertensive patients included in the Evaluation of Target Organ Damage in Hypertension (ETODH) study. Results: In the whole study population, left ventricular mass index was the most important correlate (\u3b2 = 0.418, P < 0.0001) of the absolute abdominal aortic diameter and, after age, (\u3b2 = 0.268, P < 0.0001) of abdominal aortic diameter indexed to body surface area (abdominal aorta index, AAI). In a sex-based analysis, a stepwise increase in left ventricular mass index as well as in prevalence of left ventricular hypertrophy (LVH), carotid intima-media thickness and plaques occurred from the lower to the upper quartile of AAI in men, but not in women. No correlations were found between AAI and microalbuminuria or retinal changes. Conclusion: Our findings support a sex-specific relation between abdominal aorta size and subclinical organ damage by showing that LVH in hypertensive men is an independent correlate for enlarged abdominal aorta. On the basis of these data, diagnostic protocols for detecting subclinical alterations in the abdominal aorta should be optimized

Is the nocturnal fall in blood pressure reduced in essential hypertensive patients with metabolic syndrome?

Objective: The aim of this study was to examine whether an impaired reduction in nocturnal blood pressure (BP), defined on the basis of two periods of ambulatory BP monitoring (ABPM), is present in hypertensive patients with metabolic syndrome, as defined by the NCEP criteria. Methods: 460 grade 1 and 2 untreated essential hypertensives (mean age 45.9 \ub1 11.9 years) referred for the first time to our outpatient hospital clinic underwent the following procedures: 1) medical history and physical examination; 2) repeated clinic BP measurements; 3) routine examinations; 4) ABPM over two 24-hour periods within 4 weeks. Metabolic syndrome was defined as at least three of the following alterations: increased waist circumference, increased triglycerides, decreased HDL-cholesterol, increased BP, or high fasting glucose. Nocturnal dipping was defined as a night-time reduction in average SBP and DBP > 10% compared to average daytime values. Results: The 135 patients with metabolic syndrome (group I) were similar for age, gender and known duration of hypertension to the 325 patients without it (group II). There were no significant differences between the two groups in average 48-hour, daytime, night-time SBP/DBP values and the percentage nocturnal SBP and DBP decrease (-17.7/-15.7 vs.-18.4/-16.2, p = ns). A reproducible nocturnal dipping (decrease in BP > 10% from mean daytime in both ABPM periods) and non-dipping profile (decrease in BP 64 10% in both ABPM periods) was found in 74 (54.8%) and 29 (21.4%) in group I and in 169 (52.1%) and 73 (22.4%) in group II, respectively (p = ns); 32 patients (23.7%) in group I and 83 patients (25.5%) in group II had a variable dipping profile (p = ns). Conclusions: This study shows that no significant difference exists in nocturnal BP patterns, assessed by two ABPMs, in untreated essential hypertensive patients with metabolic syndrome compared to those without it