Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension
Abstract
Resistant hypertension (RHTN) includes both patients whose blood pressure (BP) is uncontrolled on three or more medications (uncontrolled RHTN (UCRH)) and patients whose BP is controlled with use of four or more drugs (controlled RHTN (CRH)). It is unknown whether endothelial function and nocturnal drop demonstrate a similar pattern in patients with CRH and UCRH. We examined circadian BP patterns and vascular function in these patients. In all, 40 CRH and 26 UCRH patients, and 25 normotensives underwent biochemical testing, ambulatory BP monitoring, determination of brachial artery responses to endothelial-dependent (flow-mediated; dilation (FMD)) and independent (nitroglycerin mediated) stimuli. The nighttime drop in systolic BP (SBP) and diastolic BP (DBP) was less pronounced in UCRH than in CRH (SBP, 1.9±1.6 versus 4.9±1.7%; DBP, 7.5±1.8 versus 10.9±1.8%, UCRH and CRH, respectively; P<0.05). FMD was greater in control group compared with RHTN patients. Patients with UCRH had significantly impaired FMD compared with CRH (5.9±2.3% versus 7.1±5.1%; P<0.0001). Therefore, UCRH patients have less nocturnal dipping and a more impaired endothelial response compared with CRH patients. These findings suggest that important differences among patients with RHTN may allow identify subgroups with increased cardiovascular risk.
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Physiological aberrations in resistant hypertension include vascular disease/dysfunction as evidenced by high rates of peripheral and carotid artery atherosclerosis, impaired endothelial function, reduced arterial compliance, and raised systemic vascular resistance, all of which may be more pronounced in resistant hypertension compared with non-resistant hypertension.
“Physiological aberrations in RH include vascular disease/dysfunction as evidenced by high rates of peripheral39 and carotid artery atherosclerosis,42 impaired endothelial function,51,52 reduced arterial compliance, and raised systemic vascular resistance,40 all of which may be more pronounced in RH compared with non-RH.”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [52]
The attenuated nocturnal decline in blood pressure is even more pronounced in uncontrolled compared with controlled resistant hypertension.
“The attenuated nocturnal decline in BP is even more pronounced in uncontrolled compared with controlled RH.52”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [52]
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Ilić, A., Stojšić‐Milosavljević, A., Miljković, T., Bjelobrk, M., Stojšić, S., Tadić, S., Stefanović, M., Vulin, A., Preveden, A., Komazec, N., et al. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms252011324 · Cited by 3 · see citing works
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Blood pressure variability in CKD patients with and without nocturnal hypertension
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The Correlation Between Arterial Hypertension and Endothelial Function
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The Correlation Between Arterial Hypertension and Endothelial Function
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POSICIONAMENTO BRASILEIRO SOBRE HIPERTENSÃO ARTERIAL RESISTENTE – 2020
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- Authors
- Quinaglia, T., Martins, L. C., Figueiredo, V. N., Santos, R. C., Yugar-Toledo, J. C., Martin, J. F. V., Demacq, C., Pimenta, E., Calhoun, D. A., & Moreno, H.
- Affiliations
- Universidade Estadual de Campinas (UNICAMP) (BR)
- The University of Queensland (AU)
- University of Alabama at Birmingham (US)
- Corresponding author
- Moreno, H
- Venue
- Journal of Human Hypertension
- Published
- 2011-05-05
- Volume
- 25
- Issue
- 11
- Pages
- 656-664
- ISSN
- 0950-9240 (ISSN-L)
- 1476-5527
- OpenAlex
- W1968519415
- Cited by
- 57
- References
- 47
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 3 · 2020: 9 · 2019: 2 · 2018: 4 · 2017: 1 · 2016: 5 · 2015: 5 · 2014: 4 · 2013: 10 · 2012: 5
- FWCI
- 4.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Human Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Fundação de Amparo à Pesquisa do Estado de São Paulo
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Keywords
- resistant hypertension, endothelial dysfunction, nocturnal blood pressure dipping, circadian blood pressure rhythm, flow-mediated dilation, cardiovascular risk stratification
- MeSH terms
- Adult, Analysis of Variance, Antihypertensive Agents, Blood Pressure, Brachial Artery, Brazil, Cardiovascular Diseases, Circadian Rhythm, Drug Resistance, Drug Therapy, Combination, Endothelium, Vascular, Female, Nitroglycerin, Humans, Hypertension, Male, Middle Aged, Risk Factors, Ultrasonography, Vasodilation, Vasodilator Agents, Linear Models, Treatment Failure, Risk Assessment, Blood Pressure Monitoring, Ambulatory
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