Prevalence and Factors Associated With Circadian Blood Pressure Patterns in Hypertensive Patients
Open accessAbstract
Ambulatory blood pressure (BP) monitoring has become useful in the diagnosis and management of hypertensive individuals. In addition to 24-hour values, the circadian variation of BP adds prognostic significance in predicting cardiovascular outcome. However, the magnitude of circadian BP patterns in large studies has hardly been noticed. Our aims were to determine the prevalence of circadian BP patterns and to assess clinical conditions associated with the nondipping status in groups of both treated and untreated hypertensive subjects, studied separately. Clinical data and 24-hour ambulatory BP monitoring were obtained from 42 947 hypertensive patients included in the Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry. They were 8384 previously untreated and 34 563 treated hypertensives. Twenty-four-hour ambulatory BP monitoring was performed with an oscillometric device (SpaceLabs 90207). A nondipping pattern was defined when nocturnal systolic BP dip was <10% of daytime systolic BP. The prevalence of nondipping was 41% in the untreated group and 53% in treated patients. In both groups, advanced age, obesity, diabetes mellitus, and overt cardiovascular or renal disease were associated with a blunted nocturnal BP decline ( P <0.001). In treated patients, nondipping was associated with the use of a higher number of antihypertensive drugs but not with the time of the day at which antihypertensive drugs were administered. In conclusion, a blunted nocturnal BP dip (the nondipping pattern) is common in hypertensive patients. A clinical pattern of high cardiovascular risk is associated with nondipping, suggesting that the blunted nocturnal BP dip may be merely a marker of high cardiovascular risk.
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Variation in the day-night blood pressure pattern appears to be an important predictor of both target organ damage and cardiovascular events.
“Furthermore, variation in the day–night blood pressure pattern appears to be an important predictor of both target organ damage and cardiovascular events 68.”
From The Circadian Syndrome: is the Metabolic Syndrome and much more! (2019) · cites this paper as [68]
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“Diastolic aBPM, daytime, mm Hg 84 (9) 85 (10) 85 (9) 87 (8) 0.”
Rahman, A., Kittikulsuth, W., Fujisawa, Y., Sufiun, A., Rafiq, K., Hitomi, H., Nakano, D., Sohara, E., Uchida, S., & Nishiyama, A. (2016) · Journal of Hypertension · doi:10.1097/hjh.0000000000000871 · Cited by 52 · see citing works
de la Sierra, A., Vinyoles, E., Banegas, J., Segura, J., Gorostidi, M., de la Cruz, J. D., & Ruilope, L. (2017) · Journal of Hypertension · doi:10.1097/hjh.0000000000001493 · Cited by 54 · see citing works
Self-citationde la Sierra, A., Vinyoles, E., Banegas, J. R., Parati, G., de la Cruz, J. J., Gorostidi, M., Segura, J., & Ruilope, L. M. (2016) · Journal of Clinical Hypertension · doi:10.1111/jch.12792 · Cited by 51 · see citing works
Self-citationCrinion, S. J., Ryan, S., & McNicholas, W. T. (2017) · European Respiratory Journal · doi:10.1183/13993003.01818-2016 · Cited by 50 · see citing works
Orthostatic hypotension is associated with nocturnal change in systolic blood pressure
Voichanski, S., Grossman, C., Leibowitz, A., Peleg, E., Koren-Morag, N., Sharabi, Y., Shamiss, A., & Grossman, E. (2012) · American Journal of Hypertension · doi:10.1038/ajh.2011.191 · Cited by 49 · see citing works
Diurnal blood pressure variation, risk categories and antihypertensive treatment
de la Sierra, A., Segura, J., Gorostidi, M., Banegas, J. R., de la Cruz, J. J., & Ruilope, L. M. (2010) · Hypertension Research · doi:10.1038/hr.2010.111 · Cited by 49 · see citing works
Self-citationHabitual coffee consumption and 24-h blood pressure control in older adults with hypertension
López‐García, E., ARBELAEZ, E. O., León-Muñoz, L. M., Guallar‐Castillón, P., Graciani, A., Banegas, J. R., & Rodríguez‐Artalejo, F. (2016) · Clinical Nutrition · doi:10.1016/j.clnu.2016.03.021 · Cited by 49 · see citing works
Self-citationHermida, R. C., Ríos, M. T., Crespo, J. J., Moyá, A., Domínguez-Sardiña, M., Otero, A., Sánchez, J. J., Mojón, A., Fernández, J. R., Ayala, D. E., et al. (2013) · Chronobiology International · doi:10.3109/07420528.2012.701460 · Cited by 48 · see citing works
“…on the published literature, it is common for a large proportion of hypertensive patients, including those with RH, to ingest all their hypertension medications in the morning (de la Sierra et al., 2009, 2011; Hermida et al., 2002c, 2005a, 2008, 2010b; Muxfeldt et al., 2003; Salles et al., 2008).”
BackgroundHypotension as a marker or mediator of perioperative organ injury: a narrative review
Ackland, G. L., & Abbott, T. E. F. (2022) · British Journal of Anaesthesia · doi:10.1016/j.bja.2022.01.012 · Cited by 50 · see citing works
Rotter, D., Grinsfelder, D. B., Parra, V., et al. (2014) · Journal of Molecular and Cellular Cardiology · doi:10.1016/j.yjmcc.2014.05.004 · Cited by 48 · see citing works
“For instance, in humans, the incidence ofmyocardial infarction (MI) [7,8], sudden cardiac death [9,10], ventricular tachyarrhythmias [11], and rupture of aortic aneurysms [12–14] peaks in themorning around the time of transition from sleep towaking [15,16].”
BackgroundRahman, A., Hitomi, H., & Nishiyama, A. (2017) · Hypertension Research · doi:10.1038/hr.2016.193 · Cited by 47 · see citing works
CHILTON, R. J., Tikkanen, I. T., Hehnke, U., Woerle, H. J., & Johansen, O. E. (2017) · Diabetes Obesity and Metabolism · doi:10.1111/dom.12962 · Cited by 48 · see citing works
“Physiologically, BP displays a circadian rhythm, peaking during the day and decreasing, or dipping, during the night.12 Obese hypertensive patients with T2DM and/or renal or cardiovascular disease frequently demonstrate a blunted, or non-dipping, decrease in nocturnal BP.13 Non-dipping is associated with an increased…”
BackgroundInfluentialRole of ambulatory and home blood pressure recording in clinical practice.
Ghuman, N., Campbell, P., & White, W. B. (2009) · Current Cardiology Reports · doi:10.1007/s11886-009-0060-6 · Cited by 44 · see citing works
“Numerous studies showed that mean ambulatory BP averages are lower than clinic BP averages and correlate better with end-organ damage [ 43 ].”
BackgroundResultNon-Dipping Blood Pressure or Nocturnal Hypertension: Does One Matter More?
Tang, A. B., Yang, E., & Ebinger, J. E. (2023) · Current Hypertension Reports · doi:10.1007/s11906-023-01273-1 · Cited by 49 · see citing works
The effect of zolpidem on sleep quality, stress status, and nondipping hypertension
Huang, Y., Mai, W., Cai, X., Hu, Y., Song, Y., Qiu, R., Wu, Y., & Kuang, J. (2011) · Sleep Medicine · doi:10.1016/j.sleep.2011.07.016 · Cited by 45 · see citing works
“It has been reported that, on average, each 5% attenuation in the decline in nocturnal systolic BP (SBP)/diastolic BP (DBP) conferred a 20% rise in the risk of cardiovascular mortality, and the prevalence of nondipping was 41% in hypertensive patients untreated with anti-hypertensive medication and 53% in treated pati…”
BackgroundMethodInfluentialNondipping Nocturnal Blood Pressure Predicts Sleep Apnea in Patients With Hypertension
Crinion, S. J., Ryan, S., Kleinerova, J., Kent, B. D., Gallagher, J., Ledwidge, M., McDonald, K., & McNicholas, W. T. (2019) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7870 · Cited by 45 · see citing works
“34 Furthermore, there was no difference in the proportion of pa - tients with drug-rest hypertension between dippers and non-dippers in our cohort.”
Kario, K., Hoshide, S., Nagai, M., Okawara, Y., & Kanegae, H. (2021) · Hypertension Research · doi:10.1038/s41440-021-00709-y · Cited by 45 · see citing works
Isolated Nocturnal Hypertension: What Do We Know and What Can We Do?
Tadic, M. V., Cuspidi, C., Grassi, G. M., & Mancia, G. (2020) · Integrated Blood Pressure Control · doi:10.2147/ibpc.s223336 · Cited by 44 · see citing works
Hermida, R. C., Ayala, D. E., Mojón, A., & Fernández, J. R. (2009) · American Journal of Hypertension · doi:10.1038/ajh.2009.260 · Cited by 44 · see citing works
Çiçek, Y., Durakoğlugil, M. E., Kocaman, S. A., Çetın, M., Erdoğan, T., Doğan, S., Uğurlu, Y., & Çanğa, A. (2012) · Blood Pressure · doi:10.3109/08037051.2012.701409 · Cited by 43 · see citing works
Impact of non-dipping on cardiovascular outcomes in patients with obstructive sleep apnea syndrome
Sasaki, N., Ozono, R., Edahiro, Y., Ishii, K., Seto, A., Okita, T., Teramen, K., Fujiwara, S., & Kihara, Y. (2015) · Clinical and Experimental Hypertension · doi:10.3109/10641963.2015.1057833 · Cited by 44 · see citing works
“disease, and diabetes mellitus were associated with the increased prevalence of non-dipping (25), and OSAS was frequently accompanied by these factors.”
BackgroundPati, P., Fulton, D. J., Bagi, Z. A., Chen, F., Wang, Y., Kitchens, J., Cassis, L. A., Stepp, D. W., & Rudic, R. D. (2016) · Hypertension · doi:10.1161/hypertensionaha.115.06194 · Cited by 43 · see citing works
“hypertension has recently been reported to be as high as 45% in individuals,(33) and even higher in patients being treated with antihypertensives (53%).(43) Indeed, it is established that nondipping or nocturnal hypertension has a substantially negative influence on patient morbidity.”
BackgroundSeasonal variation in nocturnal home blood pressure fall: the Nagahama study
and the Nagahama study group, Tabara, Y., Matsumoto, T., Murase, K., Nagashima, S., Hirai, T., Kosugi, S., Nakayama, T., Wakamura, T., Chin, K., et al. (2018) · Hypertension Research · doi:10.1038/s41440-017-0003-3 · Cited by 43 · see citing works
Complexities in cardiovascular rhythmicity: perspectives on circadian normality, ageing and disease
Monfredi, O., & Lakatta, E. G. (2019) · Cardiovascular Research · doi:10.1093/cvr/cvz112 · Cited by 40 · see citing works
Katz, A., Lemoine, Wade, Nir, & Zisapel (2012) · Integrated Blood Pressure Control · doi:10.2147/ibpc.s27240 · Cited by 39 · see citing works
Gijón‐Conde, T., Gorostidi, M., Banegas, J. R., de la Sierra, A., Segura, J., Vinyoles, E., Divisón, J. A., & Ruilope, L. M. (2019) · Hipertensión y Riesgo Vascular · doi:10.1016/j.hipert.2019.05.002 · Cited by 41 · see citing works
Self-citationMancia, G., Facchetti, R., Bombelli, M., Quarti‐Trevano, F., Cuspidi, C., & Grassi, G. M. (2021) · Hypertension · doi:10.1161/hypertensionaha.120.16827 · Cited by 39 · see citing works
Elevated Ambulatory Blood Pressure in a Multi-Ethnic Population of Obese Children and Adolescents
Aguilar, A., Ostrow, V., Luca, F. D., & Suarez, E. A. (2010) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2009.12.028 · Cited by 39 · see citing works
Ruiz‐Hurtado, G., Ruilope, L. M., de la Sierra, Á., Sarafidis, P. A., de la Cruz, J. J., Gorostidi, M., Segura, J., Vinyoles, E., & Banegas, J. R. (2016) · Diabetes Care · doi:10.2337/dc16-0748 · Cited by 39 · see citing works
Self-citationDrummond, J. C., Blake, J., Patel, P. M., et al. (2012) · Journal of Neurosurgical Anesthesiology · doi:10.1097/ana.0b013e31827a0151 · Cited by 38 · see citing works
Mezick, E. J., Matthews, K. A., Hall, M. H., Kamarck, T. W., Strollo, P. J., Buysse, D. J., Owens, J. F., & Reís, S. E. (2010) · Health Psychology · doi:10.1037/a0017790 · Cited by 38 · see citing works
“Moreover, epidemiological studies frequently use a similar ratio when reporting relationships between BP rhythms and disease risk or cardiovascular co-morbidities (e.g., de la Sierra et al., 2009; Fagard, Thijs, Staessen, Clement, De Buyzere, & De Bacquer, 2009).”
BackgroundKräuchi, K., Gompper, B., Hauenstein, D., Flammer, J., Pflueger, M. O., Studerus, E., Schötzau, A., & Orgül, S. (2012) · Chronobiology International · doi:10.3109/07420528.2012.719961 · Cited by 38 · see citing works
“…(r = −.607, p < .0001), but not with d-MAP (r = .032, n.s.; Table 4 and thin arrows in Figure 5), we support the notion that dipping patterns mainly depend on the nocturnal decline in BP (Birkenhager & van denMeiracker, 2007; Dolan et al., 2005;Modesti et al., 2006; de la Sierra et al., 2009).”
ResultDecoding white coat hypertension
Bloomfield, D. A., & Park, A. (2017) · World Journal of Clinical Cases · doi:10.12998/wjcc.v5.i3.82 · Cited by 37 · see citing works
White matter hyperintensities mediate the association of nocturnal blood pressure with cognition
Chesebro, A. G., Melgarejo, J. D., Leendertz, R., et al. (2020) · Neurology · doi:10.1212/wnl.0000000000009316 · Cited by 37 · see citing works
“Nondipping, or a lack of nocturnal decline in blood pressure levels, is a frequent comorbidity with hypertension, with >40% of hypertensive older adults experiencing nondipping.(9,10) Nondipping is associated with an increased risk of type 2 diabetes mellitus, reduced renal function, and left ventricular hypertrophy,…”
BackgroundBurnier, M., Kreutz, R. H., Narkiewicz, K., Kjeldsen, S. E., Oparil, S., & Mancia, G. (2020) · Journal of Hypertension · doi:10.1097/hjh.0000000000002532 · Cited by 42 · see citing works
“Currently, the night-time dip is a recognized measure of cardiovascular risk with a strong predictive value for adverse cardiovascular events [46].”
BackgroundShin, S. M., Shim, W., & Park, S. (2014) · Clinical and Experimental Hypertension · doi:10.3109/10641963.2013.863326 · Cited by 35 · see citing works
Comparative Prognostic Role of Nighttime Blood Pressure and Nondipping Profile on Renal Outcomes
Tsioufis, C. P., Andrikou, I., Thomopoulos, C., Petras, D., Manolis, A. J., & Stefanadis, C. (2011) · American Journal of Nephrology · doi:10.1159/000324697 · Cited by 37 · see citing works
“Along the same lines, in a large cohort of 42,947 hypertensive patients [”
ResultSueta, D., Kataoka, K., Koibuchi, N., Toyama, K., Uekawa, K., Katayama, T., Ma, M., Nakagawa, T., Waki, H., Maeda, M., et al. (2013) · Journal of the American Heart Association · doi:10.1161/jaha.113.000035 · Cited by 37 · see citing works
“The major findings of this work are as follows: (1) SHRcp display nondipper hypertension, differing from SHR, and are therefore a suitable animal model for studying the mechanism underlying abnormal circadian BP rhythm in MetS; and (2) it is likely that this disrupted circadian BP rhythm in SHRcp was at least in part…”
BackgroundResultKoroboki, E., Manios, E. D., Ψαλτοπούλου, Θ., et al. (2013) · PubMed · Cited by 36 · see citing works
O’Flynn, A. M., Madden, J. M., Russell, A., et al. (2015) · Hypertension Research · doi:10.1038/hr.2015.43 · Cited by 35 · see citing works
Amyloid burden and sleep blood pressure in amnestic mild cognitive impairment
Tarumi, T., Harris, T. S., Hill, C., German, Z., Riley, J. R., Turner, M., Womack, K. B., Kerwin, D. R., Monson, N. L., Stowe, A. M., et al. (2015) · Neurology · doi:10.1212/wnl.0000000000002167 · Cited by 35 · see citing works
“The age difference between the dippers and nondippers observed in the present study is consistent with the literature.(29) In contrast, the link between the elevated sleep BP and Ab provide new insights into the previous observations that nondippers have a higher risk of cognitive impairment and brain structural deter…”
ResultBrunner‐Ziegler, S., Jilma, B., Schoergenhofer, C., et al. (2015) · Journal of Thrombosis and Haemostasis · doi:10.1111/jth.13213 · Cited by 34 · see citing works
Cai, A., Zhong, Q., Liu, C., Zhou, D., Li, X., Zhang, Y., Feng, Y., & Zhou, Y. (2016) · Hypertension Research · doi:10.1038/hr.2016.82 · Cited by 32 · see citing works
Acelajado, M. C., Pisoni, R., Dudenbostel, T., Oparil, S., Calhoun, D. A., & Glasser, S. P. (2011) · Journal of the American Society of Hypertension · doi:10.1016/j.jash.2011.09.001 · Cited by 34 · see citing works
Gray, C., Gardiner, S. M., Elmes, M. J., & Gardner, D. S. (2015) · British Journal Of Nutrition · doi:10.1017/s0007114515004936 · Cited by 34 · see citing works
“48[39-50] 209 mm Hg for medians [IQR] of CD vs.”
BackgroundWang, C., Deng, W., Gong, W., et al. (2015) · Journal of Clinical Hypertension · doi:10.1111/jch.12589 · Cited by 33 · see citing works
Riser Pattern: Another Determinant of Heart Failure With Preserved Ejection Fraction
Komori, T., Eguchi, K., Saito, T., Hoshide, S., & Kario, K. (2016) · Journal of Clinical Hypertension · doi:10.1111/jch.12818 · Cited by 32 · see citing works
“It was reported that patients with advanced age, obesity, diabetes, dyslipidemia, a history of stroke or coronary heart disease, and CKD show an association with the riser BP pattern.(25) Sleep apnea syndrome and poor sleep quality are additional causes of the riser BP pattern.”
BackgroundAntihypertensive Medication Adherence and Confirmation of True Refractory Hypertension
Siddiqui, M., Judd, E. K., Dudenbostel, T., Gupta, P., Tomaszewski, M., Patel, P., Oparil, S., & Calhoun, D. A. (2019) · Hypertension · doi:10.1161/hypertensionaha.119.14137 · Cited by 33 · see citing works
Nocturnal urinary melatonin excretion is associated with non-dipper pattern in elderly hypertensives
Obayashi, K., Saeki, K., Iwamoto, J., Okamoto, N., Tomioka, K., Nezu, S., Ikada, Y., & Kurumatani, N. (2013) · Hypertension Research · doi:10.1038/hr.2013.20 · Cited by 32 · see citing works
- Authors
- de la Sierra, A., Redon, J., Banegas, J. R., Segura, J., Parati, G., Gorostidi, M., de la Cruz, J. J., Sobrino, J., Llisterri, J. L., Alonso, J., Vinyoles, E., Pallarés, V., Sarría, A., Aranda, P., & Ruilope, L. M.
- Affiliations
- From the Hypertension Unit (A.d.l.S.), Hospital Clínic, University of Barcelona, Barcelona, Spain; Hypertension Unit, Hospital Clínico (J.R.), University of Valencia and Centro de Investigación Biomédica au Red (CIBER) of Obesity and Nutritional Disorders, Valencia, Spain; Department of Preventive Medicine and Public Health (J.R.B., J.J.d.l.C.), Autonomous University and CIBER of Epidemiology and Public Health, Madrid, Spain; Hypertension Unit (J.Segura, L.M.R.), Hospital 12 de Octubre, Madrid,...
- Universidad Complutense de Madrid (ES)
- Universitat Autònoma de Barcelona (ES)
- ORCID
- Venue
- Hypertension
- Published
- 2009-03
- Volume
- 53
- Issue
- 3
- Pages
- 466-472
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2137218363
- Semantic Scholar
- 1acddbb4ed2a4020230b89f1921ced018ea70f76
- Cited by
- 379
- References
- 34
- Citations by year
- 2026: 14 · 2025: 17 · 2024: 24 · 2023: 19 · 2022: 11 · 2021: 17 · 2020: 22 · 2019: 22 · 2018: 22 · 2017: 19 · 2016: 17 · 2015: 28 · 2014: 28 · 2013: 23 · 2012: 31
- FWCI
- 20.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- circadian blood pressure rhythm, non-dipping blood pressure, ambulatory blood pressure monitoring, nocturnal blood pressure dipping, cardiovascular risk, antihypertensive drugs, obesity, diabetes mellitus, kidney disease, untreated hypertension
- MeSH terms
- Adult, Aged, Antihypertensive Agents, Blood Pressure, Circadian Rhythm, Female, Humans, Hypertension, Male, Middle Aged, Registries, Spain, Cohort Studies, Prevalence, Linear Models, Blood Pressure Monitoring, Ambulatory
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