The relation between non-dipping status and antihypertensive drugs

Introduction: Patients with nocturnal hypertension have a higher incidence of cardiovascular events especially in those with mild dipping or non-dipping status. The purpose of this retrospective study was to observe the influence of antihypertensive drugs on nocturnal dipping and cardiovascular risk in patients with nocturnal hypertension. Methods: In this study we included 73 patients with hypertension who were under antihypertensive treatment to which blood pressure values were recorded with 24 hour ambulatory BP monitoring. For each patient, risk SCORE was determined, respectively dipping/ non-dipping index. Patients were divided into two groups according to the presence of nocturnal hypertension: group 1 (n = 34, with nocturnal hypertension) and group 2 (n = 39, without nocturnal hypertension). Th ere was a comparison between demographic characteristics and variables used to determine the risk of nocturnal hypertension. We analyzed the relationship of dipping/non-dipping status and the combination of hypertensive drug classes. For statistical analysis we used independent t test, Pearson x² test and multivariate logistic regression. Results: The mean age was 57 years in group 1 and 55 years in group 2. In the first group there were (n = 20 males, n = 14 females) and the second group (n = 16 males, n = 23 females). SBP and DBP in group 1 were (133 ± 10 mm Hg, 78 ± 8 mm Hg ), in group 2 (111 ± 6 mm Hg, 64 ± 6 mm Hg). Th e risk SCORE was higher in group 1 (8% vs 6% group 2 – p = 0.3). By logistic regression we identified a protective factor against nocturnal non-dipping: free combination of antihypertensive drugs (p = 0.02,OR = 0.059), fi xed combination had no eff ect on nocturnal blood pressure decline (p = 0.1). Th e combination of 3 – 4 classes of antihypertensive drugs reduced significantly nocturnal hypertension (p = 0.048, OR = 0.059). A predictor for nocturnal hypertension was uncontrolled blood pressure during daytime, despite medication (p < 0.0001). Conclusions: Free combination of antihypertensive drugs decreases the risk of non-dipping status in comparison to fixed combinations of antihypertensive drugs. Also a significant role in nocturnal dipping is the association of at least three classes of antihypertensive drugs. Uncontrolled hypertension during the day despite medication significantly increases the risk for nocturnal hypertension. Patients with nocturnal hypertension tend to have a higher risk SCORE than those with normal nocturnal values.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)