Nondipping Blood Pressure

Blood pressure fluctuates throughout the day and normally decreases during nighttime. Patients can be classified as either dippers or non-dippers dependent on how much their blood pressure decreases over the course of the night. Dippers are considered patients whose blood pressure reduces by at least 10% during the night in comparison to their daytime readings, a dipping pattern is desired. The goal blood pressure for nighttime is <0.005). Nondipping blood pressure is a common manifestation associated with cardiovascular risk factors such as diabetes, chronic kidney function and coronary artery disease which may have an impact on all-cause mortality results, since these comorbidities are more prevalent in nondipping patients.

In addition patients with isolated nocturnal hypertension, which is characterized as elevated blood pressure at night with normal daytime blood pressure, have a higher risk of total mortality and all cardiovascular events including fatal and nonfatal stroke, fatal and nonfatal acute MI, death from ischemic heart diseases, fatal and nonfatal heart failure and cases of surgical and percutaneous coronary revascularization. It’s important to note that those more likely to have isolated nocturnal hypertension tended to be of older age and had comorbities such as diabetes or a history of cardiovascular disease, which can contribute to the worsened outcomes.

However, nocturnal nondipping and isolated nocturnal blood pressure are difficult to diagnosis, which is why ambulatory blood pressure monitoring plays a crucial role in management of 24-hour blood pressure. Appropriate interventions to control nighttime blood pressures are important to reduce cardiovascular risk and