Association between non-dipper blood pressure pattern and coronary artery disease burden in hypertensive patients

Non-dipper blood pressure (BP) patterns are associated with increased cardiovascular risk, but their relationship to coronary artery disease (CAD) complexity remains unclear. This study evaluated whether a non-dipper BP profile is linked to greater CAD burden in hypertensive patients using SYNTAX Scores (SS) I and II. A total of 381 hypertensive patients undergoing elective coronary angiography were prospectively enrolled. All underwent 24-hour ambulatory BP monitoring (ABPM) and were categorized as dipper or non-dipper. CAD burden was assessed using SS I and II. ROC analysis and multivariate logistic regression were performed. Non-dippers had significantly higher SS I (14.24 ± 8.47 vs. 9.81 ± 5.24) and SS II (28.64 ± 9.64 vs. 22.30 ± 6.57) than dippers (p < 0.001). SS II had greater predictive value (AUC: 0.704). Non-dipper status (OR: 20.1), diabetes, lower eGFR, and higher platelet count were independently associated with high SS, while age, gender, and high-sensitivity C-reactive protein (hs-CRP) were not. Non-dipper BP was independently associated with greater anatomical and clinical CAD complexity. Integrating ABPM and SS may enhance cardiovascular risk stratification and inform individualized preventive strategies in hypertensive patients.