What question did this study set out to answer?

To determine whether distinct diurnal blood pressure dipping patterns in essential hypertension are related to differences in sympathetic nerve traffic, metabolic state, and baroreflex function.

September 9, 2008HypertensionOpen Access

Adrenergic, Metabolic, and Reflex Abnormalities in Reverse and Extreme Dipper Hypertensives

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Population

96 middle-aged individuals, including 79 untreated essential hypertensives and 17 age-matched dipper…

Design

Cross-sectional

Authors

GGGuıdo GrassıGeneral / Preventive / Lipids GSGino SeravalleGeneral Cardiology FQFosca Quarti‐TrevanoAzienda Ospedaliera San Gerardo

Discussion

Member takes

Implication

Sympathetic hyperactivity may underlie reverse dipping; hypothesis-generating and should not yet change practice.

Key Points

To determine whether distinct diurnal blood pressure dipping patterns in essential hypertension are related to differences in sympathetic nerve traffic, metabolic state, and baroreflex function.
Assessed muscle sympathetic nerve traffic, heart rate, beat-to-beat blood pressure, and baroreceptor sensitivity at rest and during baroreceptor modulation in 79 untreated hypertensive patients and 17 age-matched normotensive controls.
Categorized hypertensive participants by reproducible ambulatory patterns: 34 dippers, 17 extreme dippers, 18 nondippers, and 10 reverse dippers.
Evaluated metabolic insulin sensitivity across groups using the homeostasis model assessment index.
Muscle sympathetic nerve traffic was higher in nondipper (58.6±1.8), dipper (55.6±0.9), and extreme dipper (53.3±0.8) hypertensives than in normotensives (43.5±1.4 bursts/100 heartbeats; P<0.01 for all), peaking markedly in reverse dippers (76.8±3.1 bursts/100 heartbeats; P<0.05).
Day-night blood pressure difference correlated inversely with sympathetic nerve traffic (r=-0.76; P<0.0001) and homeostasis model assessment index (r=-0.32; P<0.005).
Baroreflex-heart rate control was impaired across all four hypertensive states compared with normotensives, while baroreflex-sympathetic control remained preserved.

Structured PICO

Population

96 middle-aged individuals, including 79 untreated essential hypertensives (34 dippers, 17 extreme dippers, 18 nondippers, 10 reverse dippers) and 17 age-matched dipper normotensives.

Comparator

Normotensive controls and comparisons among different hypertensive dipping patterns

Outcome

Muscle sympathetic nerve traffic, heart rate, and beat-to-beat arterial blood pressure at rest and during baroreceptor deactivation and stimulationsurrogate

Reverse dipping in hypertension is characterized by significantly greater sympathetic activation compared to other nocturnal blood pressure patterns, suggesting sympathetic drive contributes to day-night blood pressure differences.

Cite This Study

Grassı et al. (2008) studied this question.

synapsesocial.com/papers/69f14c1a2811130d0cde24ac https://doi.org/10.1161/hypertensionaha.108.116368

Topics

Hypertension management

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Adrenergic, Metabolic, and Reflex Abnormalities in Reverse and Extreme Dipper Hypertensives

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Adrenergic, Metabolic, and Reflex Abnormalities in Reverse and Extreme Dipper Hypertensives

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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