Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension.

Abstract:

:Resistant hypertension (RHTN) includes both patients whose blood pressure (BP) is uncontrolled on three or more medications (uncontrolled RHTN (UCRH)) and patients whose BP is controlled with use of four or more drugs (controlled RHTN (CRH)). It is unknown whether endothelial function and nocturnal drop demonstrate a similar pattern in patients with CRH and UCRH. We examined circadian BP patterns and vascular function in these patients. In all, 40 CRH and 26 UCRH patients, and 25 normotensives underwent biochemical testing, ambulatory BP monitoring, determination of brachial artery responses to endothelial-dependent (flow-mediated; dilation (FMD)) and independent (nitroglycerin mediated) stimuli. The nighttime drop in systolic BP (SBP) and diastolic BP (DBP) was less pronounced in UCRH than in CRH (SBP, 1.9±1.6 versus 4.9±1.7%; DBP, 7.5±1.8 versus 10.9±1.8%, UCRH and CRH, respectively; P<0.05). FMD was greater in control group compared with RHTN patients. Patients with UCRH had significantly impaired FMD compared with CRH (5.9±2.3% versus 7.1±5.1%; P<0.0001). Therefore, UCRH patients have less nocturnal dipping and a more impaired endothelial response compared with CRH patients. These findings suggest that important differences among patients with RHTN may allow identify subgroups with increased cardiovascular risk.

journal_name

J Hum Hypertens

authors

Quinaglia T,Martins LC,Figueiredo VN,Santos RC,Yugar-Toledo JC,Martin JF,Demacq C,Pimenta E,Calhoun DA,Moreno H Jr

doi

10.1038/jhh.2011.43

subject

Has Abstract

pub_date

2011-11-01 00:00:00

pages

656-64

issue

11

eissn

0950-9240

issn

1476-5527

pii

jhh201143

journal_volume

25

pub_type

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