Can nocturnal hypertension predict cardiovascular risk?

Abstract

Oded Friedman1, Alexander G Logan21Samuel Lunenfeld Research Institute, Division of Nephrology, Mount Sinai Hospital, 2Mount Sinai Hospital and University Health Network and Department of Medicine, University of Toronto, Toronto, CanadaAbstract: Nocturnal hypertension and non-dipping of blood pressure during sleep are distinct entities that often occur together and are regarded as important harbingers of poor cardiovascular prognosis. This review addresses several aspects related to these blood pressure abnormalities including definitions, diagnostic limitations, pathogenesis and associated patient profiles, prognostic significance, and therapeutic strategies. Taken together, persistent nocturnal hypertension and non-dipping blood pressure pattern, perhaps secondary to abnormal renal sodium handling and/or altered nocturnal sympathovagal balance, are strongly associated with deaths, cardiovascular events, and progressive loss of renal function, independent of daytime and 24-hour blood pressure. Several pharmacological and non-pharmacological approaches may restore nocturnal blood pressure and circadian blood pressure rhythm to normal; however, whether this translates to a clinically meaningful reduction in unfavorable cardiovascular and renal consequences remains to be seen.Keywords: blood pressure, sleep, nocturnal hypertension