Antihypertensive therapy: nocturnal dippers and nondippers. Do we treat them differently?

Figures & data

Table 1 Correlation coefficients (r) for systolic and diastolic BPs with left ventricular hypertrophy

	Systolic	Diastolic
Average ambulatory BP night^Citation25	0.51 (P < 0.01)	0.35 (P < 0.01)
Average ambulatory BP night^Citation26	0.275 (P < 0.01)	0.243 (P < 0.05)
Night home monitored^Citation27	0.66 (P < 0.001)	0.496 (P < 0.005)
Average ambulatory BP night^Citation14	0.77 (P < 0.0001)	0.61 (P < 0.0001)

Abbreviation: BP, blood pressure.

Table 2 Cardiovascular outcomes in long-term observational studies with respect to dipping status of BP

Study	Number of patients	Follow-up	Outcome
Verdecchia et al^Citation30	715	1–13 years	Relative risk of cardiovascular events was 2.77 in nondippers compared to dippers
Ohasama study^Citation32	1542	9.2 years	20% greater risk of cardiovascular mortality for every 5% reduction in decline of nocturnal BP
Dublin outcome study^Citation33	5292	8.4 years	Hazard ratio for cardiovascular mortality was 1.21 for each 10 mmHg higher night systolic BP

Abbreviation: BP, blood pressure.

Table 3 Improvement in proteinuria by improving dipping pattern

Study	Number of patients	Intervention	Duration	Outcome
Hermida et al 2005^Citation36	200	Valsartan 160 mg morning or evening	3 months	Protein excretion reduced by 41% in those receiving night dose
Hermida et al 2005^Citation39	148	nondippers Valsartan 160 mg morning or evening	3 months	75% of those receiving night dose became dippers with reduction of proteinuria
Hoshino et al^Citation38	31	Amlodipine-Olmesartan combination – morning or evening	8 weeks	Urinary albumin/creatinine ratio was 42.5 ± 59.9 mg/g versus 75.3 ± 26.4 mg/g in bedtime versus daytime administration

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