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to normalization of the nocturnal blood pressure pattern in during the night . In one pilot study involving patients with
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salt-sensitive patients . All forms of nocturnal hypertension obstructive sleep apnea (OSA), a higher correlation was in-
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can be the first manifestation of hypertension, most com- dicated between nocturnal blood pressure values measured
monly as a result of excessive sympathetic activity, which in home settings compared to those obtained with ABPM,
links it to adverse cardiovascular events (stroke, coronary with the severity of the disease . Supporting this modality
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artery disease, heart failure) or damage to other target or- is the absence of significant discrepancies in values obta-
gans (renal dysfunction or cognitive disorders). A serious ined through home monitoring and ABPM, as well as the
problem is that nocturnal hypertension often remains un- correlation of such measured values with target organ da-
detected for a long time . This especially applies to isola- mage .
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ted nocturnal hypertension. On the other hand, nocturnal
hypertension can be a characteristic of an advanced stage
of hypertension. In these circumstances, the increase in The impact of nocturnal hypertension
nocturnal values is explained by the fact that in the supine on target organ damage and
position, with an increase in circulating fluid volume, there cardiovascular outcomes
is increased venous return and increased wall stress of the
left ventricle . The absence of the expected decrease in blood pressure
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values during the night by ≥ 10% (non-dipping) is found in
Table 1. Definition of AH adapted to the measurement modality 3
about one-third of untreated patients with arterial hyper-
Measurement modality SAP DAP tension. In a slightly higher percentage, this pattern is
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Ambulatory monitoring ≥ 140 and/or ≥ 90 found in treated patients - in close to 40% . Non-dipping
24-hour ABPM pattern is more frequently found in older individuals, wo-
24-hour values ≥ 130 and/or ≥ 80 men, obese patients, and those with longstanding arterial
hypertension. Psychosocial factors such as depression and
Daily values ≥ 135 and/or ≥ 85
lower socioeconomic status are characteristic of patients
Nightly values ≥ 120 and/or ≥ 70
with a non-dipping pattern. De la Sierra et al. found, in a
Home measurement ≥ 135 and/or ≥ 85 sample of 42,947 patients with arterial hypertension, that
Legend: SAP - Systolic Arterial Pressure; DAP - Diastolic Arterial Pressure; ABPM - Ambu- the non-dipping pattern is more common in older, obese,
latory Blood Pressure Monitoring.
and diabetic patients, and it is associated with a higher risk
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Diagnosis of nocturnal hypertension of cardiovascular and renal diseases . The absence of the
expected decrease in nocturnal blood pressure values plays
ABPM is the gold standard in measuring nocturnal blo- a crucial role in the expression of target organ damage,
od pressure values. Typically, this method determines the such as myocardial hypertrophy and intima-media thicke-
average 24-hour blood pressure values by programming ning of the carotid arteries . The influence of the non-dip-
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the device to record blood pressure readings every 15 to 30 ping pattern on changes in left ventricular mechanics has
minutes during the day and every 30 to 60 minutes during also been demonstrated, affecting global longitudinal and
the night. It is possible to determine the average 24-hour, circumferential strain, as well as endocardial and epicardial
daytime, and nighttime blood pressure values using this strain .
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method . According to the recommendations of the Europe-
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an Society of Cardiology (ESC) and the European Society of The results of recent studies have changed the traditio-
Hypertension (ESH), hypertension is defined as 24-hour blo- nal perception of the impact of the non-dipping pattern on
od pressure values greater than 130/80 mmHg, daytime va- myocardial hypertrophy, intima-media thickening of the ca-
lues greater than 135/85 mmHg, and nighttime values grea- rotid arteries, arterial stiffness, endothelial dysfunction, and
ter than 120/70 mmHg (Table 1). The absence of a nocturnal albuminuria. It has been concluded that it should be viewed
blood pressure decrease by 10% indicates a non-dipping in the context of whether it is newly diagnosed hypertensi-
pattern. Finding higher average nighttime values compa- on or treated hypertension, where the favorable influence
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red to daytime values indicates a reverse dipping pattern, of controlled daytime blood pressure values is inevitable .
while finding average nighttime values greater than 120/70 The absence of the expected decrease in blood pressure
mmHg with normal daytime values indicates isolated no- values is associated with an increased risk of stroke, acute
cturnal hypertension. Despite its clear benefits, there are myocardial infarction, heart failure, and increased cardio-
some limitations to ABPM. The first limitation is its low ava- vascular mortality 19, 23, 24 .
ilability, and another limitation is discomfort, especially du- In several retrospective studies, this is a significant pre-
ring sleep, when cuff inflation may lead to awakening which dictor of cardiovascular outcomes during 5, 7, 6, and 9 years
can affect blood pressure measurements.
of follow-up . In the meta-analysis by Gavriilaki et al., which
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Home blood pressure monitoring (Arterial Pressure, AP) included 10,483 patients, it was shown that in untreated pa-
is a widely accepted method for diagnosing and monitoring tients, the non-dipping pattern was associated with a hig-
blood pressure values. Recent technological advancements her risk of cardiovascular events and overall mortality, but
have enabled blood pressure monitoring at home, including not with a higher risk of strokes. They found that the reverse

REVIEW PAPER Galenika Medical Journal, 2024; 3(9):35-41. 37