Page 40 - GALENIKA MEDICAL JOURNAL

dipping pattern was associated with a higher risk of cardio- Data on the differences in the impact of the non-dipping
vascular events, strokes, and overall mortality . pattern and INH on target organ damage and increased
18
cardiovascular risk are not uniform. One reason is the low
As mentioned, the reverse dipping pattern is characte- reproducibility of the non-dipping pattern and differences
rized by higher average nighttime blood pressure values in defining isolated nocturnal hypertension and the over-
compared to daytime values. Data on prevalence are incon- lap between the non-dipping pattern and INH. For instan-
sistent. It has been found that the prevalence among trea- ce, Androulakis et al. demonstrated that INH is responsible
ted patients is twice as high (13.5%) compared to untreated for the development of asymptomatic atherosclerosis and
patients (6%). This disproportion is explained by emphasi- left ventricular hypertrophy, but it is less involved in target
zing medication control of daytime blood pressure values. organ damage compared to the non-dipping pattern . On
11
This pattern is more common in patients with associated the other hand, in the CARDIA study, an association was
type 2 diabetes mellitus, chronic kidney disease, and sleep found between left ventricular myocardial hypertrophy
apnea. The reverse dipping pattern poses a risk for the deve- and both daytime and nighttime AH, but not with dipping
lopment of left ventricular myocardial hypertrophy, carotid status . The combination of nocturnal hypertension and
32
abnormalities, microalbuminuria, and proteinuria . Similar the non-dipping pattern has a greater impact on increasing
26
to the non-dipping pattern, the reverse dipping pattern is microalbuminuria and reducing renal function compared to
associated with changes in the mechanics of the left ven- nocturnal hypertension without the non-dipping pattern or
tricle, specifically reduced longitudinal strain. However, at isolated non-dipping pattern .
33
the same time, the reverse dipping pattern is also associa-
ted with reduced longitudinal strain of the right ventricle .
26
Cuspidi et al. found a significant association between the Treatment of nocturnal hypertension
reverse dipping pattern and increased risk of cardiovascular
events, including strokes, in their analysis of the impact of The significance of salt and water retention, along with
reverse dipping on cardiovascular risk . Palatini et al. found other mechanisms such as excessive activity of the sympat-
26
in their study that there was a significantly higher risk of hetic nervous system and the renin-angiotensin-aldoste-
cardiovascular events observed in reverse dippers with pre- rone system, in the development of nocturnal hypertension
vious cardiovascular disease . has been emphasized. Supporting this is the fact that re-
27
ducing salt intake and using diuretics successfully reduce
Numerous studies have shown the unfavorable effect of nighttime blood pressure values . The efficacy of other cla-
34
isolated nocturnal hypertension on target organ damage sses of antihypertensive medications has been examined
and increased cardiovascular risk. In a meta-analysis cove- in the context of the timing of therapy. Hermida et al. de-
ring 2.083 patients with INH and 1.547 patients with normal monstrated that ACE inhibitors, administered before bedti-
nocturnal blood pressure values, significantly higher left me, effectively reduce nighttime blood pressure values .
35
ventricular mass and intima-media thickening of the caro- The same author compared the efficacy of valsartan, ad-
tid arteries were found in those with nocturnal hyperten- ministered in the morning and evening over three months,
sion . The same group of authors has demonstrated that and showed that the drug given in the evening was more
21
nocturnal hypertension is associated with the deteriorati- effective in regulating both daytime and nighttime blood
on of strain in the left and right ventricles, as well as the pressure values. Evening administration of the therapy led
left atrium . The findings of changes in target organs are to a significant reduction in the number of patients with a
28
comparable to those found in daytime hypertension, but it non-dipping pattern (73.1% vs 12.5%, p < 0.001) . Similar
36
is important to note that the changes are more significant results were obtained with the use of telmisartan. Admini-
in daytime-nighttime hypertension compared to isolated stering the drug at a dose of 80 mg before bedtime led to
daytime or nighttime hypertension . a decrease in the prevalence of non-dipping from 34% to
29
37
INH is a significant predictor of adverse outcomes. In 8% . The significance of administering medications before
the Japan Morning Surge-Home Blood Pressure study, whi- bedtime in reducing nighttime blood pressure values has
ch included 2.745 patients, it was shown that nocturnal also been demonstrated with the use of a combination of
38
hypertension is a stronger independent predictor of cardio- calcium channel blockers and ACE inhibitors .
vascular events (angina pectoris, myocardial infarction, and The advantage of administering medications before
strokes) than daytime hypertension . In a large registry bedtime has also been investigated in patients with noctur-
30
comprising 8.711 patients of different nationalities, it was nal hypertension as part of resistant hypertension who were
shown that patients with INH have a significantly higher taking three antihypertensive medications. One of the three
risk of cardiovascular events and overall mortality, but not antihypertensive drugs was given before bedtime, and this
of strokes, acute coronary events, and cardiovascular mor- chronotherapeutic modality proved to be more effective in
tality . It is unequivocal that patients with isolated daytime terms of better reduction in 24-hour values and improve-
31
and nighttime hypertension have a similarly increased risk ment in the ratio of daytime and nighttime values .
39
of cardiovascular events and overall mortality compared to
normotensive individuals. In the MAPEC study, which included 2.156 patients, the
effects of taking medication upon waking and at least one

38 DOI: 10.5937/Galmed2409041I