Does sympathetic overactivation feature all hypertensives? Differences of sympathovagal balance according to night/day blood pressure ratio in patients with essential hypertension

Antonino Tuttolomondo, Alessandra Casuccio, Giuseppe Miceli, Domenico Di Raimondo, Antonio Pinto, Carmelo Butta', Caterina Schimmenti, Valentina Zappulla

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8 Citazioni (Scopus)

Abstract

When evaluating the 'night/day BP ratio', both hypertensives and normotensives can be arbitrarily classified into four groups: extreme dippers (ratio ≤0.8), dippers (0.8<ratio ≤0.9), mild dippers (0.9<ratio≤1.0) and reverse dippers (ratio ≥1.0). Reverse and mild dipper hypertensives have poorer prognoses compared with the physiological dipper profile, but the prognostic relevance of the extreme dipper profile remains uncertain. The evaluation of heart rate variability (HRV), obtained by 24-h Holter ECG monitoring, is the most frequently used noninvasive form of assessment of the activity of the autonomic nervous system. Reverse and mild dipper hypertensives have reduced HRV, indicating an overactivation of the sympathetic nervous system (SNS); however, the HRV behavior in extreme dippers is still controversial. The goal of this study was to compare HRV indexes of extreme vs. reverse dipper essential hypertensives measured on the basis of time domains. We enrolled 125 hypertensive subjects, divided in 4 quartiles according to day/night blood pressure (BP) ratios. The upper and lower quartiles (31 subjects per quartile) were compared; 30 normotensive subjects were enrolled as a control group. Time domain HRV parameters of the three groups revealed a higher degree of sympathetic activation in the lower quartile (reverse dipper) vs. the upper quartile (extreme) and normotensive controls. HRV parameters related to parasympathetic tone did not show any significant variations among the three groups. Contrary to common belief, not all hypertensives have SNS overactivation.
Lingua originaleEnglish
pagine (da-a)440-448
Numero di pagine9
RivistaHypertension Research
Volume39
Stato di pubblicazionePublished - 2016

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Heart Rate
Blood Pressure
Sympathetic Nervous System
Ambulatory Electrocardiography
Autonomic Nervous System
Essential Hypertension
Electrocardiography
Control Groups

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cita questo

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title = "Does sympathetic overactivation feature all hypertensives? Differences of sympathovagal balance according to night/day blood pressure ratio in patients with essential hypertension",
abstract = "When evaluating the 'night/day BP ratio', both hypertensives and normotensives can be arbitrarily classified into four groups: extreme dippers (ratio ≤0.8), dippers (0.8<ratio ≤0.9), mild dippers (0.9<ratio≤1.0) and reverse dippers (ratio ≥1.0). Reverse and mild dipper hypertensives have poorer prognoses compared with the physiological dipper profile, but the prognostic relevance of the extreme dipper profile remains uncertain. The evaluation of heart rate variability (HRV), obtained by 24-h Holter ECG monitoring, is the most frequently used noninvasive form of assessment of the activity of the autonomic nervous system. Reverse and mild dipper hypertensives have reduced HRV, indicating an overactivation of the sympathetic nervous system (SNS); however, the HRV behavior in extreme dippers is still controversial. The goal of this study was to compare HRV indexes of extreme vs. reverse dipper essential hypertensives measured on the basis of time domains. We enrolled 125 hypertensive subjects, divided in 4 quartiles according to day/night blood pressure (BP) ratios. The upper and lower quartiles (31 subjects per quartile) were compared; 30 normotensive subjects were enrolled as a control group. Time domain HRV parameters of the three groups revealed a higher degree of sympathetic activation in the lower quartile (reverse dipper) vs. the upper quartile (extreme) and normotensive controls. HRV parameters related to parasympathetic tone did not show any significant variations among the three groups. Contrary to common belief, not all hypertensives have SNS overactivation.",
keywords = "Ambulatory blood pressure monitoring, Cardiology and Cardiovascular Medicine, Diurnal/nocturnal blood pressure ratio, Essential hypertension, Extreme dipper, Heart rate variability, Internal Medicine, Physiology",
author = "Antonino Tuttolomondo and Alessandra Casuccio and Giuseppe Miceli and {Di Raimondo}, Domenico and Antonio Pinto and Carmelo Butta' and Caterina Schimmenti and Valentina Zappulla",
year = "2016",
language = "English",
volume = "39",
pages = "440--448",
journal = "Hypertension Research",
issn = "0916-9636",
publisher = "Nature Publishing Group",

}

TY - JOUR

T1 - Does sympathetic overactivation feature all hypertensives? Differences of sympathovagal balance according to night/day blood pressure ratio in patients with essential hypertension

AU - Tuttolomondo, Antonino

AU - Casuccio, Alessandra

AU - Miceli, Giuseppe

AU - Di Raimondo, Domenico

AU - Pinto, Antonio

AU - Butta', Carmelo

AU - Schimmenti, Caterina

AU - Zappulla, Valentina

PY - 2016

Y1 - 2016

N2 - When evaluating the 'night/day BP ratio', both hypertensives and normotensives can be arbitrarily classified into four groups: extreme dippers (ratio ≤0.8), dippers (0.8<ratio ≤0.9), mild dippers (0.9<ratio≤1.0) and reverse dippers (ratio ≥1.0). Reverse and mild dipper hypertensives have poorer prognoses compared with the physiological dipper profile, but the prognostic relevance of the extreme dipper profile remains uncertain. The evaluation of heart rate variability (HRV), obtained by 24-h Holter ECG monitoring, is the most frequently used noninvasive form of assessment of the activity of the autonomic nervous system. Reverse and mild dipper hypertensives have reduced HRV, indicating an overactivation of the sympathetic nervous system (SNS); however, the HRV behavior in extreme dippers is still controversial. The goal of this study was to compare HRV indexes of extreme vs. reverse dipper essential hypertensives measured on the basis of time domains. We enrolled 125 hypertensive subjects, divided in 4 quartiles according to day/night blood pressure (BP) ratios. The upper and lower quartiles (31 subjects per quartile) were compared; 30 normotensive subjects were enrolled as a control group. Time domain HRV parameters of the three groups revealed a higher degree of sympathetic activation in the lower quartile (reverse dipper) vs. the upper quartile (extreme) and normotensive controls. HRV parameters related to parasympathetic tone did not show any significant variations among the three groups. Contrary to common belief, not all hypertensives have SNS overactivation.

AB - When evaluating the 'night/day BP ratio', both hypertensives and normotensives can be arbitrarily classified into four groups: extreme dippers (ratio ≤0.8), dippers (0.8<ratio ≤0.9), mild dippers (0.9<ratio≤1.0) and reverse dippers (ratio ≥1.0). Reverse and mild dipper hypertensives have poorer prognoses compared with the physiological dipper profile, but the prognostic relevance of the extreme dipper profile remains uncertain. The evaluation of heart rate variability (HRV), obtained by 24-h Holter ECG monitoring, is the most frequently used noninvasive form of assessment of the activity of the autonomic nervous system. Reverse and mild dipper hypertensives have reduced HRV, indicating an overactivation of the sympathetic nervous system (SNS); however, the HRV behavior in extreme dippers is still controversial. The goal of this study was to compare HRV indexes of extreme vs. reverse dipper essential hypertensives measured on the basis of time domains. We enrolled 125 hypertensive subjects, divided in 4 quartiles according to day/night blood pressure (BP) ratios. The upper and lower quartiles (31 subjects per quartile) were compared; 30 normotensive subjects were enrolled as a control group. Time domain HRV parameters of the three groups revealed a higher degree of sympathetic activation in the lower quartile (reverse dipper) vs. the upper quartile (extreme) and normotensive controls. HRV parameters related to parasympathetic tone did not show any significant variations among the three groups. Contrary to common belief, not all hypertensives have SNS overactivation.

KW - Ambulatory blood pressure monitoring

KW - Cardiology and Cardiovascular Medicine

KW - Diurnal/nocturnal blood pressure ratio

KW - Essential hypertension

KW - Extreme dipper

KW - Heart rate variability

KW - Internal Medicine

KW - Physiology

UR - http://hdl.handle.net/10447/199380

UR - http://www.nature.com/hr/archive/index.html

M3 - Article

VL - 39

SP - 440

EP - 448

JO - Hypertension Research

JF - Hypertension Research

SN - 0916-9636

ER -