Nondipping Pattern and Cardiovascular and Renal Damage in a Population-Based Study (The STANISLAS Cohort Study)

Am J Hypertens. 2019 Jun 11;32(7):620-628. doi: 10.1093/ajh/hpz020.

Abstract

Objective: The attenuation of physiological nocturnal decline of blood pressure (BP)-called nondipper pattern-has previously been reported to be associated with target organ damage in hypertensive subjects. However, this association remains debated and poorly studied in normotensive patients. This study aimed to investigate the association between nondipper pattern and subclinical cardiovascular and renal damage in an initially healthy population-based cohort study.

Methods: The STANISLAS Cohort is a single-center, familial longitudinal cohort composed of 1,006 families (4,295 subjects) recruited in 1993-1995 for a 5-year periodic health examination. A total of 1,334 subjects from the 4th visit (2011-2016) of the STANISLAS cohort were included. This 4th examination included estimated glomerular filtration rate, albumin/creatinine ratio, pulse wave velocity, central systolic BP, carotid intima-media thickness and distensibility, left ventricular mass index, left ventricular hypertrophy, diastolic dysfunction, and ambulatory blood pressure monitoring (ABPM). Nondipping status was defined as a mean reduction in systolic BP (SBP) or diastolic BP (DBP) lower than 10% during nighttime.

Results: Data were obtained from 798 normotensive subjects (45 ± 14 years, 395 [49%] nondippers, SBP/DBP mmHg 24 hours: 116/71 ± 7/5) and 536 hypertensive patients (56 ± 11 years, 257 [48%] nondippers, SBP/DBP mmHg 24 hours: 127/78 ± 10/7). Mean 24-hour and daytime ABPM measurements were within the normal range, even in hypertensive participants (19% treated). The nondipping pattern was not associated with cardiovascular or renal alterations in this population.

Conclusion: In this middle-aged population with an overall 24-hour optimal BP control, the nondipper pattern was not associated with increased cardiovascular or renal damage.

Keywords: The STANISLAS Cohort; ambulatory blood pressure monitoring; arterial stiffness; blood pressure; echocardiographic diastolic dysfunction; hypertension; intima-media thickness; microalbuminuria; nondipping pattern; renal disease.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Albuminuria / epidemiology
  • Albuminuria / physiopathology
  • Blood Pressure*
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / epidemiology*
  • Carotid Artery Diseases / physiopathology
  • Circadian Rhythm*
  • Female
  • France / epidemiology
  • Humans
  • Hypertension / diagnosis
  • Hypertension / epidemiology*
  • Hypertension / physiopathology
  • Hypertrophy, Left Ventricular / diagnostic imaging
  • Hypertrophy, Left Ventricular / epidemiology*
  • Hypertrophy, Left Ventricular / physiopathology
  • Kidney / physiopathology
  • Kidney Diseases / diagnosis
  • Kidney Diseases / epidemiology*
  • Kidney Diseases / physiopathology
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / epidemiology*
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left
  • Ventricular Remodeling