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Clinical relevance of circadian dipping patterns in hypertension

Abstract:

In recent years, chronobiology has occupied an increasingly more significant place in modern medicine, being recognized as a relevant modifier of the course, diagnosis, and treatment of numerous medical disorders, including hypertension (HTN). The effect of circadian rhythms in the physiology of blood pressure (BP) has been widely studied, with the sum of different neurohumoral factors dictating a normal tenden-cy towards a decrease in BP during the night. The loss of this pattern could lead to worse clinical outcomes. Based on these premises, the concepts of dipper vs non-dipper patterns (DP vs NDP) have been introduced, referring to those with the nighttime decrease vs those without it. Numerous differences exist between patients with DP and NDP regarding their cardiovascular risk profiles, HTN severity, target organ injury, and frequency of long-term complications. Therefore, categorization of patients by their BP circadian rhythms is an attractive prospect for guiding treatment and prognosis in clinical practice. Current research has emphasized optimiza-tion of the management of hypertensive patients through this and other tools, due to the overwhelming epidemiological impact of this disease. Thus, this review discusses key clinical aspects for understanding circadian BP rhythms, as well as DP and NDP.