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Endothelial dysfunction and diurnal variation of blood pressure: night secrets of arterial hypertension?

Journal of Human Hypertension volume 25, pages 653–655 (2011)Cite this article

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Despite substantial improvement in the management of hypertension and large choice of medications available for a clinician, the optimal control of blood pressure (BP) is difficult to achieve in a significant proportion of patients.1 The failure to adequately control BP remains one of the most frequent problems in cardiovascular prevention.1 Arterial hypertension is a complex, multifactorial condition mediated by the combination of genetic and environmental factors, and leading to numerous abnormalities of cardiovascular homeostasis. Because of this complex nature of hypertension, the disorder cannot be ‘abolished’ in the vast majority of patients and its prevention and treatment remain difficult tasks. In the Framingham Heart Study, only 48% were able to keep their BP below 140/90 mm Hg, while uncontrolled BP was associated with development of the target organ damage.2 Control of BP proved to be difficult in patients of, especially high risk, such as those with chronic kidney disease or diabetes. According to the Fourth National Health and Nutrition Survey target BP levels below 130/80 mm Hg have been only achieved in 37% of participants with chronic kidney disease.3 Moreover, BP levels below 130/85 mm Hg have been reached only in 25% of diabetics.4

The Joint National Committee (JNC) 7 defined resistant hypertension as failure to reduce BP below 140/90 mm Hg in the general population and below 130/80 mm Hg in those with diabetes or chronic kidney disease, despite treatment with maximum tolerated doses of three antihypertensive agents including a diuretic.5 More recently, the definition of resistant hypertension has been expanded to include patients whose BP can only be controlled by more than three medications administered simultaneously.6 These patients attract particular attention of healthcare providers because of a worse prognosis compared with those with more easily controlled hypertension. Indeed, according to World Health Report 2002, suboptimal BP control is the most common attributable risk for death worldwide, being responsible for 62% of cerebrovascular disease and 49% of coronary artery disease.7

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  1. Centre for Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK

    A Shantsila & E Shantsila

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Shantsila, A., Shantsila, E. Endothelial dysfunction and diurnal variation of blood pressure: night secrets of arterial hypertension?. J Hum Hypertens 25, 653–655 (2011). https://doi.org/10.1038/jhh.2011.54

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