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Extreme dipping and target organ damage: is there any relationship?

Journal of Human Hypertension volume 35, pages 755–757 (2021)Cite this article

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The importance of circadian blood pressure (BP) rhythm has been established more than 30 years ago when dipping and non-dipping BP patterns were introduced and large amount of data appeared [1]. New classification introduced two new BP patterns: reverse and extreme dipping, which enabled detailed assessment of nighttime BP drop, target organ damage, and outcome of hypertensive patients with different circadian BP patterns. Studies promptly showed that reverse dipping was associated with significant hypertension-mediated organ damage (left ventricular [LV] remodeling, vascular remodeling, renal function impairment), adrenergic, metabolic, and reflex abnormalities [2,3,4], which are even more pronounced than in non-dippers and definitely significantly more than in dippers and extreme dippers [3, 5]. The role of extreme dipping pattern remains controversial because a number of investigations did not show any relationship with cardiac remodeling on one side [3, 5, 6], while recent studies reported significant negative effect of extreme dipping on cardiovascular mortality in hypertensive patients older than 70 years [7].

In this issue of the Journal Triantafyllidi et al. investigated the impact of different BP patterns on target organ damage [8]. The researchers studied the association between different BP patterns and arterial stiffness, 24-h microalbumin levels, carotid intima-media thickness, diastolic dysfunction, and LV mass index in newly diagnosed, never treated hypertensive patients [8]. Reverse dippers were more frequently associated with the LV hypertrophy, LV diastolic dysfunction, and vascular remodeling. Parameters of target organ damage were similar between dippers and extreme dippers, which is why authors concluded that extreme dipping pattern in middle-aged hypertensive patients was not associated with target organ damage and therefore is not related to adverse outcome in these patients [8]. On the other hand, LV mass index and carotid intima-media thickness were significantly higher in reverse dippers than in other three groups of patients, which implies that the level of cardiovascular remodeling is the highest among hypertensive patients with nocturnal increase in BP. This confirms previous findings from our study group [3, 5].

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Authors and Affiliations

  1. Department of Cardiology, University Hospital “Dr. Dragisa Misovic - Dedinje”, Belgrade, Serbia

    Marijana Tadic

  2. University of Milan-Bicocca, Milan, Italy

    Cesare Cuspidi

  3. Istituto Auxologico Italiano, IRCCS, Milan, Italy

    Cesare Cuspidi

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  1. Marijana Tadic
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  2. Cesare Cuspidi
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Correspondence to Marijana Tadic.

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Tadic, M., Cuspidi, C. Extreme dipping and target organ damage: is there any relationship?. J Hum Hypertens 35, 755–757 (2021). https://doi.org/10.1038/s41371-021-00501-y

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