Antihypertensive therapy: nocturnal dippers and nondippers. Do we treat them differently?

摘要: Hypertension is a major independent risk factor for cardiovascular diseases. Management of hypertension generally based on office blood pressure since it easy to determine. Since casual readings in the are influenced by various factors, they do not represent basal pressure. Dipping night normal physiological change that can be blunted factors and severity hypertension. Nondipping pattern associated with disease severity, left ventricular hypertrophy, increased proteinuria, secondary forms hypertension, insulin resistance, fibrinogen level. Long-term observational studies have documented events patients nondipping patterns. Nocturnal dipping improved administering antihypertensive medications night. clinical trials shown reduced achieving better patterns during Identifying useful decisions investigate causes, initiating treatment, necessity chronotherapy, withdrawal or reduction unnecessary medications, monitoring after treatment initiation. Use this concept at primary care level has been limited because 24-hour ambulatory only method documenting dipping/nondipping status so far. This technique expensive inconvenient routine usage. Simpler methods using home systems evolving document night, which would help greater acceptance use dipper/nondipper managing