Abstract

Extreme dipping has been proposed as an added risk in hypertensive patients. To explore total cardiovascular risk in this population, we studied 4560 consecutive untreated patients with essential hypertension, with clinical, laboratory and ambulatory blood pressure (ABP) measurements. Dippers (D) were 2660 (58,3%) and extreme dippers (ED) with nighttime fall over 20% were 194 (7.3%). ED were somewhat older (54 vs 52 years old p=0,01), with similar systolic BP clinic and ABP measurements (p=NS) but higher diastolic BP by 2 mmHg (p<0,01). D and ED did not differ in gender, smoking, diabetes mellitus or glucose intolerence, obesity, and had similar values in all plasma lipids, throbogenetic parameters, kidney function indices and plasma renin activity (p=NS). On echocardiography, they had similar LV dimensions, mass and function (p=NS), but D had higher incidence of LV concentric hypertrophy (30.9 vs 23,7% p=0.04). Microalbuminuria was relatively more common in D (23,1 vs 16,7% p=NS), who had higher microalbumin values (20,1 vs 16,2 mg/L p=0,002).

It is concluded that ED have not excessive cardiovascular risk, and have less target–organ damage, compared to D hypertensives.

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