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Review
. 2017 Jul;19(7):713-721.
doi: 10.1111/jch.13023.

Clinical and prognostic significance of a reverse dipping pattern on ambulatory monitoring: An updated review

Cesare Cuspidi  1   2 , Carla Sala  3 , Marijana Tadic  4 , Elisa Gherbesi  3 , Antonio De Giorgi  5 , Guido Grassi  1   6 , Giuseppe Mancia  1
Affiliations
Review

Clinical and prognostic significance of a reverse dipping pattern on ambulatory monitoring: An updated review

Cesare Cuspidi et al. J Clin Hypertens (Greenwich). 2017 Jul.

Abstract

Reverse or inverted dipping (ie, the phenomenon characterized by higher nighttime compared with daytime blood pressure values) is an alteration of circadian blood pressure rhythm frequently documented in hypertension, type 2 diabetes mellitus, chronic kidney disease, and sleep apnea syndrome, and generally regarded as a harmful condition. Available literature on the clinical and prognostic implications of reverse dipping is scanty. The present article will review a number of relevant issues concerning reverse dipping, in particular: (1) its possible mechanisms; (2) prevalence and clinical correlates, (3) concomitant cardiac and extracardiac subclinical organ damage; (4) association with acute and chronic cardiovascular diseases; (5) prognostic value in predicting cardiovascular events and mortality; and (6) therapeutic interventions aimed at reverting this abnormal circadian blood pressure rhythm.

Keywords: cardiovascular disease; cardiovascular prognosis; hypertension; reverse dipping; target organ damage; treatment.

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Figures

Figure 1
Figure 1
Prevalence rates of reverse dipping pattern in nine studies conducted in different clinical settings including general population samples 10, 18 and patients with untreated 20 and treated 15, 19 essential hypertension, diabetes mellitus, 21 sleep apnea syndrome, 24 and chronic kidney disease 22, 23
Figure 2
Figure 2
Cardiovascular event rates and 95% confidence intervals (CIs) in five studies conducted in the hypertensive setting according to the classification in dippers (n=2900), nondippers (n=2712), and reverse dippers (n=696)
Figure 3
Figure 3
Relative risk of cardiovascular (CV) events, 95% confidence intervals (CIs), and relative weight in reverse dippers (n=696) vs dippers (n=2900)
Figure 4
Figure 4
Relative risk of cardiovascular (CV) events, 95% confidence intervals (CIs) and relative weight, in reverse dippers (n=696) vs nondippers (n=2712)
See this image and copyright information in PMC

References

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