Improving the detection of preclinical organ damage in newly diagnosed hypertension: nocturnal hypertension versus non-dipping pattern

The clinical relevance of nocturnal hypertension (NH) in comparison with non-dipping status has not been clarified yet, as regards subclinical target organ damage. We aimed to elucidate whether NH or dipping status reflects better organ damage. The study population included 319 newly diagnosed hypertensive patients. Subclinical organ damage was evaluated to all participants. On the basis of nocturnal blood pressure (BP) levels the population was divided into two groups: NH and nocturnal normotension. Also, individuals were defined as dippers and non-dippers according to systolic BP fall. Patients with NH were characterized by increased arterial pulse wave velocity (PWV; 9.1 +/- 1.7 vs 8.4 +/- 1.5 ms(-1), P = 0.0001) and carotid intima-media thickness (0.77 +/- 0.18 vs 0.69 +/- 0.15 mm, P = 0.016) compared with normotensive subjects. Notably, they also exhibited higher values of left ventricular mass index (88.1 +/- 22.9 vs 82.8 +/- 16.6 gm(-2) P = 0.043). On the contrary, non-dipping status was associated only with differences in PWV (9.26 +/- 0.2 vs 8.64 +/- 0.2 ms(-1), P = 0.031, 8) and in creatinine clearance (95 +/- 3 vs 106 +/- 4, P = 0.025) in the group of NH. The presence of NH is accompanied by subclinical atherosclerosis, as well as structural abnormalities of the left ventricle. Therefore, NH rather than non-dipping status could be preferably integrated with the risk of organ damage.