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CLINICAL STUDY

Circadian variation of blood pressure and endothelial function in patients with essential hypertension

a comparison of dippers and non-dippers

Yukihito Higashi, MD, PhD^*,*, Keigo Nakagawa, MD, Masashi Kimura, MD, Kensuke Noma, MD, Keiko Hara, MD, Satoshi Sasaki, MD, Chikara Goto, RTP, MS, Tetsuya Oshima, MD, PhD, Kazuaki Chayama, MD, PhD and Masao Yoshizumi, MD, PhD^*

^* Department of Cardiovascular Physiology and Medicine, Hiroshima, Japan
Department of Medicine and Molecular Science, Hiroshima, Japan
Division of Physical Therapy, Institute of Health Sciences, Hiroshima, Japan
Department of Clinical Laboratory Medicine, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan

Manuscript received May 1, 2002; revised manuscript received June 25, 2002, accepted August 26, 2002.

^* Reprint requests and correspondence: Dr. Yukihito Higashi, Department of Cardiovascular Physiology and Medicine, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
yhigashi{at}hiroshima-u.ac.jp

OBJECTIVES: The purpose of this study was to evaluate the relationship between the circadian blood pressure (BP) rhythm and endothelial function in patients with essential hypertension.

BACKGROUND: Hypertension is associated with alterations in resistance artery endothelial function. Patients with a non-dipper circadian pattern of BP have a greater risk of cerebrovascular and cardiovascular complications than do patients with a dipper circadian pattern.

METHODS: We evaluated the forearm blood flow (FBF) response to inra-arterial acetylcholine (ACh), an endothelium-dependent vasodilator, and isosorbide dinitrate (ISDN), an endothelium-independent vasodilator, infusion in 20 patients with non-dipper hypertension and 20 age- and gender-matched patients with dipper hypertension. The FBF was measured using a mercury-filled Silastic strain-gauge plethysmograph.

RESULTS: The 24-h systolic BP, as well as nocturnal systolic and diastolic BPs were higher in non-dipper patients than in dipper patients. The 24-h urinary excretion of nitrite/nitrate and cyclic guanosine monophosphate was lower in non-dippers than in dippers. The response of FBF to ACh was smaller in non-dippers than in dippers (25.1 ± 3.1 vs. 20.2 ± 3.0 ml/min/100 ml tissue, p < 0.05). The FBF response to ISDN was similar in dippers and non-dippers. The FBF response to ACh was similar in the two groups following intra-arterial infusion of the nitric oxide (NO) synthase inhibitor N^G-monomethyl-L-arginine.

CONCLUSIONS: These findings suggest that endothelium-dependent vasodilation is blunted through a decrease in NO release in non-dippers compared with patients who have dipper hypertension.

Abbreviations and Acronyms   ABPM   ambulatory blood pressure monitoring   ACh   acetylcholine   ANOVA   analysis of variance   BP   blood pressure   FBF   forearm blood flow   ISDN   isosorbide dinitrate   L-NMMA   NG-monomethyl-L-arginine   NE   norepinephrine   NO   nitric oxide   NOx   nitrite/nitrate

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