A Methodological Approach To Dipping In Essential Hypertension nursing Essay

A Methodological Approach To Dipping In Essential Hypertension

Ambulatory blood pressure monitoring (ABPM) has shown that blood pressure (BP) is highest during the day and lowest during the night in both normotensives and hypertensives [1]. Patients with essential hypertension (HT) are divided into two groups based on circadian blood pressure patterns: dippers and non-dippers [2]. Dippers manifest a reduction of blood pressure during the night, and non-dippers exhibit persistently elevated blood pressure throughout the 24-hour period.

Compared with dippers, non-dippers have higher left ventricular mass [3] and higher cardiovascular morbidity [4]. Non-dipper hypertensives have greater vascular damage in the carotid arteries and higher carotid intima media thickness as well [5,6]. Growing evidence indicates that increased sympathetic activation may cause decreased BP decline during the sleep.

One important generally accepted mechanism is related to the imbalance between the sympathetic nerve system and the parasympathetic nerve system tone, particularly the failure to shift from sympathetic to parasympathetic during sleep. Kohara et al. reported significantly higher plasma catecholamine levels in non-dippers compared to dippers (Ref.).

At the same time, non-dippers also may have an impairment in the autonomic nervous system, characterized mainly by decreased parasympathetic system activity (Ref.). Most probably, as shown by Hojo et al., it it’s the abnormal sympathetic vs. vagal balance that plays an important role in the genesis of abnormal nocturnal BP decline in patients with hypertension

Indeed, it was shown that while dippers have a relatively low sympathetic nervous tone during nighttime, non-dippers have a relatively low sympathetic nervous tone during daytime as well as decreased parasympathetic nervous activity during the night  As a result, the autonomic nervous system abnormality may impact heart rate and vascular tonus, so it may blunt night time BP decline.

Hypertensive patients are known to report lower general well-being, more severe psychological distress, poorer perceived health status, more physical symptoms, and functional disability when compared to normotensive patients.

As non-dipping is known to be related to increased target organ damage in essential hypertension, one might speculate that non-dipper patients had a poorer quality of life and would report more physical and psychological distress. However, the relationship between nocturnal BP and quality of life has not been thoroughly investigated and it remains to be elucidated whether non-dipping is associated with a worse health status compared to dipping patients.

Effort should be made to extend ambulatory blood pressure monitoring to 24 hours in order to obtain information on both daytime and nighttime blood pressure profiles, day-night blood pressure difference, morning blood pressure ri……

Overall, non-dipping BP pattern has been well established as an entity with potentially important clinical implications. The normalization of the circadian BP pattern to a dipper profile is a novel therapeutic goal, and accumulating medical evidence suggests this can delay the progression towards the renal and cardiovascular pathology known to be a consequence of the non-dipper BP pattern. Nevertheless, the claim that non-dipping is associated with an elevated cardiovascular risk and a worse prognosis [4], however, is not undisputed [5].

Although a nocturnal BP decline of less than 10% compared with daytime values is usually regarded as indicative for the diagnosis of non-dipping, it should be remarked that this threshold is arbitrary. This issue has been complicated mainly by observations questioning the reproducibility of the dipping status [6-8] and the use of differ……………………….

A Methodological Approach To Dipping In Essential Hypertension

A Methodological Approach To Dipping In Essential Hypertension

Our group of highly qualified and skilled writers is ready to help you with a similar paper within a specified deadline. Just click ORDER NOW and provide us with your assignment details, contact information and make payments. You will get periodic updates on order progress in your email.