Relation of nocturnal blood pressure dipping to cellular adhesion, inflammation and hemostasis

• Published in: Journal of hypertension Vol. 22; no. 11; pp. 2087 - 2093
• Main Authors: von Känel, Roland, Jain, Shamini, Mills, Paul J, Nelesen, Richard A, Adler, Karen A, Hong, Suzi, Perez, Christy J, Dimsdale, Joel E
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-11-2004; Lippincott Williams & Wilkins
• Subjects: Adult; Arterial hypertension. Arterial hypotension; Arteriosclerosis - epidemiology; Arteriosclerosis - physiopathology; Biological and medical sciences; Biomarkers; Blood and lymphatic vessels; Blood Pressure - physiology; Cardiology. Vascular system; Cell Adhesion - physiology; Circadian Rhythm - physiology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Endothelium, Vascular - physiopathology; Female; Fundamental and applied biological sciences. Psychology; Hemodynamics. Rheology; Hemostasis - physiology; Humans; Hypertension - epidemiology; Hypertension - immunology; Hypertension - physiopathology; Male; Medical sciences; Multivariate Analysis; Risk Factors; Vasculitis - epidemiology; Vasculitis - physiopathology; Vertebrates: cardiovascular system; Hypertension; coronary artery disease; cell adhesion molecules; Interleukin; Cell adhesion molecule; Cardiovascular disease; Inflammation; cardiovascular diseases; Coronary heart disease; Endothelium; interleukins; Hemostasis; Arterial pressure; Blood pressure; Ambulatory; Monitoring; blood pressure monitoring
• DOI: 10.1097/00004872-200411000-00009
• EISSN: 1473-5598
• ISSN: 0263-6352

BACKGROUNDSubjects who fail to dip their nocturnal blood pressure (BP) are at substantially increased risk for cardiovascular diseases. The pathogenetic mechanisms of this relationship have not been elucidated. We investigated whether non-dipping would relate to procoagulant and proinflammatory activity.
DESIGNStudy participants were 76 unmedicated normotensive and hypertensive subjects (44 male, 32 female; 41 white, 35 black; mean age, 36 ± 8 years) who underwent 24-h outpatient ambulatory BP monitoring. Based on whether their average nocturnal systolic BP relative to their average daytime systolic BP declined by less than 10%, 34 subjects were categorized as non-dippers. D-dimer, plasminogen activator inhibitor-1, von Willebrand factor, soluble intercellular adhesion molecule-1, and interleukin-6 were measured in plasma.
RESULTSMultivariate analyses showed that D-dimer (median/interquartile range, 242/162–419 ng/ml versus 175/132–254 ng/ml; P = 0.041), plasminogen activator inhibitor-1 (36/19–61 ng/ml versus 17/6–44 ng/ml; P = 0.010), von Willebrand factor (122/91–179% versus 92/66–110%; P = 0.001), and soluble intercellular adhesion molecule-1(227/187–291 ng/ml versus 206/185–247 ng/ml; P = 0.044) were all higher in non-dippers than in dippers. Adjustment for gender, ethnicity, age, body mass index, smoking status, hypertension status, and social class revealed independent effects of non-dipping. Non-dippers continued to have higher D-dimer (P = 0.030) and von Willebrand factor (P = 0.034) than dippers. A similar trend not reaching statistical significance emerged for soluble intercellular adhesion molecule-1 (P = 0.055). In contrast, dipping status had no effect on interleukin-6.
CONCLUSIONNocturnal BP non-dipping is associated with elevated levels of molecules related to endothelial dysfunction and atherosclerosis. The finding provides one possible mechanism linking non-dipping with cardiovascular disease.