Diurnal blood pressure profile in patients with severe congestive heart failure: Dippers and non-dippers

Kastrup J., Wroblewski H., Sindrup J., Rolighed Christensen H., Wiinberg N. Diurnal blood pressure profile in patients with severe congestive heart failure. Dippers and non-dippers. Scand J Clin Lab Invest 1993; 53: 577-583. Patients with severe congestive heart failure (CHF) have increased sympathetic nervous acitivty and altered baroreceptor function, which may influence the diurnal blood pressure rhythm. The 24-h blood pressure profile was measured in 25 patients with severe CHF (mean ejection fraction: 17%) and 25 control subjects. Systemic blood pressure was measured automatically at the arm by a non-invasive blood pressure monitoring system every 15min. The mean±SD systolic blood proessure in CHF patients and controls was during day-time 105 ± 10 and 130i- 11mmHg and night-time 97 ± 10 and 112± lOmmHg, i.e. the nocturnal decrease was 9±6 and 18±8mmHg, respectively (p < 0.0005 for all). The subjects could be divided into two groups: dippers and non-dippers, with and without a relative decrease in nocturnal systolic blood pressure > 10%. There was significantly more non-dipping CHF patients (16) than controls (5) (p < 0.01). Systolic blood pressure was in CHF dippers vs. non-dippers during day-time: 108 ± 7 vs. 104 ± 12mmHg (NS) and night-time: 92 ±7 vs. 99 ±11 mm Hg (p = 0.08). The nocturnal decrease was 16 ±3 vs. 5±4mmHg and the relative nocturnal decrease 15 ±3 vs. 5 ± 3% (p < 0.00001 for both). It is concluded that patients with severe congestive heart failure can be divided into two groups: dippers and non-dippers, with and without a normal decrease in nocturnal blood pressure. This abnormality may be a prognostic factor in these severely ill patients.