Dippers and non-dippers

The significance of average night time blood pressure readings remains equally uncertain. Stroke, silent cerebrovascular disease, and left ventricular hypertrophy are more common in patients who do not demonstrate the normal nocturnal fall in blood pressure, and this has led to the assumption that non-dipper status is an independent predictor of cardiovascular morbidity and mortality. There are a number of potential problems that may complicate this interpretation. Vascular disease itself could impair nocturnal blood pressure fall through impairment of cardiovascular reflexes. It remains uncertain whether this nondipper
status genuinely reflects a greater daily blood pressure load or whether it merely means that the patient did not sleep as soundly, having been disturbed by the inflation of the blood
pressure cuff. The results of a number of large scale studies of ambulatory blood pressure and prognosis are awaited. These include the European study OVA, the study on ambulatory blood pressure and treatment of hypertension (APTH), the SAMPLE study and the ABP arm of the European Working Party on High Blood Pressure Syst-Eur study.