Background
We aimed to assess insulin sensitivity and other metabolic features of dippers and
non-dippers among overweight middle-aged men.
Methods
We studied 73 men (45.8 ± 5.3 years) who were overweight but normotensive. Participants
were separated into dippers and non-dippers based on the magnitude of the nocturnal
decline of blood pressure, with dippers experiencing an overnight decline ≥10% as
per standard definition. Our study included 51 dippers and 22 non-dippers. All participants
underwent 24-hour ambulatory blood pressure monitoring. Insulin sensitivity was assessed
by the Matsuda method from an oral glucose tolerance test; other assessments included
carotid artery intima-media thickness (CIMT), body composition derived from dual-energy
X-ray absorptiometry, lipid profiles, and a physical activity questionnaire.
Results
Non-dippers had lower daytime systolic (-5.0 mmHg; p = 0.022) and diastolic (-3.3 mmHg; p = 0.035) blood pressure than dippers. Conversely, during sleep, non-dippers had higher
systolic (+6.5 mmHg; p = 0.003) and diastolic (+5.6 mmHg; p = 0.001) blood pressure. In continuous associations, increasing CIMT was associated
with decreasing systolic (p = 0.012) and diastolic (p = 0.042) dipping. Thus, non-dippers had CIMT that was 9% greater than that of dippers
(749 vs 820 μm; p = 0.036). Importantly, there was no association between non-dipping status or the magnitude
of the nocturnal dip with insulin sensitivity.
Conclusions
Non-dippers had lower blood pressure in the daytime, but higher blood pressure in
the night time compared to dippers. Non-dippers had increased CIMT, which suggests
that normotensive men with a non-dipping ambulatory blood pressure profile may be
at increased cardiovascular risk. However, it appears that the non-dipping profile
is unrelated to dysfunction of glucose homeostasis in overweight normotensive men.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Fifty years of Framingham Study contributions to understanding hypertension.J Hum Hypertens. 2000; 14: 83-90
- Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society.BMJ. 2000; 320: 1128-1134
- Nocturnal hypertension: poor correlation with office blood pressure but strong prognostic factor for target organ damage.Hellenic J Cardiol. 2012; 53: 263-272
- Nocturnal hypertension or nondipping: which is better associated with the cardiovascular risk profile?.Am J Hypertens. 2014; 27: 680-687
- Predictive role of the nighttime blood pressure.Hypertension. 2011; 57: 3-10
- Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality. The Ohasama Study.Hypertension. 2005; 45: 240-245
- Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes.J Hum Hypertens. 2010; 25: 281-293
- Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations.J Hypertens. 2010; 28: 2036-2045
- Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension.JAMA. 1999; 282: 539-546
- Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study.Hypertension. 2005; 46: 156-161
- Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension.Hypertension. 2008; 51: 55-61
- Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension.Hypertension. 1994; 24: 793-801
- Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study.J Hypertens. 2002; 20: 2183-2189
- Non-dipping circadian blood pressure and renal impairment are associated with increased mortality in diabetes mellitus.Diabet Med. 2000; 17: 360-364
- Impaired diurnal blood pressure variation and all-cause mortality.Am J Hypertens. 2008; 21: 92-97
- Predictors of mortality in patients with type 2 diabetes with or without diabetic nephropathy: a follow-up study.J Hypertens. 2007; 25: 2479-2485
- Target organ damage and non-dipping pattern defined by two sessions of ambulatory blood pressure monitoring in recently diagnosed essential hypertensive patients.J Hypertens. 2001; 19: 1539-1545
- Reduced nocturnal fall in blood pressure, assessed by two ambulatory blood pressure monitorings and cardiac alterations in early phases of untreated essential hypertension.J Hum Hypertens. 2003; 17: 245-251
- Role of insulin resistance in nondipper essential hypertensive patients.Hypertens Res. 2003; 26: 669-676
- Relation between abnormalities in circadian blood pressure rhythm and target organ damage in normotensives.Circ J. 2009; 73: 899-904
- Associations between nondipping of nocturnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives.Am J Hypertens. 2003; 16: 434-438
- Blunted sleep-time relative blood pressure decline increases cardiovascular risk independent of blood pressure level—the “normotensive non-dipper” paradox.Chronobiol Int. 2013; 30: 87-98
- Predictors of all-cause mortality in clinical ambulatory monitoring: unique aspects of blood pressure during sleep.Hypertension. 2007; 49: 1235-1241
- Is nondipping harmful in normotensive, healthy subjects?.Am J Hypertens. 2010; 23: 222-223
- Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease.Diabetes Care. 1991; 14: 173-194
- Insulin resistance in essential hypertension.N Engl J Med. 1987; 317: 350-357
- Insulin resistance/compensatory hyperinsulinemia, essential hypertension, and cardiovascular disease.J Clin Endocrinol Metab. 2003; 88: 2399-2403
- Elevated myocardial repolarization lability and arterial baroreflex dysfunction in healthy individuals with nondipping blood pressure pattern.Am J Hypertens. 2010; 23: 255-259
- Causes and consequences of a non-dipping blood pressure profile.Neth J Med. 2007; 65: 127-131
- Blood pressure dipping: ethnicity, sleep quality, and sympathetic nervous system activity.Am J Hypertens. 2011; 24: 982-988
- Olive (Olea europaea L.) leaf polyphenols improve insulin sensitivity in middle-aged overweight men: a randomized, placebo-controlled, crossover trial.PLoS ONE. 2013; 8: e57622
- Supplementation with a blend of krill and salmon oil is associated with increased metabolic risk in overweight men.Am J Clin Nutr. 2015; 102: 49-57
- Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp.Diabetes Care. 1999; 22: 1462-1470
- Relation of direct and surrogate measures of insulin resistance to cardiovascular risk factors in nondiabetic Finnish offspring of type 2 diabetic individuals.J Clin Endocrinol Metab. 2010; 95: 5082-5090
- Repeatability of indices of insulin sensitivity and secretion from a standard liquid meal test in subjects with type 2 diabetes, impaired or normal fasting glucose.Nutr J. 2009; 8: 22
- Dippers and non-dippers.Lancet. 1988; 332: 397
- Prediction of clinical cardiovascular events with carotid intima-media thickness a systematic review and meta-analysis.Circulation. 2007; 115: 459-467
- Carotid intima-media thickening indicates a higher vascular risk across a wide age range prospective data from the Carotid Atherosclerosis Progression Study (CAPS).Stroke. 2006; 37: 87-92
- A practical protocol to measure common carotid artery intima-media thickness.Clinics. 2008; 63: 515-520
- Validation of an automated computerized analyzing system for measuring common carotid artery intima-media thickness by brightness mode ultrasound.J Vascular Ultrasound. 2005; 29: 21-26
- The International Physical Activity Questionnaire (IPAQ): a study of concurrent and construct validity.Public Health Nutr. 2006; 9: 755-762
- NZDep2006 Index of Deprivation.Department of Public Health, University of Otago, Wellington2007
- Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome.Ann Intern Med. 1999; 131: 485-491
- Among overweight middle-aged men, first-borns have lower insulin sensitivity than second-borns.Sci Rep. 2014; 4: 3906
- European Society of Hypertension position paper on ambulatory blood pressure monitoring.J Hypertens. 2013; 31: 1731-1768
- Reproducibility of nocturnal blood pressure fall in early phases of untreated essential hypertension: a prospective observational study.J Hum Hypertens. 2004; 18: 503-509
- Relation of extent of nocturnal blood pressure decrease to cardiovascular remodeling in never-treated patients with essential hypertension.Am J Cardiol. 2002; 89: 1193-1196
- Effect of insulin and glucose infusions on sympathetic nervous system activity in normal man.Diabetes. 1981; 30: 219-225
- Sympathetic nervous system and insulin resistance: from obesity to diabetes.Am J Hypertens. 2001; 14 (304S-9S)
- The effect of insulin on renal sodium metabolism.Diabetologia. 1981; 21: 165-171
- Obesity/insulin resistance is associated with endothelial dysfunction. Implications for the syndrome of insulin resistance.J Clin Invest. 1996; 97: 2601-2610
- Ambulatory blood pressure monitoring in obese children: role of insulin resistance.J Hypertens. 2006; 24: 2431-2436
- Ambulatory blood pressure parameters in office normotensive obese and non-obese children: relationship with insulin resistance and atherosclerotic markers.Med Princ Pract. 2013; 23: 154-159
- Insulin resistance and blood pressure circadian variation in an obese hypertensive population.Clin Exp Hypertens. 2006; 28: 625-630
- Adiponectin, insulin resistance, and left ventricular structure in dipper and nondipper essential hypertensive patients.Am J Hypertens. 2005; 18: 30-35
- The majority of nondipping men do not have increased cardiovascular risk: a population-based study.J Hypertens. 2002; 20: 1501-1506
- Association between nocturnal blood pressure dipping and insulin resistance in children affected by NAFLD.Eur J Pediatr. 2014; 173: 1511-1518
- Nonalcoholic fatty liver disease, adiponectin and insulin resistance in dipper and nondipper essential hypertensive patients.J Hypertens. 2008; 26: 2191-2197
- Circadian pattern of ambulatory blood pressure in hypertensive patients with and without type 2 diabetes.Chronobiol Int. 2013; 30: 99-115
- Loss of nocturnal decline in blood pressure after cardiac transplantation.Circulation. 1986; 73: 401-408
- Regulation of plasma triglycerides in insulin resistance and diabetes.Arch Med Res. 2005; 36: 232-240
- The FFA receptor GPR40 links hyperinsulinemia, hepatic steatosis, and impaired glucose homeostasis in mouse.Cell Metab. 2005; 1: 245-258
- Fatigue and autonomic dysfunction in non-alcoholic fatty liver disease.Clin Auton Res. 2009; 19: 319-326
- Autonomic neural dysfunction in recently diagnosed diabetic subjects.Diabetes Care. 1984; 7: 447-453
- Nondipping pattern and carotid atherosclerosis in a middle-aged population: OPERA Study.Am J Hypertens. 2012; 25: 60-66
- Reproducibility of ambulatory blood pressure in treated and untreated hypertensive patients.J Hypertens. 2010; 28: 918-924
- Reproducibility of ambulatory and clinic blood pressure measurements in elderly hypertensive subjects.J Hypertens. 1993; 11: 573-580
- Long-term reproducibility of ambulatory blood pressure.J Hypertens. 1994; 12: 703-708
- A test of reproducibility of blood pressure and heart rate variability using a controlled ambulatory procedure.J Hypertens. 1993; 11: 1127-1131
- Reliability of nocturnal blood pressure dipping.Blood Press Monit. 2000; 5: 217-221
- Reproducibility and clinical value of nocturnal hypotension: prospective evidence from the SAMPLE study.J Hypertens. 1998; 16: 733-738
- Carotid intima-media thickness measurements in intervention studies design options, progression rates, and sample size considerations: a point of view.Stroke. 2003; 34: 2985-2994
Article info
Publication history
Published online: May 17, 2016
Accepted:
April 8,
2016
Received in revised form:
March 16,
2016
Received:
December 14,
2015
Identification
Copyright
© 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
