Heart, Lung and Circulation

Morning Blood Pressure Surge Relates to Autonomic Neural Activity in Young Non-Dipping Adults: The African-PREDICT Study

  • Gontse G. Mokwatsi
    Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
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  • Aletta E. Schutte
    Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa

    Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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  • Catharina M.C. Mels
    Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa

    Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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  • Ruan Kruger
    Corresponding author at: Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, 2531, South Africa. Tel.: +27 18 299 2904, Fax: +27 18 285 2432.
    Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa

    Medical Research Council: Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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      It is well established that an exaggerated morning blood pressure surge (MBPS) is associated with an increased risk for cardiovascular disease development in hypertensive individuals. However, in non-dipping individuals, a lower surge was reportedly associated with increased cardiovascular risk. Sympathetic nervous system activity is involved in 24-hour blood pressure fluctuations, including night-time dipping and the MBPS. To better understand this interaction, we investigated associations of MBPS with heart-rate variability and baroreceptor sensitivity in young healthy dippers and non-dippers.


      We included black and white men and women (n = 827), aged 20-30 years and determined the MBPS using two formulas: the sleep-trough and dynamic morning surge. For autonomic function we determined baroreceptor sensitivity and heart-rate variability.


      The majority of non-dippers in this population were black (70.4%), presenting lower sleep-trough and dynamic morning surge (all p < 0.001). Heart-rate variability was comparable between dippers and non-dippers, whereas baroreceptor sensitivity was higher in non-dippers (p = 0.021). Despite a suppressed MBPS profile in non-dippers, we found both sleep-trough (β = −0.25; p = 0.039) and dynamic morning surge (β = −0.14; p = 0.047) to be inversely and independently associated with 24-hour heart-rate variability (total power). These results were absent in dippers.


      In conclusion, we found a higher night-time blood pressure coupled with lower MBPS in young healthy non-dippers. Furthermore, this lower MBPS was independently and negatively associated with autonomic neural activity, suggesting increased autonomic function involvement in MBPS suppression of non-dippers. The predictive value of suppressed nocturnal dipping pattern should be investigated while taking autonomic neural activity into account.


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