CLINICAL CHARACTERISTICS AND PROGNOSTIC SIGNIFICANCE OF NON-DIPPER HYPERTENSION

Wiktoria Szkatuła; Marcin Schulz; Dawid Studziński; Agnieszka Morawa; Karolina Osińska; Michał Kulczak; Anna Kołcz

doi:10.31435/ijitss.2(50).2026.5139

Authors

Wiktoria Szkatuła Provincial Specialist Hospital No. 2 in Jastrzębie-Zdrój, Jastrzębie-Zdrój, Poland https://orcid.org/0009-0000-8206-3926
Marcin Schulz II Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland https://orcid.org/0009-0006-4466-5794
Dawid Studziński Municipal Hospital in Zabrze, Zabrze, Poland https://orcid.org/0009-0005-3834-716X
Agnieszka Morawa Municipal Hospital in Zabrze, Zabrze, Poland https://orcid.org/0009-0001-2325-7998
Karolina Osińska Municipal Hospital in Kędzierzyn-Koźle, Kędzierzyn-Koźle, Poland https://orcid.org/0009-0003-9731-0629
Michał Kulczak School of Medicine, Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0006-4968-3318
Anna Kołcz School of Medicine, Medical University of Silesia, Katowice, Poland https://orcid.org/0009-0006-1446-2865

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5139

Keywords:

Non-Dipper Hypertension; ABPM; Cardiovascular Risk; Circadian Rhythm

Abstract

Non-dipper hypertension, characterized by a nocturnal blood pressure (BP) decline of less than 10% relative to daytime means, represents a significant clinical phenotype associated with heightened cardiovascular morbidity and mortality. While conventional office measurements often fail to capture these variations, ambulatory blood pressure monitoring (ABPM) has emerged as the gold standard for assessing 24-hour BP variability and identifying circadian rhythm disruptions. This review synthesizes current evidence regarding the clinical profile, pathophysiology, and prognostic impact of the non-dipper pattern.

The pathophysiology of non-dipper hypertension involves a complex interplay of autonomic dysregulation, nocturnal renin-angiotensin-aldosterone system hyperactivity, and impaired renal sodium handling. This profile is highly prevalent among patients with metabolic comorbidities, such as type 2 diabetes and obesity, where prevalence rates can reach up to 77%. Prognostically, the non-dipper pattern is a potent independent predictor of target organ damage, including left ventricular hypertrophy, stroke, and chronic kidney disease. Notably, each 5% reduction in nocturnal BP fall is associated with a 20% increase in cardiovascular mortality.

Therapeutic management emphasizes personalized chronotherapy specifically bedtime dosing of antihypertensive agents alongside novel pharmacological options like SGLT2 inhibitors and ARNIs. Furthermore, lifestyle interventions such as sodium restriction and the treatment of sleep disorders are crucial for restoring the physiological circadian rhythm. Ultimately, systematic use of ABPM is essential for accurate risk stratification and the implementation of targeted therapies to reduce the global burden of cardiovascular events.

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