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(Hypertension. 2000;35:787.)
© 2000 American Heart Association, Inc.
Scientific Contributions |
Changes of Nocturnal Blood Pressure Dipping Status in Hypertensives by Nighttime Dosing of 
-Adrenergic Blocker, Doxazosin
Results from the HALT Study
From the Hypertension Center (K.K., J.E.S., T.G.P.), Weill Medical College of Cornell University - The New York Presbyterian Hospital, New York, and the Department of Psychiatry (J.E.S.), SUNY - Stony Brook, NY.
Correspondence to Dr. Kazuomi Kario, MD, PhD, FACC, or Thomas G. Pickering, MD, DPhil, Hypertension Center, Department of Medicine, Weill Medical College of Cornell University, 1300 York Ave, New York, NY, 10021. E-mail kak2012@mail.med.cornell.edu or tpicker{at}mail.med.cornell.edu
Abstract—Abnormal nocturnal blood
pressure (BP) dipping status may be partly determined by nocturnal
sympathetic activity. We studied the effect of nighttime dosing of an
1-adrenergic blocker, doxazosin, on the BP dipping
status of 118 hypertensives, all of whom underwent 24-hour ambulatory
BP monitoring before and after treatment. The mean nighttime/daytime
ratio of systolic BP was increased (0.91 after therapy versus
0.89 at baseline, P<0.05). The patients were initially
divided into 4 groups on the basis of their dipping status at the
baseline assessment: 18 (15%) were extreme dippers, with a nighttime
systolic BP fall of at least 20% of daytime BP; 46 (39%) were
dippers (fall between 10% and 20%); 48 (41%) were nondippers (fall
between 0% and 10%); and 6 (5%) were risers (nocturnal increase of
systolic BP). A shift in dipping status toward less nocturnal
BP dipping was observed after doxazosin therapy
(P<0.05). Dipping status was determined by nighttime
more than by daytime BP, and this was not explained by differences in
the number of daytime and nighttime readings. The effects of doxazosin
on the mean nocturnal systolic BP changes were an increase of
4.3 mm Hg in extreme dippers and decreases of 0.7 mm Hg in
dippers, 12 mm Hg in nondippers, and 18 mm Hg in risers;
the reduction was only significant in the latter 2 groups (both
P<0.01). To estimate the effects of regression to the
mean on the changes in dipping status, we also defined dipping status
with the average of the BPs before and after doxazosin and found no
difference in the degree of nighttime BP reduction among each group.
The reduction of daytime BP was now significantly greater in the
subgroups with less dipping: 6.4 mm Hg for extreme dippers and
16 mm Hg for risers (P<0.05). In conclusion,
nighttime dosing with doxazosin markedly affects the nocturnal BP
dipping status of hypertensives, but the apparently greater reduction
in nighttime pressure in nondippers and risers may be, at least partly,
due to the effect of regression to the mean. The most important
determinants of the effect of doxazosin were the absolute BP levels,
both day and night, rather than dipping status per se.
Key Words: : blood pressure monitoring • adrenergic receptor blocking • circadian rhythm • prospective studies
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