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(Hypertension. 2009;53:e1.)
© 2009 American Heart Association, Inc.

Letters to the Editor

Possible Difference in the Sympathetic Activation on Extreme Dippers With or Without Exaggerated Morning Surge

Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with great interest the report by Grassi et al¹ that sympathetic activation is responsible for the nocturnal blood pressure (BP) dipping status in hypertensive subjects. We agree that reverse dipping status is characterized by a marked sympathetic activation. We have reported previously that an -adrenergic blocker, doxazosin, markedly affects the nocturnal BP dipping status of hypertensive subjects, with apparently greater reduction of nighttime, as well as daytime, BP in reverse dippers.² In contrast, the finding that doxazosin had no significant effects on nighttime BP in extreme dippers suggests that -adrenergic tone falls, at least during the nighttime, in extreme dippers. However, we disagree with the authors that there was no correlation between extreme dipper status and morning sympathetic activation, as determined using direct measurement of muscle sympathetic nerve activity performed in the morning.

First, there are at least 2 possible patterns of morning BP surge (MBPS) in extreme dippers, one with exaggerated MBPS and another with no exaggerated MBPS. The pathological mechanisms of these variations and their clinical use remain unclear, but the former may be closely associated with morning sympathetic activation.³ Our previous report⁴ showed that 24% of extreme dippers had exaggerated MBPS (55 mm Hg: top decile of the population), defined as the difference between the mean systolic BP during the 2 hours after waking and the average of 3 readings centered on the lowest systolic BP taken while patients were asleep. The differences in study population between the present study by . . . [Full Text of this Article]

This article has been cited by other articles:

				G. Grassi, G. Seravalle, F. Quarti-Trevano, R. Dell'Oro, M. Bombelli, C. Cuspidi, R. Facchetti, G. Bolla, and G. Mancia Response to Possible Difference in the Sympathetic Activation on Extreme Dippers With or Without Exaggerated Morning Surge Hypertension, January 1, 2009; 53(1): e2 - e2. [Full Text] [PDF]