Naples, Italy – A newly published study suggests a link between a non-dipping blood pressure pattern – where blood pressure doesn’t decrease sufficiently during sleep – and increased systemic inflammation and arterial stiffness in newly diagnosed hypertension patients. Researchers found that patients exhibiting this non-dipping pattern also demonstrated higher levels of a marker reflecting immune and nutritional status, known as the Naples Prognostic Score (NPS).
The research, conducted retrospectively on , involved 297 individuals recently diagnosed with hypertension who had not yet begun treatment. Participants underwent 24-hour ambulatory blood pressure monitoring to classify them as either “dippers” – those with a normal nocturnal blood pressure decline – or “non-dippers.” Laboratory tests were conducted, NPS scores were calculated, and arterial stiffness was measured using pulse wave velocity (PWV).
The findings, published in PubMed, revealed significantly higher median NPS values in the non-dipper group [2 (0-4) vs. 1 (0-4), p < 0.001]. A greater proportion of non-dippers also had high NPS scores (3-4) – 42.8% compared to 13.8% of dippers (p < 0.001). Median PWV, an indicator of arterial stiffness, was notably higher in non-dippers [7.70m/s (4.70-12.90) vs. 7.00m/s (4.40-11.20), p = 0.005].
After adjusting for other clinically relevant factors, the study demonstrated that both NPS (OR 1.71, 95% CI 1.19-2.47; p = 0.004) and PWV (OR 1.37, 95% CI 1.12-1.68; p = 0.002) were independently associated with the non-dipper hypertension pattern. This suggests that these factors are not merely correlated but have a distinct and independent influence on the development of this potentially more dangerous form of hypertension.
Hypertension, or high blood pressure, is a major global health concern, contributing significantly to cardiovascular disease, stroke, and kidney failure. The normal circadian rhythm of blood pressure – a decrease during sleep – is considered a healthy physiological function. Disruptions to this rhythm, such as the non-dipping pattern, have long been suspected of increasing cardiovascular risk, but the underlying mechanisms have remained incompletely understood.
The NPS, as described in the study, is a laboratory-based score that provides an assessment of a patient’s immune-inflammatory and nutritional status. The finding that higher NPS scores are associated with non-dipping hypertension suggests a potential link between systemic inflammation and the dysregulation of blood pressure during sleep. This connection is further supported by separate research highlighting the role of systemic inflammation in circadian blood pressure dysregulation, as noted in a study published by the American Heart Association.
Researchers also point to arterial stiffness as a key factor. Increased stiffness of the arteries can impair the body’s ability to regulate blood pressure effectively, potentially contributing to the non-dipping pattern. The study’s finding that PWV is higher in non-dippers reinforces this connection.
Another study, published in Tandfonline, found elevated levels of the Pan-Immune-Inflammation Value (PIV) were significantly associated with non-dipper hypertension, further reinforcing the contribution of systemic inflammation to the condition. This suggests that PIV could potentially serve as a biomarker for identifying patients at higher risk.
A separate study, also published in PubMed, examined inflammatory biomarkers in hypertensive patients and found significant differences between dipper and non-dipper groups. The study identified several inflammatory indices – including the neutrophil-to-lymphocyte ratio (NLR) and the derived NLR (dNLR) – that strongly correlated with non-dipper hypertension, with dNLR demonstrating the strongest predictive value.
The Italian research team concluded that the NPS could serve as a “simple and clinically applicable marker” for early cardiovascular risk stratification in newly diagnosed hypertension patients. This could allow clinicians to identify individuals who may benefit from more aggressive interventions to manage their blood pressure and reduce their risk of cardiovascular events.
While the study focused on a specific population – newly diagnosed, untreated hypertensive patients – the findings have broader implications for the understanding and management of hypertension globally. Further research is needed to determine whether these associations hold true across different populations and whether interventions targeting inflammation and arterial stiffness can improve outcomes for patients with non-dipping hypertension. The study’s retrospective nature also means it can only demonstrate association, not causation, requiring further prospective studies to confirm the findings.
