Non-dipping Hypertension — EECC MCQ

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ModerateHypertension & Preventive CardiologyNon-dipping HypertensionEECC

A 55-year-old man with hypertension has his ABPM reviewed. The nocturnal BP is 135/85 mmHg (diurnal 138/88 mmHg), showing a non-dipping pattern. What is the clinical significance?

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Correct answer: C — Non-dipping (nocturnal BP drop <10% of daytime values) is associated with increased cardiovascular risk, including higher rates of LVH, stroke, and renal damage compared with normal dipping

Normal circadian BP variation shows a 10-20% nocturnal dip ('dipping' pattern). Non-dipping (<10% nocturnal decline) and reverse dipping (nocturnal rise) are associated with: increased LVH, microalbuminuria, stroke, cardiovascular events, and all-cause mortality. Non-dipping may indicate: secondary hypertension (OSA, CKD, primary aldosteronism, phaeochromocytoma), autonomic dysfunction, diabetes, or excessive sodium intake. The 2024 ESC Hypertension Guidelines recommend 24-hour ABPM as the preferred out-of-office BP measurement method (Class I), as it captures nocturnal patterns and dipping status. Evening dosing of antihypertensives may improve nocturnal dipping, though the TIME trial showed no difference in outcomes based on dosing time.

Reference: ESC (2024): Guidelines for the Management of Elevated Blood Pressure and Hypertension