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Table 5: High blood pressure phenotypes according high blood pressure variability. |
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Phenotype |
Nocturnal and day-night variety high blood pressure |
Orthostatic high blood pressure |
Reactive high blood pressure |
|
Definition |
Nocturnal: Mean diastolic > 70 mmHg systolic < 120 mmHg during sleep. Dipper: decrease between 10 - 20%. Hyper-dipper: decrease > 20% Non-Dipper: decrease < 10% Reverse riser or dipper: Lack of descent (0%) or ascent. |
Difference between lying and standing position: > 15 to 20 mmHg |
Disproportionate increase in BP due to physical exertion or emotional changes. Disproportionate increase in the double product (heart rate x blood pressure) during physical exercise. |
|
Etiology |
Obesity, sleep disorders, inadequate antihypertensive therapy. |
Unknown |
Personality disorders. |
|
Pathophysiology |
Due to increased cardiac output and peripheral vascular resistance and in some cases due to sleep apnea. |
Autonomic dysfunction. |
Increased cardiac output and peripheral vascular resistance. |
|
Prognosis |
Increased risk for subclinical cardiovascular and renal damage and increased mortality. |
Increased risk of syncope and cognitive impairment. |
Increased cardiovascular and renal risk. |
|
Treatment |
Treatment of sleep disorder and use of fixed combinations. Chronotherapy? |
Evaluate monotherapy. |
Psychological and adjustment of pharmacological treatment. |