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BP Dipping? -- The Secret Reason You Have Hypertension

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July 27, 2016

By ARIADNE WEINBERG, Featured Columnist




What's B.P. Dipping? Nope, it's not as fun as skinny dipping on a hot summer day, or dipping vanilla ice cream in warm chocolate sauce, but it is absolutely necessary for your health.

For the average human, blood pressure drops at night, the time when people on a regular Circadian rhythm sleep. In healthy people, nocturnal blood pressure should “dip” about 10-20% from its baseline during the day.

If your nocturnal blood pressure doesn't experience this change—if it either stays the same or rises—it could be an indicator of various health problems.

In a 1999 report, Eoin O'Brien from the University College, Dublin, reports one instance of a study of blood pressure.

In 123 patients, when walking around (ambulatory) blood pressure was measured, 83% were dippers.  In other words, they had a difference of equal to or more than 10/5 mmHg between their day and nighttime blood pressure).  But 17% of the patients were non-dippers.

Researchers noted that the non-dippers had a significantly higher instance of stroke. A stroke isn't the only related condition or side effect of a lack of drop in blood pressure, but it is one of the more serious ones.

So, what are some steps you can take to become part of the Dipper/good health club?

Being good to your organs and treating any chronic conditions is the best way to go.

Read on to find out some practical ways to keep your blood pressure in equilibrium, night and day.















  1. Take Care of Your Kidneys to Become a Dipper

Yes, this is an organ that will cause the rest of your body myriad problems if you don't keep an eye on it.

In the case of blood pressure, fluid retention in kidneys is a leading culprit for non-dipping.

Unhealthy kidneys will retain fluids during the day, which is related to low renal perfusion pressure.

When you lie down at night, pooled blood is remobilized, causing an increase in stroke volume and cardiac output, and consequently, an increase in blood pressure, too.

It is difficult to correct, when there is already an impaired autonomic function.

Remember that, while your favorite filtering organ, the kidney, could be the issue, excessive extracellular fluid is a general part of the pathogenesis of non-dipping. So, look for other possible diagnoses with your health professional if necessary.

2. Adjust Your Salt Levels

One way to make your kidneys feel better immediately is to consume less salt.

But regardless of kidney health, all the salt-sensitive folks should cut down.

According to a 2007 report by A.M. Birkenhager, in sodium-sensitive hypertensives, a non-dipping profile changed to a dipping one, with a sodium-restricted diet or with the use of diuretics.

Dr. Uzu T. Ishikawa backs up this statement in his 1997  Circulation article, observing that sodium-sensitive subjects are more likely to be non-dippers than sodium-resistant ones.

When put on a low sodium diet, their blood pressure then shifts to a healthy Dipper pattern. So, the key might be to tweak your diet a tad.

3. Treat Sleep Apnea

If your blood pressure doesn't dip and you find yourself otherwise healthy, it could be due to a condition that you don't know about.

Sleep apnoea is relatively common, and is correlated to being a non-dipper.

In the report by Birkenhager, they claim that sleep apnea is caused by a relatively high sympathetic tone or increased concentration of circulating catecholamines.

One way to treat both obstructive sleep apnea (OSA) and hypertension is using continuous airway pressure (CPAP) to improve blood pressure.

Tests conducted in 2014 by Dr. M.G. Denker and Dr. D.L. Cohen from the Perelman School of Medicine at the University of Philadelphia revealed that patients with severe obstructive sleep apnoea that adhered to the airway pressure therapy got the most benefit.

They also found that not only did the technique restored nocturnal dipping, but it also improved arterial stiffness.

Consult your doctor for the best therapies and medications, if you find your lack of dipping is caused by obstructed breathing.

4. Don't Be a Reverse Dipper -- Lower your Hypertension and Care for Your Heart

There is a clear correlation between non-dippers and generally high blood pressure, regardless of the time of day.

Dippers are generally categorized in three ways: Extreme dippers (less than or equal to 0.8), dippers (0.8 less than ratio or 0.9), and non-dippers (0.9 less than ratio or equal to 1.0).

In 2009, Robert Fagard and researchers from the Hypertension and Rehabilitation Unit at the University of Leuven in Belgium, observed that the worst prognosis was in reverse dippers --- those whose blood pressure actually rises at night.

Usually people in this category had a combination of hypertension and major cardiovascular disease at the baseline.

Higher instances of cardiovascular events and mortality was also found in reverse dippers in comparison with dippers, in a comprehensive meta-analysis of population-based studies.

It goes both ways: Take care of your heart to keep your blood pressure stable. Keep your blood pressure stable to take care of your heart.

5. Take Your Blood Pressure Medication at Night

There are many ways to take care of yourself, but sometimes, timing is the answer to success.

A 2015 study by Ramon Hermida from the University of Vigo in Spain, revealed that blood pressure medications were generally more effective when taken at night.

He also pointed out that non-dippers had more potential for turning into type II diabetes patients in comparison with dippers.

So, this new information has implication not only for the problematic dippers, but also for your diabetes risk.

Generally, medications for high blood pressure specifically target "angiotensins", hormones that causes blood vessels to constrict and blood pressure to rise.

These include angiotensin receptor blockers (ARBS), ACF inhibitors, and beta blockers. All three are related with a reduced risk of type II diabetes when taken at bedtime.

In Hermida's investigation, more than 2000 people who had high blood pressure but no diabetes were assigned to take these types of medications either first thing in the morning or before bed.

The bedtime treatment group experienced more significant reduction, with non-dipping happening in only 32% of the group, compared to 52% of patients who experienced non-dipping in the morning group.

So, before you drift off to dreamland, don't forget your medication.

6. Change Your Body Position While Sleeping

Yes, oddly enough, it may be that simple. Flip to the other side or sleep on your back, and see what happens.

According to an article by Dr. Thomas G. Pickering from the Columbia Presbyterian Medical Center in New York, New York, there is a possibility to record body position during ambulatory blood pressure monitoring, and tests have shown that non-dipping status may be affected.

When a patient is lying on one side, the blood pressure recorded in two arms is distinct due to the effects of hydrostatic pressure differences between the arm and the right atrium.

Differences can be up to 10 mmHg or more. So, if it's possible to record, test how sleeping in one position versus another affects your dipping.

    7. Get a Good Night's Sleep

    It's not only the position in which you sleep; it's also the quality of your sleep.

    If you're an insomnia prince(ss), that could be one likely explanation.

    In subjects kept awake during the first part of the night, it is found that their blood pressure remains high until they can sleep.

    In his 1995 article from Blood Press, M. Pedulla references a study that revealed that non-dippers had a worse sleep profile than dippers, with less stage 4 sleep (the time when blood pressure is the lowest) and fewer rapid eye movements.

    There are many who subscribe to the philosophy “I'll sleep when I'm dead”, but if you don't sleep correctly, well, that moment could come sooner than you think.   




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