Further observations on reverse-dipper or riser patterns identified with ambulatory blood pressure monitoring

Introduction:Despite debate over definitions, patterns like reverse-dipper phenotypes (RDPs) are determined solely by the nightto-day mean systolic blood pressure (mSBP) ratio, without considering variations in nighttime SBP load and hyperbaric impact (HBI).Objective: This study aims to describe the potential spectrum of RDP phenotypes.Materials and methods: This was a cross-sectional observational study of adults diagnosed with RDP using 24-hour ambulatory blood pressure monitoring (ABPM).Clinical information was extracted from electronic medical records and ABPM.The systolic hyperbaric impact (SHBI) at night, the ratio of nighttime mSBP/daytime mSBP, isolated nocturnal hypertension (INHTN), and sustained hypertension (SHTN) (day and night) were recorded.Results: A total of 136 RDP patients were included.Three subgroups were identified based on ratio, SBP load, day/night mSBP difference, SHTN, INHTN, and SHBI.These subgroups showed different ABPM values, characterizing distinct phenotypes with statistical significance.Conclusion: This study revealed diverse phenotypes within RDP, marked by a varying nighttime SBP load and HBI, alongside day to night SBP gradients and the presence or absence of INHTN/SHTN.These subtypes may exhibit different clinical behaviors and prognoses, offering a fresh perspective on RDP classification.