Association of diurnal blood pressure patterns with heart rate variability and retinopathy in patients with essential hypertension

To investigate the association of different diurnal blood pressure patterns with heart rate variability (HRV) and hypertensive retinopathy (HR) risk in essential hypertension patients. A total of 181 patients (Jan 2023-Jun 2025) were grouped by nocturnal systolic blood pressure fall rate (SBPF): dipper (n = 57, 10%≤SBPF < 20%), non-dipper (n = 62, 0 ≤ SBPF < 10%), reverse-dipper (n = 62, SBPF < 0%). Ambulatory blood pressure (BP), HRV indices, and HR detection rate were compared. Reverse-dipper had higher nocturnal SBP (nSBP), 24-hour SBP (24hSBP) than the other two groups (all P < 0.05), and higher nocturnal DBP (nDBP) than dipper (P = 0.002). Dipper's HRV indices (SDNN, SDANN, RMSSD, PNN50, LF, HF) were better than non-dipper (P < 0.05); SDNN, SDANN, LF were better than reverse-dipper (all P < 0.001). Reverse-dipper's LF/HF was lower than others (P < 0.05). HR detection rates: 3.5% (dipper), 46.8% (non-dipper), 50.0% (reverse-dipper) (P < 0.001). Multivariable regression: BMI (OR = 1.131) was an independent risk factor; dipper (vs. reverse-dipper, OR = 0.031) was protective (P < 0.05). Reverse-dipper has the highest nocturnal BP load, dipper the most favorable (better autonomic regulation). Ambulatory BP monitoring and BMI control are crucial to reduce target organ damage.