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This study was performed in order to define who are the "non-dippers", knowing that their present definition does not imply any explanation about the mechanisms. The investigation was performed on 34 heart transplanted patients, 28 males (mean age 52 +/- 11 years) and 6 women (mean age 35 +/- 14 years), knowing that the "non-dippers" were described as the hypertensives who are devoid of the expected nocturnal fall in blood pressure (BP). The "non-dipping" phenomenon was investigated by exploring the BP 24-h pattern via ambulatory non-invasive BP monitoring, and by applying the rhythmometric analysis for quantifying the BP circadian rhythm. The study provided evidence that the "non-dippers" can be found among the hypertensives as well as the normotensives, suggesting that high BP is not a necessary condition for the "non-dipping" phenomenon, and vice versa. Both the normotensive and hypertensive "non-dippers" were seen to show stereotypic changes in BP circadian rhythm. There are normotensive and hypertensive "non-dippers" with or without the BP circadian rhythm. The "rhythmic non-dippers" show a BP circadian rhythm which is inverted in phase or demodulated in amplitude. The "non-dippers" are, thus, a heterogeneous category.

This study is aimed at investigating the relationship between cardiac hypertrophy and blood pressure (BP) 24-h pattern in 34 heart transplanted patients (HTP), 9 out of them (26%) being considered as normotensives, the other ones (74%) being regarded as hypertensives under adequate treatment, via casual sphygmomanometry. The study is an attempt to explain the occurrence of at least one sign of hypertrophic cardiopathy in 20 cases (59%), hypothesizing the presence of false normotensives among the putative normotensives and presumably-cured hypertensives. The ambulatory BP monitoring was able to identify 7 hypertensives (78%) among the putative normotensives, and 17 not well-cured subjects (68%) among the presumably cured hypertensives. At least one sign of cardiac hypertrophy was found in 5 (50%) of the 10 true normotensives, who were all non-dipper, and in 15 (63%) of the 24 hypertensives. The 9 hypertensives without cardiac hypertrophy (37%) had developed hypertension very recently. These findings stress the role of the ambulatory BP monitoring as a diagnostic tool during the follow-up of HTP, in order to identify the false normotensives as well as the not well-treated hypertensives. This role can contribute to optimize the prophylaxis of hypertensive damage for the transplanted heart.

This investigation was performed in 34 heart transplanted patients (HTP), 28 males and 6 females, mean age 49 +/- 13 years. The aim of the study was to detect hypertension in HTP by casual sphygmomanometry and non-invasive ambulatory blood pressure monitoring (ABPM). The evaluation of ABPM demonstrated that 71% out of the HTP was hypertensive because of some elevated blood pressure values scattered during the hours of the day and/or of the night. These hypertensives were found within the groups of normotensives as well as of hypertensives considered to be correctly treated. Fifty percent hypertensive HTP did not show the physiologic nocturnal decrease in blood pressure (non-dippers); 25% out of the non-dipper hypertensives showed absence of the blood pressure circadian rhythm, demonstrating that their hypertension was prevalently nocturnal and could not be detected by casual sphygmomanometry-The ABPM is recommended in clinical follow-up of HTP for a correct diagnosis of hypertension, which frequently complicates heart transplantation, and with the aim of avoiding hypertensive damage of the transplanted organ. The ABPM is useful for adjusting the antihypertensive therapy, in order to restore the blood pressure circadian rhythm.