The significance of nondipping and increased nighttime systolic blood pressure (SBP) in established hypertension is well defined. We investigated whether these factors alone or combined correlate with vascular damage in early-stage hypertension. Newly diagnosed, untreated hypertensives were classified as dippers and nondippers according to ambulatory blood pressure (BP). Twenty-four–hour urinary albumin excretion and markers of arterial stiffness (pulse wave velocity, augmentation index, central and peripheral pulse pressure, central BP) and atherosclerosis (carotid intima-media thickness) were assessed. Serum asymmetric dimethylarginine, an index of endothelial dysfunction, was measured in a study subgroup; 10-year cardiovascular risk was calculated. Among 222 hypertensives, only urinary albumin excretion was increased in nondippers, compared to dippers (P = .026). When dippers were further stratified according to nighttime SBP (<120 or ≥120 mm Hg), the first group demonstrated the lowest levels of office, aortic, 24-hour, daytime and nighttime BP, compared to dippers with elevated nighttime SBP and nondippers. Although vascular measurements and asymmetric dimethylarginine were comparable between these groups, dippers with normal nighttime SBP exhibited the lowest cardiovascular risk score (P = .050). In early-stage hypertension, nondipping was accompanied by microvascular, yet not macrovascular and endothelial dysfunction. Dippers with elevated nighttime SBP appear as a distinct group with increased hemodynamic pressure load and cardiovascular risk.

明确确定的非高血压和夜间收缩压升高对已确立的高血压的重要性。我们调查了这些因素单独还是综合与早期高血压患者的血管损伤相关。根据动态血压（BP），新诊断的未经治疗的高血压被分类为北斗星和非北斗星。评估二十四小时尿白蛋白排泄和动脉僵硬度（脉搏波速度，增强指数，中央和周围脉压，中央血压）和动脉粥样硬化（颈动脉内膜中层厚度）的标志物。在一个研究亚组中测量了血清不对称二甲基精氨酸，这是内皮功能障碍的指标。计算了10年的心血管风险。在222名高血压患者中，非北斗七星中仅尿白蛋白排泄增加，P  = .026）。当根据夜间SBP（<120或≥120mm Hg）将铲斗进一步分层时，与夜间SBP和非铲斗升高的铲斗相比，第一组的办公室，主动脉，24小时，白天和夜间BP最低。尽管这些组之间的血管测量值和不对称二甲基精氨酸水平相当，但夜间SBP正常的北斗七星显示出最低的心血管风险评分（P  = .050）。在早期高血压中，不浸润伴有微血管，但不伴有大血管和内皮功能障碍。夜间SBP升高的北斗星是一个明显的群体，其血液动力学压力负荷增加和心血管风险增加。