Introduction:

Despite debate over definitions, patterns like reverse-dipper (RDP) phenotypes are determined solely by the night-to-day mean systolic blood pressure (mSBP) ratio, without considering variations in nighttime SBP load and hyperbaric impact (HBI).

Objective:

To describe the potential spectrum of RDP phenotypes.

Materials and method:

This was a cross-sectional observational study of adults diagnosed with an 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, nighttime mSBP/daytime mSBP ratio, 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 SBP load and HBI at night, alongside day-night SBP gradients and the presence or absence of INHTN/SHTN. These subtypes may exhibit different clinical behaviours and prognoses, offering a fresh perspective on RDP classification.

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