ABC | Volume 114, Nº1, January 2019

Short Editorial Póvoa Aortic arch calcification and non-dipper blood pressure pattern Arq Bras Cardiol. 2020; 114(1):118-119 1. Brasil. Ministério da Saúde. Vigitel Brasil 2018. Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico. [Acesso em 2019 maio 13] Disponível em :https://portalarquivos2.saude.gov.br/ images/pdf/2019/julho/25/vigitel-brasil-2018.pdf 2. Boggia J, Li Y, Thijs L, Hansen TW, Kikuya M, Bjork Lund-Bodgard K,et al. International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes (IDACO) Investigators. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. Lancet. 2007;370(9594):1219–29. 3. O’Brien E, Sheridan J, O’Maleey K. Dippers and Non-Dippers. Lancet. 1988;2(8607):397. 4. Kario K, Matsuo T , Kobayashi H, ImiyaM, MatsuoM, Shimada K. Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly hypertension patients. Hypertension. 1996;27(1):130-5. 5. Ohkubo T, Hozawa A, Yamaguchi J, KikuyaM, MichimataM, MatsubaraM, et al. Prognostic significance of the nocturnal decline in blood pressure in individuals with andwithout high 24-h blood pressure: theOhasama study. J Hypertens. 2002;20(11):2183-9. 6. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for themanagement of arterial hypertension The Task Force for themanagement of arterial hypertension of the European SocietyofCardiology (ESC)andtheEuropeanSocietyofHypertension (ESH). Eur Heart J. 2018;39(33):3021-104. 7. Mejia-Vilet JM, Bhatt U , Birmingham DJ, Arce C, Hebert CJ, Parikh SV, et al. Masked uncontrolled hypertension. J Hypertens. 2019;37(12):2501-2. 8.Stergiou GS, Tzamouranis D, Nasothimiou EG, Karpetta N, Protogerou A. Are there really differences between home and daytime ambulatory blood pressure? Comparison using a novel dual-mode ambulatory and home monitor. J HumHypertens. 2009;24(3):207-12. 9. Kario K, Pickering TG, Umeda Y, Hoshida Y, Morinai M, Murata M, et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation. 2003;107(10):1401-6. 10. Nakanishi K, Jin Z, Homma S, Elkind MSV, Rundek T, Schwartz JE, et al. Night-time systolic blood pressure and subclinical cerebrovascular disease: the Cardiovascular Abnormalities and Brain Lesions (CABL) study. Eur Heart J Cardiovasc Imaging. 2019;20(7):765-71. 11. Adar A, Onalan O, Cakan F, et al. Aortic Arch Calcification on routine Chest Radiography is Strongly and Independently Associated with Non-Dipper Blood Pressure Pattern. Arq Bras Cardiol. 2020; 114(1):109-117. 12. Turgut AT, Sonmez I, Cakit BD, Kosar P, Kosar U. Pineal gland calcification, lumbar intervertebral disc degeneration and abdominal aorta calcifying atherosclerosis correlate in low back pain subjects: A cross-sectional observational CT study. Pathophysiol.2008;15(1):31-9. 13. Pechanova O, Paulis L, Simko F. Peripheral and central effects of melatonin on blood pressure regulation. Int J Mol Sci. 2014;15(10):17920-37. 14. BowlesNP , ThosarSS, HerzigMX, SheaSA. Chronotherapy forHypertension. Curr Hypertens Rep. 2018;20(11):97-134. 15. Hermida RC, Crespo JJ, Domínguez-SardiñaM ,Moya A, OteroA, RiosMT, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. Eur Heart J. 2019 Oct 22. pii: ehz754. References This is an open-access article distributed under the terms of the Creative Commons Attribution License other reason, it can also be used to screen for non-dippers, as demonstrated in this study. This may be beneficial to the patient, since secondary causes of hypertension, including obstructive sleep apnea, are frequent. The pathophysiological justification of this association, between the aortic artery calcification and the non-dipping of pressure during sleep, remains unknown. The authors mention the association of this calcification with pineal gland calcification and melatonin reduction, which plays an important role in sleep regulation. 12 Moreover, it also participates in the autonomic regulation with greater accentuation of the parasympathetic system with direct vasodilating effects, thereby reducing blood pressure. 13 The finding of calcification in the aortic arch allowing the diagnosis of the presence of atherosclerosis immediately changes the cardiovascular risk, wherein clinical care should be more intense and thus improve our clinical practice. Although there are not robust clinical trials evaluating chromotherapy and the influence of antihypertensive drugs on the non-dipper pattern yet, it is sensible and intuitive that this should be done, when there is no objective cause for no reduction of blood pressure during sleep. In hypertensive patients, the change in the time of medication may change the pattern of nocturnal dipping and possibly benefit the patient. 14,15 An adequate BP control in the early hours of the morning means the use of drugs with adequate 24-hour coverage; however, some medications do not provide this effect. Changing the time when the patient takes the drug, particularly to the afternoon, may result in a pressure behavior closer to the normal circadian rhythm. We still have a long road ahead to assess blood pressure behavior, but some light is already emerging to unravel the mechanisms implicated in this complex web of hypertensive disease etiology. 119