Abstract
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.