Detecting the Non-Dipper Phenotype in Adolescents Exposed to Nighttime Screen Use-Digital Chronotoxicity as a Proposed Integrative Framework: A Narrative Review of Ambulatory Blood Pressure Monitoring, Subclinical Biomarkers, and Emerging Wearable and AI-Based Screening
Abstract
Arterial hypertension in adolescents is increasingly a lifestyle-driven disorder, and a growing share of cardiovascular risk in this age group is hidden from conventional office measurement. Intensive nighttime screen use, together with the chronic sleep loss that accompanies it, may disrupt circadian control of the cardiovascular system, an effect we designate, as a proposed integrative concept, digital chronotoxicity. Through melatonin suppression, sustained sympathetic and neuroendocrine activation, oxidative stress, and metabolic dysregulation, this exposure is hypothesized to attenuate the physiological nocturnal fall in blood pressure and to contribute to the non-dipper phenotype, a predictor of early vascular aging that remains invisible to office readings. This narrative review traces the mechanistic pathway from screen exposure to the loss of nocturnal dipping and reframes the problem as a diagnostic one. Twenty-four-hour ambulatory blood pressure monitoring is positioned as the reference standard for detecting the at-risk phenotype and masked hypertension; the cardiac, vascular, renal, autonomic, and neurocognitive biomarkers of early hypertension-mediated organ damage are reviewed; and emerging wearable and artificial-intelligence tools for continuous, preventive screening are examined. An integrated screening pathway is proposed, on the premise that the evaluation of a hypertensive adolescent is incomplete without a digital and sleep history alongside ambulatory…
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