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Coronary flow reserve in dipper and non-dipper hypertensive patients
Dogan Erdogan1, Hakan Gullu, Mustafa Caliskan
1Cardiology Department, Konya Teaching and Medical Research Center, Baskent University, Konya, Turkey. aydoganer@yahoo.com
Insights
Non-dipping hypertension, a failure to lower blood pressure at night, did not affect coronary flow reserve (CFR) in patients without other cardiovascular risks. This finding suggests CFR remains stable despite non-dipping patterns in hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Echocardiography
Background:
- Non-dipping blood pressure (BP) in hypertension is linked to increased cardiovascular risks and left ventricular changes.
- The impact of non-dipping BP on coronary flow reserve (CFR) has not been previously investigated.
Purpose of the Study:
- To investigate the effect of non-dipping hypertension on coronary flow reserve (CFR).
Main Methods:
- Coronary flow reserve (CFR) was measured using transthoracic second-harmonic Doppler echocardiography.
- 22 non-dipper hypertensive subjects and 15 dipper hypertensive subjects were studied.
- Exclusion criteria included systemic diseases and cardiovascular risk factors other than hypertension.
Main Results:
- Demographics, echocardiographic findings, and office BP were similar between non-dipper and dipper groups.
- Ambulatory BP monitoring confirmed significantly higher night-time BP in non-dippers.
- Left ventricular function and CFR were comparable between the two hypertensive groups.
Conclusions:
- Coronary flow reserve (CFR) is similar in non-dipper and dipper hypertensive patients.
- This similarity holds true in the absence of significant left ventricular hypertrophy and other cardiovascular risk factors.
Background:
Failure to decrease blood pressure (BP) normally during night-time, which is called non-dipping, in hypertensive individuals is associated with higher cardiovascular morbidity and mortality. In addition, non-dipping BP leads to structural changes in the left ventricle; however, the effect of non-dipping BP on coronary flow reserve (CFR) has not been studied yet.
Methods:
In this study, we measured CFR of 22 subjects with non-dipper hypertension, and 15 subjects with dipper hypertension using transthoracic second-harmonic Doppler echocardiography (Acuson Sequoia C256. None of the subjects had any systemic disease or coronary risk factor except hypertension.
Results:
Age, gender, body mass index, lipids and echocardiographic findings including left ventricular mass index were similar between the groups. Office BP recordings were similar between non-dipper and dipper groups (147.9+/-6.1/93.9+/-4.3 vs 144.0+/-8.0/93.0+/-3.7). Daytime and 24-h ambulatory BP measurements were similar within the groups, but night-time BPs were significantly greater in non-dipper group than those were in dipper group. Left ventricular diastolic and systolic functions, and both baseline and hyperemic peak diastolic coronary velocity as well as CFR, were similar between the non-dipper and dipper groups (CFR: 2.47+/-0.59 vs 2.39+/-0.47).
Conclusion:
CFR were similar in patients with non-dipper and dipper hypertension in the absence of excessive left ventricular hypertrophy and other cardiovascular risk factors.
