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Circadian blood pressure pattern in patients with treated hypertension and left ventricular hypertrophy
Insights
Hypertension patients with left ventricular hypertrophy (LVH) often lack nighttime blood pressure decline. This non-dipping pattern may contribute to LVH development, suggesting tailored circadian blood pressure therapy is needed.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Medicine
Background:
- Left ventricular hypertrophy (LVH) is a significant prognostic factor in hypertensive patients.
- Understanding the relationship between blood pressure patterns and LVH is crucial for patient management.
Purpose of the Study:
- To investigate the association between left ventricular hypertrophy and nocturnal blood pressure dipping in treated essential hypertension.
- To explore potential therapeutic implications of abnormal circadian blood pressure patterns in hypertensive individuals with LVH.
Main Methods:
- A study involving 45 patients with treated essential hypertension.
- Patients were categorized into two groups based on echocardiographic assessment: normal left ventricular dimension and left ventricular hypertrophy (LVH).
- Ambulatory blood pressure monitoring was conducted to assess 24-hour blood pressure patterns, focusing on nighttime blood pressure decline.
Main Results:
- The group with LVH exhibited a distinct abnormal pattern of lacking blood pressure reduction during the night.
- 16 out of 22 patients with LVH showed no nighttime blood pressure decline, compared to only 6 out of 23 patients without LVH (P < 0.01).
- Adequate daytime treatment did not prevent abnormal nocturnal blood pressure patterns in the LVH group.
Conclusions:
- Hypertension patients with LVH frequently display a lack of nocturnal blood pressure decline (non-dipping).
- This non-dipping pattern may be a causative factor for LVH development, necessitating different circadian blood pressure management strategies.
- Alternatively, non-dipping could be a consequence of vascular structural changes associated with established LVH.
- Ambulatory 24-hour blood pressure monitoring is recommended for hypertensive patients with LVH to guide treatment.
Abstract:
Left ventricular hypertrophy in hypertensives is an important determinant of prognosis. In the present study 45 patients with treated essential hypertension were divided into two groups: 23 patients had normal left ventricular dimension and 22 patients had echocardiographic signs of left ventricular hypertrophy (LVH). All patients were adequately treated during daytime, but ambulatory blood pressure monitoring showed a distinct abnormal pattern in the LVH group characterized by a lack of blood pressure reduction during the night; 16 of 22 patients with LVH had no blood pressure decline during the night, whereas 17 of 23 patients without hypertrophy showed this reduction (P less than 0.01). In conclusion, patients with hypertension and LVH often reveal a lack of blood pressure decline during the night, which may be the reason for the development of left ventricular hypertrophy (and thus should be managed by a different circadian blood pressure therapy) or which may be the consequence of progressive structural changes in the resistance vessels, along with the development of left ventricular hypertrophy. It is suggested that patients with hypertension and left ventricular hypertrophy should have ambulatory twenty-four hour blood pressure monitoring.