The influence of dipper and nondipper blood pressure patterns on left ventricular functions in hypertensive patients:
Kürşat Tigen1, Tansu Karaahmet, Hakan Fotbolcu
1Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
Insights
Hypertension patients with a nondipper blood pressure pattern showed impaired left ventricular diastolic function and higher filling pressures compared to dippers. This suggests nondipper patterns are linked to worse cardiac outcomes in hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Blood pressure variability, specifically dipper and non-dipper patterns, influences cardiovascular health.
- Hypertension is a major risk factor for left ventricular diastolic dysfunction.
Purpose of the Study:
- To investigate the impact of dipper versus non-dipper blood pressure patterns on left ventricular diastolic filling parameters in hypertensive individuals.
Main Methods:
- Fifty-five hypertensive patients on antihypertensive therapy underwent echocardiography and 24-hour ambulatory blood pressure monitoring.
- Tissue Doppler imaging was used to assess systolic and diastolic parameters.
- Patients were categorized into dipper (22) and non-dipper (33) groups based on blood pressure monitoring.
Main Results:
- Non-dipper patients exhibited significantly higher left ventricular mass and mass index compared to dipper patients.
- Dipper patients demonstrated a significantly lower E/E' ratio (10.8 vs. 14.1), indicating better diastolic function.
- Higher frequency of dipper patterns was observed in patients with E/E' ratios <15 and <8, suggesting preserved diastolic function.
Conclusions:
- The non-dipper blood pressure pattern is associated with increased left ventricular mass and impaired diastolic function in hypertensive patients.
- Elevated left ventricular filling pressures may be linked to the non-dipper phenotype.
- These findings highlight the clinical significance of blood pressure patterns in assessing cardiac remodeling and function in hypertension.
Objectives:
We investigated the effect of dipper and non-dipper blood pressure patterns on left ventricular diastolic filling parameters in hypertensive patients.
Study Design:
Fifty-five hypertensive patients (37 women, 18 men; mean age 55+/-10 years) were evaluated with echocardiography and ambulatory 24-hour blood pressure monitoring. All the patients received antihypertensive drug therapy for at least three months prior to the evaluations. Tissue Doppler-derived systolic and diastolic parameters were compared.
Results:
Dipper and nondipper blood pressure patterns were found in 22 patients (40%) and 33 patients (60%), respectively. Both groups had similar left ventricular systolic and diastolic diameters. Dipper patients had significantly lower values for left atrial diameter (p<0.0001), interventricular septum (p=0.001) and posterior wall (p=0.012) thickness, left ventricular mass (p=0.017) and mass index (p=0.021). Both groups had similar mitral E and A waves, E/A ratio, E-wave deceleration time, isovolumetric relaxation time, and tissue Doppler-derived A' wave. Dipper patients had a significantly lower E/E' ratio (10.8+/-3.4 vs. 14.1+/-3.6; p=0.002) and significantly higher systolic (S') (p=0.05) and early diastolic (E') (p=0.027) tissue velocities. Based on the E/E' ratios being <15 or = or >15, the frequency of dipper hypertension was significantly higher in patients with E/E' <15 (48.8% vs. 9.1%; p=0.019). The frequency of dippers was also higher among patients having an E/E' ratio of <8, compared to those having an E/E' ratio of = or >8 to <15 (90% vs. 35.3%; p=0.019).
Conclusion:
Nondipper blood pressure pattern may be associated with increased left ventricular mass, impaired left ventricular systolic and diastolic dysfunction, and higher left ventricular filling pressures.
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