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Nocturnal nondipping and left ventricular hypertrophy in hypertension: an updated review

Cesare Cuspidi1, Valentina Giudici, Francesca Negri

  • 1Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milano, Italy. cesare.cuspidi@unmib.it

Expert Review of Cardiovascular Therapy
|June 10, 2010
PubMed

Insights

Nondipping blood pressure status, characterized by a reduced nocturnal BP fall, is linked to left ventricular hypertrophy (LVH) in hypertensive individuals. Persistent nondipping patterns suggest more significant cardiac involvement, though regression remains unproven.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Circadian Biology

Background:

  • Circadian blood pressure (BP) variations, specifically dipping versus nondipping patterns, aid in risk stratification and treatment decisions for hypertensive patients.
  • A reduced nocturnal BP fall (nondipping) is increasingly associated with cardiovascular complications, though its link to left ventricular hypertrophy (LVH) is debated.

Purpose of the Study:

  • To review and analyze studies published in the last decade (2000-2009) investigating the association between nondipping status and left ventricular hypertrophy (LVH).
  • To examine the therapeutic implications of this association in hypertensive individuals.

Main Methods:

  • A PubMed search was conducted for full-text English articles published between January 1, 2000, and December 31, 2009.
  • Studies included adult or elderly subjects diagnosed with hypertension.
  • Twenty-six studies involving 3877 participants met the selection criteria.

Main Results:

  • Out of 26 selected studies, 17 (2497 participants) found a positive association between nondipping and LVH, while 9 studies reported no significant link.
  • Three studies using consistent ambulatory blood pressure monitoring confirmed a significant association between persistent nondipping and LVH.
  • Preliminary evidence suggests that nondipping may be reversible with chronotherapy or diuretics in salt-sensitive patients.

Conclusions:

  • A significant number of studies indicate an association between nondipping blood pressure patterns and left ventricular hypertrophy in hypertensive individuals.
  • Persistent nondipping, confirmed by rigorous monitoring, appears more strongly linked to cardiac involvement.
  • While potential therapeutic strategies exist, the regression of cardiac damage by restoring normal nocturnal BP dips in hypertensive patients with LVH requires further investigation.

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