The influence of dipper/nondipper blood pressure patterns on global left ventricular systolic function in...

This study was designed to investigate the effects of dipper and nondipper patterns on global longitudinal systolic functions of left ventricle (LV) by means of two-dimensional speckle tracking echocardiography in treated hypertensive diabetic patients with preserved left ventricular ejection fraction.

We enrolled 86 hypertensive diabetic patients. Twenty-four hour ambulatory blood pressure monitoring and echocardiography were performed in each patient. The relationship between dipper/nondipper patterns and global longitudinal strain (GLS) was analyzed.

Fifty-one (59.3%) patients had a nondipper pattern. GLS and average global longitudinal strain rate systolic (GLSRs) were significantly decreased (-17.8±1.5, -19.6±1.9; P<0.001 vs. -1.01±0.171, -1.18±0.19; P<0.001) and E/E' was significantly increased (9.7±4.3, 7.7±3.8; P=0.033) in nondippers compared with dippers. Multivariate linear regression analysis showed that the difference between mean arterial pressure (MAP)-asleep and MAP-awake and left ventricular mass index (LVMI) was associated independently with GLS and GLSRs (MAP-asleep-MAP-awake β=-0.292, P=0.004; β=-0.305, P=0.001 and LVMI β=-0.373, P=0.001, β=-0.517, P<0.001; respectively). E/E' was associated independently with MAP-asleep-MAP-awake (β=0.241, P=0.022), age (β=-0.272, P=0.012), male sex (β=0.351, P=0.001), and LVMI (β=0.236, P=0.038). Also, SBP-asleep and LVMI were found to be associated independently with GLS and GLSRs (SBP-asleep β=-0.405, P<0.001; β=-0.271, P=0.004 and LVMI β=-0.339, P=0.002; β=-0.517, P<0.001; respectively).

This study shows that the nondipper pattern is associated with subclinical LV systolic dysfunction in treated hypertensive diabetic patients with preserved left ventricular ejection fraction. Also, elevated night-time SBP was found to be related to impaired LV systolic functions.