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Extreme-Dipper Profile, Increased Aortic Stiffness, and Impaired Subendocardial Viability in Hypertension

Guy Amah1, Rahma Ouardani1, Adrien Pasteur-Rousseau1,2

  • 1AP-HP, Hôpital Lariboisière, Physiologie Clinique-Explorations Fonctionnelles, Paris, France.

American Journal of Hypertension
|February 4, 2017
PubMed

Insights

Extreme-dippers with hypertension show increased aortic stiffness and impaired subendocardial viability compared to dippers. This suggests a higher risk of silent myocardial ischemia, especially in women, warranting further screening.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Vascular Physiology

Background:

  • Extreme-dippers with hypertension and stable coronary artery disease (CAD) experience more severe nighttime cardiac ischemia than dippers.
  • This study investigates subendocardial viability in extreme-dippers versus dippers, excluding confounding factors like diabetes, CAD, or chronic kidney disease (CKD).

Purpose of the Study:

  • To assess subendocardial viability in treated hypertensive patients who are extreme-dippers compared to dippers.
  • To determine if extreme-dippers exhibit more impaired subendocardial viability, independent of other comorbidities.

Main Methods:

  • Included 213 treated hypertensives (156 dippers, 57 extreme-dippers) undergoing 24-hour ambulatory blood pressure (BP) monitoring.
  • Utilized radial applanation tonometry for subendocardial viability ratio (SEVR), augmentation index (AIx), and pulse pressure amplification (PPamp).
  • Measured carotid-femoral pulse wave velocity (cfPWV) and performed cycle ergometer stress testing.

Main Results:

  • Extreme-dippers had higher cfPWV and AIx, but lower PPamp and SEVR than dippers.
  • Lower nighttime diastolic BP (DBP) was observed in extreme-dippers.
  • Women extreme-dippers showed significantly lower SEVR, PPamp, and nighttime DBP compared to men extreme-dippers.

Conclusions:

  • Treated hypertensive extreme-dippers without CAD, diabetes, or CKD exhibit increased aortic stiffness and low PPamp.
  • This study demonstrates a higher likelihood of impaired subendocardial viability in extreme-dippers compared to dippers.
  • Extreme-dipper hypertensive patients, particularly women, may face a significantly higher risk of silent myocardial ischemia, necessitating systematic screening.
Abstract

Keywords:
blood pressurecoronary microcirculationextreme dippershypertensionsubendocardial viability.

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