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Assessment of left ventricular function and peripheral vascular arterial stiffness in patients with dipper and
Yan Chen1,2, Ju-Hua Liu1,3, Zhe Zhen1
1Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Insights
High blood pressure that does not dip overnight (non-dipper pattern) is linked to worse heart function and stiffer arteries. This pattern is an independent risk factor for left ventricular systolic dysfunction in hypertensive patients.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Background:
- A non-dipper blood pressure pattern is associated with increased cardiovascular risk and organ damage in hypertensive patients.
- Understanding the impact of dipper versus non-dipper patterns on cardiac structure and vascular health is crucial for risk stratification.
Purpose of the Study:
- To assess left ventricular (LV) remodeling, function, and arterial stiffness in hypertensive patients with dipper versus non-dipper blood pressure patterns.
Main Methods:
- 183 hypertensive patients were categorized into dipper (n=66) and non-dipper (n=117) groups using 24-hour ambulatory blood pressure monitoring.
- Transthoracic echocardiography with speckle tracking strain analysis assessed LV function; tissue Doppler-derived E/E' evaluated diastolic function.
- Cardio-ankle vascular index (CAVI) measured arterial stiffness.
Main Results:
- Non-dipper hypertensive patients exhibited increased LV mass index, higher prevalence of LV hypertrophy (eccentric and concentric), and impaired LV systolic and diastolic function compared to dippers.
- Peripheral arterial stiffness was significantly greater in the non-dipper group.
- Multivariable analysis confirmed non-dipper pattern as an independent predictor of LV systolic dysfunction.
Conclusions:
- The non-dipper blood pressure pattern is an independent risk factor for left ventricular systolic dysfunction in hypertension.
- Interventions targeting the reversal of the non-dipper pattern may mitigate cardiac damage in hypertensive individuals.
Abstract:
A non-dipper pattern of high blood pressure is associated with increased risk of organ damage and cardiovascular disease in patients with hypertension. The aim of the study was to evaluate the left ventricular (LV) remodeling and function and arterial stiffness in a dipper/non-dipper pattern of high blood pressure in patients with hypertension. A total of 183 hypertensive patients with no history of adverse cardiovascular events were divided into two groups based on 24 hours ambulatory blood pressure monitoring (ABPM): 66 patients with a dipper pattern and 117 patients with non-dipper pattern. Detailed transthoracic echocardiogram was performed and analyzed with advance speckle tracking 3-orthogonal direction strain analysis to assess LV systolic function and tissue Doppler-derived E/E' for LV diastolic function assessment. Cardio ankle vascular index (CAVI) was used to evaluate arterial stiffness. Compared with patients with dipper hypertension, those with non-dipper hypertension had increased LV mass index, higher prevalence of eccentric and concentric LV hypertrophy, more impaired LV diastolic and systolic function and peripheral arterial stiffness. Multivariable analysis revealed that a non-dipper pattern was independently associated with LV systolic dysfunction evaluated by speckle tracking-derived strain analysis. In conclusion, a non-dipper pattern of hypertension is an independent risk factor for LV systolic dysfunction. Treatment that could reverse this non-dipper pattern may reduce cardiac damage in these patients.
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