Assessment of Left Ventricular Function and Peripheral Vascular Arterial Stiffness in Patients with Dipper and Non-Dipper Hypertension

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.

Effects of Angiotensin-Converting Enzyme Inhibitors on Arterial Stiffness: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Currently, there are several studies that have illustrated the pathological changes of the vascular wall that underlie cardiovascular events and play an important role in the progression of cardiovascular diseases [2][3][4]. Furthermore, changes in the structure of arterial wall caused declination in arterial compliance that might precede the clinical symptoms of the disease [5][6][7]. erefore, arterial elasticity and function are used as a variety of cardiovascular risk factors for subclinical vascular lesions [8][9][10].…”

The influence of dipper vs. non-dipper pattern on left ventricular function and ascending aorta dimensions in hypertensive patients in Angola

“…More recently, in hypertensive patients, 3D echocardiography and strain echocardiography revealed subclinical changes in left ventricular systolic and diastolic function and left atrial function, which have not been demonstrated by conventional echocardiography. These new echocardiographic www.ah.viamedica.pl methods become important tools in evaluating the effect of the dipper versus non-dipper patterns on cardiac morphology and function in hypertensive patients [19][20][21][22][23].…”

“…A study published in 2018 [20], conducted in treated hypertensive patients, where cardiac function beyond conventional echocardiography was also assessed by tissue Doppler and Speckle Tracking with Strain evaluation. In this study, the authors concluded important data on differences in morphology and cardiac function between the dipper vs. non-dipper patterns, demonstrating an association between nondipper pattern and LV remodeling, diastolic dysfunction and reduction of myocardial strain also compatible with LV systolic dysfunction and they alert that patients with uncomplicated hypertension should always consider performing ABPM or another innovative method that provides information on the nocturnal blood pressure pattern to better stratify cardiovascular risk and delineate therapeutic strategies.…”

Anti-hypertensive efficacy of amlodipine dosing during morning versus evening: A meta-analysis

“…Due to BP fluctuation, dipper hypertension is defined as nocturnal BP decline with a normal fall > 10%, and non-dipper hypertension is defined as a circadian rhythm over 24 h with abnormal fall < 10% at night with organ damage (heart, brain and kidney), high risk of cardiovascular and cerebrovascular diseases, and adverse outcomes (Chen et al, 2018;Kario et al, 2001;Kurpesa et al, 2002;Zhu, 2015). Staessen et al reported both the blood pressure decrease and ratio that showed a curvilinear correlation with age and the smallest decrease and largest ratio were observed in older (≥ 70 years) subjects (Staessen et al, 1997).…”