Conventional and Ambulatory Blood Pressure as Predictors of Diastolic Left Ventricular Function in a Flemish Population

Abstract

BackgroundNo longitudinal study compared associations of echocardiographic indexes of diastolic left ventricular function studies with conventional (CBP) and daytime ambulatory (ABP) blood pressure in the general population.Methods and ResultsIn 780 Flemish (mean age, 50.2 years; 51.7% women), we measured left atrial volume index (LAVI), peak velocities of the transmitral blood flow (E) and mitral annular movement (e′) in early diastole and E/e′ 9.6 years (median) after CBP and ABP. In adjusted models including CBP and ABP, we expressed associations per 10/5‐mm Hg systolic/diastolic blood pressure increments. LAVI and E/e′ were 0.65/0.40 mL/m2 and 0.17/0.09 greater with higher systolic/diastolic ABP (P≤0.028), but not with higher baseline CBP (P≥0.086). e′ was lower (P≤0.032) with higher diastolic CBP (−0.09 cm/s) and ABP (−0.19 cm/s). When we substituted baseline CBP by CBP recorded concurrently with echocardiography, LAVI and E/e′ remained 0.45/0.38 mL/m2 and 0.15/0.08 greater with baseline ABP (P≤0.036), while LAVI (+0.53 mL/m2) and E/e′ (+0.19) were also greater (P<0.001) in relation to concurrent systolic CBP. In categorized analyses of baseline data, sustained hypertension or masked hypertension compared with normotension or white‐coat hypertension was associated with greater LAVI (24.0 versus 22.6 mL/m2) and E/e′ (7.35 versus 6.91) and lower e′ (10.7 versus 11.6 cm/s; P≤0.006 for all) with no differences (P≥0.092) between normotension and white‐coat hypertension or between masked hypertension and sustained hypertension.Conclusions ABP is a long‐term predictor of diastolic left ventricular function, statistically outperforming distant but not concurrent CBP. Masked hypertension and sustained hypertension carry equal risk for deterioration of diastolic left ventricular function.

Nocturnal hypertension and left ventricular diastolic dysfunction in diabetic patients with pre-heart failure phase: Prospective cohort HSCAA study

“…Similarly, a cross-sectional study included 376 hypertensive patients showed that most of the parameters of the LV diastolic function (including E/e') were significantly deteriorated in the reverse dippers, with nocturnal systolic BP fall independently associated with LV diastolic function 42 . Moreover, ABPM appears superior to conventional BP in association with 9.5-years later E/e′ in longitudinal study 43 . However, only one longitudinal (over 20 years of follow up) study including 414 middle-aged subjects from OPERA cohort, 24-hour mean, daytime mean and nighttime mean pulse pressure, but neither different circadian BP profiles, showed significant association with the development of LV diastolic dysfunction as determined by E/e' >=15, even after adjustment with significant baseline clinical characteristics 44 .…”

Nocturnal Hypertension and Left Ventricular Diastolic Dysfunction in Patients With Diabetes With the Absence of Heart Failure: Prospective Cohort HSCAA Study

“…35 Moreover, ABPM appears superior to conventional BP in association with 9.5 years later E/e′ in the longitudinal study. 36 However, only 1 longitudinal (over 20 years of follow-up) study including 414 middle-aged subjects from the Oulu Project Elucidating Risk of Atherosclerosis cohort (OPERA), 24-hour mean, and daytime mean and nighttime mean pulse pressure, but neither different circadian BP profiles, showed significant association with the development of LV diastolic dysfunction as determined by E/e′≥15, even after adjustment with significant baseline clinical characteristics. 37 Moreover, patients with diabetes were reported to have higher nocturnal BP and higher morning BP surge 10 ; however, it was unknown whether nocturnal hypertension contributes to the progression of LV diastolic dysfunction in patients with diabetes with pre-HF phase.…”

“…35 Moreover, ABPM appears superior to conventional BP in association with 9.5 years later E/eʹ in the longitudinal study. 36 However, only 1 longitudinal (over 20 years of follow-up) study including 414 middle-aged subjects from the Oulu Project Elucidating Risk of Atherosclerosis cohort (OPERA), 24-hour mean, and daytime mean and nighttime mean pulse pressure, but neither different circadian BP profiles, showed significant association with the development of LV diastolic dysfunction The covariates in each multiple linear regression analysis model included age, male gender, BMI, smoking history, the presence of hypertension and dyslipidemia, HbA1c and baseline E/eʹ, time point (y), the patterns of nocturnal hypertension, and the interaction term between time point (y) and the patterns of nocturnal hypertension. BMI indicates body mass index; HbA1c, hemoglobin A1c; and SBP, systolic blood pressure.…”

Hypertension-mediated organ damage in masked hypertension

“…Impaired LV relaxation and elevated left atrial pressure are common findings in patients with hypertension and may ultimately lead to the syndrome of heart failure [26]. Evidence of early diastolic LV dysfunction can be detected in patients with high BP even before the development of LV hypertrophy [27], and masked hypertension may predict the future development of diastolic LV dysfunction [28]. We assessed characteristics of LV filling by pulsed wave and tissue Doppler echocardiography.…”