Effects of dipper and non-dipper status of essential hypertension on left atrial mechanical functions

Aydın, Mustafa; Özeren, Ali; Bilge, Mehmet; Dursun, Aydin; Cam, Fatih; Elbey, Mehmet Ali

doi:10.1016/j.ijcard.2003.08.017

Cited by 47 publications

(51 citation statements)

References 22 publications

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“…These findings suggest that cardiac structural changes among nondippers are due to the absence of night-time BP dipping (18), and are not the result of a higher overall BP load (18,43). Several other researchers have reached similar conclusions supporting a Left atrial dimension > in nondippers (20,43,49) Atrial filling fractions > in nondippers (20) End-diastolic diameter > in nondippers (11,20) Interventricular septum thickness > in nondippers (43) Aortic root diameter > in nondippers (43) Left atrial maximum/minimum > in nondippers (52) volumes Left atrium passive emptying < in nondippers (52) volume and fraction…”

Section: Cardiac Structural Alterationsmentioning

confidence: 73%

“…In studies of individuals with untreated essential hypertension and similar 24 h BPs, a nondipping BP pattern was associated with significantly larger atrial dimensions (43,49), interventricular septum thickness and aortic root diameter (43), as well as left atrium passive and active emptying volumes and fractions (52). In addition, normotensive individuals classified as nondippers displayed a higher prevalence of relative wall thickness and concentric hypertrophy independent of 24 h BP levels than their dipping counterparts (51).…”

Section: Cardiac Geometrymentioning

confidence: 95%

“…Abnormal cardiac geometry is often found among hypertensive individuals; left atrium enlargement is a common finding (52). Hypertensive individuals with LV concentric hypertrophy have been found to have more advanced target organ damage (53,54) and have the greatest likelihood of having a cardiovascular event (29,55) compared with individuals with other LV geometric patterns.…”

Section: Cardiac Geometrymentioning

confidence: 99%

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Night-time blood pressure patterns and target organ damage: A review

Routledge

McFetridge-Durdle

Dean

2007

Canadian Journal of Cardiology

119

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A mbulatory blood pressure monitoring (ABPM) is a noninvasive, automated portable technology that measures and records blood pressure (BP) over a 24 h period (1). This technique has allowed researchers and clinicians to measure the percentage of elevated BP readings, as well as 24 h BP loads and BP patterns (2). Consequently, it has been discovered that BP varies over 24 h in a diurnal manner, being higher during the day and lower at night (3). The normal variation in BP is characterized by a 10% to 20% reduction in BP from day to night (2). Individuals with this decline in night-time BP are known as 'dippers', and those who experience a blunted decline in night-time BP are known as 'nondippers' (4). Researchers have determined individuals to be nondippers on the basis of a less than 10% reduction in night-time systolic BP (SBP) (5-11), diastolic BP (DBP) (5) or both SBP and DBP measurements (12-31).The exact mechanisms of action responsible for nondipping are not fully understood. However, data suggest that nondippers have an increase in sympathetic nervous system activity (32,33) and a decrease in parasympathetic nervous system activity throughout the night (32,34). Nondipping is more commonly found among individuals with renal diseases, autonomic neuropathies, diabetes, sleep apnea, autonomic dysfunction, malignant hypertension and secondary hypertension (35,36). In addition, approximately 25% of individuals with essential hypertension have a nondipping BP profile (37).There is evidence to suggest that individuals who exhibit a nondipping BP profile are at higher risk of cardiac and extracardiac morbidity (38). Verdecchia et al (39) used data from the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study to examine the morbidity and mortality rates of 715 essential hypertensive patients over a one-to 13-year BACKGROUND: Individuals who do not have a 10% to 20% reduction in blood pressure (BP) during the night are known as 'nondippers'. The cause of this nondipping phenomenon is not fully understood; however, there is a growing body of evidence linking a nondipping BP pattern with target organ damage. OBJECTIVE: To review the literature and present an overview of the target organ damage found to be associated with a nondipping BP pattern. METHODS: PubMed, CINAHL and Medscape searches of all available English language articles from 1986 to 2005 were performed. Search terms included 'BP nondipping', 'BP dipping' and 'target organ damage'. RESULTS: There is evidence to suggest that individuals with hypertension who exhibit a nondipping BP profile are at higher risk of cardiac and extracardiac morbidity and mortality. In particular, nondippers with essential hypertension have been found to have more advanced left ventricular hypertrophy, left ventricular mass and left ventricular mass index, carotid artery wall thickness, carotid artery atherosclerotic plaques, silent cerebral infarct, stroke, cognitive impairment and microalbuminuria. CONCLUSION: A better understanding of the importance of the cir...

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Section: Cardiac Structural Alterationsmentioning

confidence: 73%

Section: Cardiac Geometrymentioning

confidence: 95%

Section: Cardiac Geometrymentioning

confidence: 99%

See 1 more Smart Citation

Night-time blood pressure patterns and target organ damage: A review

Routledge

McFetridge-Durdle

Dean

2007

Canadian Journal of Cardiology

119

View full text Add to dashboard Cite

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“…For the assessment of LA mechanical functions, the following indices calculated from the volumes were used. [24][25][26][27] -LA total emptying volume (LATEV) = V max -V min -LA total emptying fraction (LATEF) = LATEV / V max x 100 -LA expansion index (LAEI) = (V max -V min )/V min x 100 -LA active emptying fraction (LAAEF) = (V p -V min )/V p x 100 -LA passive emptying fraction (LAPEF) = (V max -V p )/V max x 100 LATEF and LAEI were used to assess LA reservoir function; LAPEF was used to evaluate LA conduit function; and LAAEF was used to assess LA pump function. 2,28 Immediately after the BMV procedure a repeat echocardiogram was performed to define the success of procedure as mentioned previously.…”

Section: Echocardiographymentioning

confidence: 99%

“…2,28 Immediately after the BMV procedure a repeat echocardiogram was performed to define the success of procedure as mentioned previously. 15,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] All patients, in whom BMV was successful, underwent a repeat echocardiographic evaluation 24-48 hours after the procedure for the measurement of post-procedural parameters.…”

Section: Echocardiographymentioning

confidence: 99%

Acute Impact of Balloon Mitral Valvotomy on Left Atrial Functions in Mitral Stenosis

Beig¹,

Dar²,

Kumar³

et al. 2017

JCDR

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Background: Rheumatic mitral stenosis (MS) is associated with progressive impairment of left atrial (LA) mechanical functions. This study was conducted to assess the acute impact of Balloon Mitral Valvotomy (BMV) on these functions. Methods: This single centre observational study included 25 patients with severe MS (aged 34.1 ± 7.1 years, with mean mitral valve area of 0.74 ± 0.13 cm²), in sinus rhythm, who underwent successful BMV at our hospital. Phasic LA volumes (V max : maximal LA volume, V min : minimal LA volume, and V p : LA volume at the onset of P-wave) were measured by modified Simpson's method. Parameters of LA reservoir function i.e. LA total emptying fraction (LATEF) and LA expansion index (LAEI); conduit function i.e. LA passive emptying fraction (LAPEF); and pump function i.e. LA active emptying fraction (LAAEF) were calculated from these volumes. All these parameters were evaluated before and 24-48 hours after BMV. Results: Successful BMV led to significant reduction in V max (p < 0.001), V min (p < 0.001), and V p (p < 0.001). There was a significant increase in LATEF (p= 0.001) and LAEI (p= 0.002). LAPEF increased insignificantly (p= 0.057), while there was no significant change in LAAEF (p =0.127) after BMV. Conclusion: Successful BMV leads to early improvement in left atrial reservoir and conduit functions, without significantly affecting left atrial pump function. Whether these acute changes translate into long term left atrial reverse remodelling and clinical benefits thereof needs to be established by further studies.

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