The influence of night-time hypertension on left ventricular mechanics

Tadić, Marijana; Cuspidi, Cesare; Pencic-Popovic, Biljana; Celic, Vera; Mancia, Giuseppe

doi:10.1016/j.ijcard.2017.06.011

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…Our previous study group showed that RV endocardial and mid‐myocardial longitudinal strains were reduced in the hypertensive patients . In the current study, all three layers are impacted, which again indicates that AS and HT have a cumulative negative effect on RV mechanics.…”

Section: Discussionsupporting

confidence: 63%

Right ventricular mechanics in patients with aortic stenosis and preserved ejection fraction: Is arterial hypertension a new player in the game?

Tadić

Cuspidi

Pencic

et al. 2019

J of Clinical Hypertension

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The purpose of this investigation was to evaluate the influence of aortic stenosis (AS) on right ventricular (RV) strain and particularly the importance of arterial hypertension on this association. This cross‐sectional study included 107 patients with moderate and severe AS (with and without hypertension) and preserved left ventricular ejection fraction (>50%) and 82 age‐matched normotensive and hypertensive controls who underwent comprehensive echocardiographic examination. AS patients were divided into normotensive and hypertensive groups. Left ventricle (LV) mass index gradually increased from the controls, across the moderate AS to the severe AS. There was a trend of reduction of RV global and layer‐specific longitudinal strain of the whole ventricle and RV free wall from the controls, across the moderate AS to the severe AS. RV global longitudinal strain, as well as layer‐specific RV longitudinal strains, was significantly lower in the patients with severe AS than the controls and the normotensive patients with moderate AS. Endocardial and epicardial RV strains were lower in hypertensive than in normotensive patients with moderate AS. In patients with severe AS, there was no difference between normotensive and hypertensive patients. LV mass index and mean aortic valve gradient were associated with RV global longitudinal strain in AS patients independently of systolic blood pressure, LV ejection fraction (EF), age, and body mass index (BMI). In conclusion, RV mechanics was deteriorated in the patients with moderate and severe AS. There was a trend of RV longitudinal strain worsening in the hypertensive patients with AS in comparison with their normotensive counterparts. Severity of AS, expressed by the mean AV gradient, was related with RV longitudinal strain.

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Section: Discussionsupporting

confidence: 63%

Right ventricular mechanics in patients with aortic stenosis and preserved ejection fraction: Is arterial hypertension a new player in the game?

Tadić

Cuspidi

Pencic

et al. 2019

J of Clinical Hypertension

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“…[14][15][16] However, there are also investigations that showed that nondipping and reverse BP patterns were independent of nocturnal BP associated with target organ damage and outcome. 9,10,12 Our study group showed that nocturnal hypertension was associated with left and right ventricular remodeling, [17][18][19] whereas other authors demonstrated its negative effect on cardiovascular outcome in hypertensive patients. 20 There are still differences in definition between guidelines regarding cutoff values that define nocturnal hypertension and this could represent one of the major obstacles in the assessment of its influence on target organ damage and prognosis.…”

Section: Introductionmentioning

confidence: 77%

“…Our study group showed that nocturnal hypertension was associated with impaired left and right ventricular structure, diastolic function and mechanics. 18,19 The PAMELA study showed that nocturnal BP level rather than the nocturnal BP decline represented a reliable parameter for prediction of LV hypertrophy in subjects with normal LV mass. 36 Similar findings were reported from other authors.…”

Section: Target Organ Damagementioning

confidence: 99%

<p>Isolated Nocturnal Hypertension: What Do We Know and What Can We Do?</p>

Tadić¹,

Cuspidi²,

Mancia³

2020

IBPC

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Nocturnal hypertension has been recognized as a significant risk factor for cardioand cerebrovascular diseases. Blood pressure (BP) monitoring significantly increased our awareness of nocturnal hypertension and studies revealed its influence on target organ damage. Nocturnal hypertension is associated with nonphysiological 24-h BP patterns, which consider inadequate drop or even increment of nighttime BP in comparison with daytime BP (nondipping and reverse dipping). Nevertheless, investigations showed that nocturnal hypertension was a predictor of adverse outcome independently of circadian BP pattern. There are still many uncertainties regarding diagnosis, mechanisms and treatment of nocturnal hypertension. There is a small difference between American and European guidelines in cutoff values defining nocturnal hypertension. Pathophysiology is also not clear because many conditions such as diabetes, metabolic syndrome, obesity, sleep apnea syndrome, and renal diseases are related to nocturnal hypertension and nonphysiological circadian BP pattern, but mechanisms of nocturnal hypertension still remain speculative. Therapeutic approach is another important issue and chronotherapy provided the best results so far. There are studies which showed that some groups of antihypertensive medications are more effective in regulation of nocturnal BP, but it seems that the timing of drug administration has a crucial role in the reduction of nighttime BP and conversion of circadian patterns from nonphysiologic to physiologic. Follow-up studies are necessary to define clinical benefits of nocturnal BP reduction and restoring unfavorable 24-h BP variations to physiological variant.

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“… 28 The heart always serves as an important target organ, as undergoing traumatic changes under the influence of elevated BP over a long period of time, including mechanical and functional damage changes in the LV. 29 However, this short‐term mechanical adaptation to elevated BP in acute HA conditions is more likely to be interpreted as a compensatory change that maintains normal physiological function.…”

Section: Discussionmentioning

confidence: 99%

“…Peripheral hyperemia did cause a significant increase in LV twist, and blood flow restriction reduced LV twist and untwisting rate conversely 28. The heart always serves as an important target organ, as undergoing traumatic changes under the influence of elevated BP over a long period of time, including mechanical and functional damage changes in the LV 29. However, this short-term mechanical adaptation to elevated BP in acute HA conditions is more likely to be interpreted as a compensatory change that maintains normal physiological function.Furthermore, we first used VAC, which plays a major role in the physiology of cardiac and aortic mechanics in this study, to further evaluate functional variations in LV after HA exposure.…”

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confidence: 95%