Left ventricular structural alterations in treated hypertensives with or without nocturnal fall in blood pressure

ABSTRACT

The lack of the normal nocturnal fall in blood pressure in hypertensive patients has been suggested to augment target organ damage. The aim of our study was to assess the effects of dipper and non-dipper BP profiles, in treated hypertensives on left ventricular structural alterations. This study included 85 patients with treated hypertension. They were divided into 2 groups, group I included 26 patients with controlled clinic BP and group II, included 59 patients with ucontrolled and resistant BP. All patients underwent 24-hour ambulatory blood pressure [BP] monitoring and echocardiographic examination. Using ambulatory BP measurements patients were classified into dipper and non-dippers in each group. Using echocardiographic measurements of left ventricular [LV] dimensions, LV mass was calculated and indexed for body surface area to obtain the left ventricular mass index [LVMI]. LV hypertrophy [LVH] was diagnosed when LVMI was >110g/m2 in women and >134g/m2 in men. LV relative wall thickness [LVRWT] was calculated with values <0.45 were considered normal for both sexes. LV geometric pattern was estimated according to the relation between LVMI and relative wall thickness. The prevalence of non-dippers was significantly higher in group II [53%] than in group I [31%]. There were no differences in the demographic and metabolic characteristics as well as mean 24-h BP values in dippers and non-dippers in both groups. There was higher prevalence of LVH in group II [37%] compared to group I [19%]. However, the prevalence of LVH was similar in dippers and non-dippers in group I [16% and 25%, respectively] and group II [61% and 65%, respectively]. LVM, LVMI, LVRWT and LV fractional shortening were similar in dippers and non-dippers in both groups. Most patients in group I had normal LV geometry with only 2 patients of each of the dippers and non-dippers showing eccentric LVH. Group II patients had higher incidence of concentric LVH both in dippers and non-dippers [39% and 42 and respectively]. Our results indicate that the non-dipping BP profile, diagnosed on the basis of a single ABPM, in treated hypertensives with or without BP control is not associated with an increase prevalence of LVH or LV geometric alterations