Cardiovascular abnormalities in never-treated hypertensives according to nondipper status

Abstract

Ambulatory blood pressure monitoring allows a better understanding of blood pressure fluctuations over 24 h than simple clinic measurements. In this way the diagnosis of "white coat" versus "sustained" hypertension and that of "dipper" (patient with blood pressure fall during nighttime > 10% of daytime levels) versus "nondipper" status were made possible. This pilot study has been undertaken to investigate whether patients with recently discovered, never-treated, mild, sustained hypertension have cardiovascular abnormalities according to their dipper/nondipper status. Patients with long-standing (n = 123) and newly discovered (n = 56) sustained hypertension were classified according to their nighttime blood pressure fall, and compared with normotensive controls. Ambulatory blood pressure monitoring was performed noninvasively. Parameters of left ventricular structure, cardiac systolic and diastolic function, and carotid anatomy were determined noninvasively by echographic methods. Significant increases in parameters of cardiac structure as well as abnormalities in diastolic function were observed in patients with long-standing hypertension, regardless of their dipper status. In the group with newly discovered hypertension, left atrium (3.4+/-0.3, 3.7+/-0.5, 3.2+/-0.4 cm in dippers, nondippers, and controls, respectively), end-diastolic diameter index (2.9+/-0.3, 3.0+/-0.2, 2.8+/-0.2 cm/m), and atrial filling fraction (0.50+/-0.07, 0.52+/-0.05, 0.42+/-0.04) were significantly altered only in the nondipper subgroup, in comparison with controls. Significant changes in cardiac structure and diastolic function were observed in nondipper patients with recently discovered hypertension, who, at variance with dippers, show changes similar to those in patients with long-standing hypertension. Hypertensives with the observed abnormalities may benefit from active antihypertensive treatment, which appears, therefore, justified even in an early phase of mild hypertension, in terms of potential reduction of end-organ complications as well as cost-effectiveness.

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

“…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…”

“…In addition, these early abnormalities may occur before development of LVH or systolic dysfunction. The data also suggest that structural cardiovascular abnormalities may develop faster among nondippers with high BP levels (20).…”

“…Cuspidi et al (15,18,43) (12,20,28,50,86), isolated systolic hypertension (42) and normotension (51). In addition, several researchers have discovered sex-specific cardiovascular adaptation due to diurnal BP variations among persons with essential hypertension.…”

“…Ferrara et al (20) discovered that nondippers had significantly larger left atriums, greater atrial filling fractions and end-diastolic diameter indexes than normotensive controls. However, the nondipping group also had higher clinic and 24 h BP values than the dipping group (20). These findings imply that elevated 24 h BP levels among individuals with mild hypertension could contribute to early cardiac structural and functional changes.…”

The effects of nocturnal dipping on cardiovascular outcomes and proteinuria in essential hypertensive patients

“…Verdecchia et al reported that, the changes in LVM showed a significant direct association with the changes in 24-hour systolic blood pressure [36]. Ferrrara et al assessing LV structure and diastolic function in 123 patients with long-standing hypertension in whom antihypertensive treatment was discontinued for a period of 4 weeks, made note of any significant difference in left ventricle among dippers and non-dippers, suggesting that unfavorable consequences of non dipper status might be blunted by the duration of hypertension [37]. In a large sample of treated dipper and non-dipper essential hypertensive patients with different clinic BP control and prevalence of LVH shows that a reduced nocturnal fall in BP, established on the basis of a single ABPM, is not associated with more pronounced cardiac involvement.…”