Left ventricular (LV) geometry and dipping state are determinants of LV mass reduction with angiotensin-converting enzyme inhibitor antihypertensive treatment

Aznaouridis, Konstantinos; Vyssoulis, Gregory P.; Karpanou, Eva A.; Marinakis, A.G.; Barbetseas, John; Zervoudaki, A.; Cokkinos, Dennis V.; Stefanadis, Christodoulos

doi:10.1097/mbp.0b013e32809efa02

Cited by 3 publications

(5 citation statements)

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“…8,9,[11][12][13][14]39 Recent data support that quinapril and captopril are equally efficient in modifying important surrogate end points with prognostic significance, such as left ventricular mass. 11 On the other hand, some studies have underscored that an improvement of arterial function in hypertensives may benefit prognosis, 5,7 but there are no trials to directly compare different ACEIs with regard to outcomes. Our findings cannot guide chronic antihypertensive treatment, and they do not suggest, by any means, that quinapril is a better antihypertensive drug.…”

Section: Potential Clinical Implicationsmentioning

confidence: 99%

“…5 Likewise, there are data showing that the reversal of endothelial dysfunction, that is present in hypertensive patients, 6 may benefit prognosis. 7 Drugs that block the renin-angiotensin system (RAS), such as angiotensin converting enzyme (ACE) inhibitors (ACEIs), may improve cardiovascular structure and function, [8][9][10][11][12][13] and this effect is not fully explained by the respective BP change. [8][9][10]12,14 However, different ACEIs may not confer a same degree of organoprotection, and this is perhaps due to dissimilarities in their propensity to penetrate vascular tissue and inhibit the tissue ACE.…”

Section: Introductionmentioning

confidence: 99%

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Acute effects of renin-angiotensin system blockade on arterial function in hypertensive patients

et al. 2007

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Section: Potential Clinical Implicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute effects of renin-angiotensin system blockade on arterial function in hypertensive patients

et al. 2007

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“…One alternative is to use short fixed clock-time intervals, which eliminate the transition periods in the morning and evening during which the blood pressure rapidly changes in most subjects. 59 The daytime and nighttime blood pressures defined in this way approximate within 1 to 2 mm Hg to the awake and asleep blood pressures. 59 In defining the clock-time intervals, one should account for differences in lifestyle across different cultures.…”

Section: How To Measure Daytime and Nighttime Blood Pressure?mentioning

confidence: 99%

“…59 The daytime and nighttime blood pressures defined in this way approximate within 1 to 2 mm Hg to the awake and asleep blood pressures. 59 In defining the clock-time intervals, one should account for differences in lifestyle across different cultures. 29 Although the last European guideline recommends that proportionally to the duration of daytime and nighttime the number of valid blood pressure readings should be similar, 58 it is common practice to space the readings at a greater interval during the night in order not to impair sleep quality.…”

Section: How To Measure Daytime and Nighttime Blood Pressure?mentioning

confidence: 99%

Predictive Role of the Nighttime Blood Pressure

et al. 2011

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Abstract-Numerous studies addressed the predictive value of the nighttime blood pressure (BP) as captured by ambulatory monitoring. However, arbitrary cutoff limits in dichotomized analyses of continuous variables, data dredging across selected subgroups, extrapolation of cross-sectional studies to prospective outcomes, and lack of comprehensive adjustments for confounders make interpretation of the literature difficult. We reviewed prospective studies with total mortality or a composite cardiovascular end point as an outcome in relation to the level and the circadian profile of systolic BP. We analyzed studies in hypertensive patients (nϭ23 856) separately from those in individuals randomly recruited from populations (nϭ9641). We pooled summary statistics and individual subject data, respectively. In both patients and populations, in analyses in which nighttime BP was additionally adjusted for daytime BP and vice versa, nighttime BP was a stronger predictor than daytime BP. With adjustment for the 24-hour BP, both the night-to-day BP ratio and dipping status remained significant predictors of outcome but added little prognostic value over and beyond the 24-hour BP level. In the absence of conclusive evidence proving that nondipping is a reversible risk factor, the option whether or not to restore the diurnal blood pressure profile to a normal pattern should be left to the clinical judgment of doctors and should be individualized for each patient. Current guidelines on the interpretation of ambulatory BP recording need to be updated. (Hypertension. 2011;57:3-10.) • Online Data Supplement Key Words: ambulatory blood pressure monitoring Ⅲ dipping status Ⅲ nighttime blood pressure Ⅲ night-to-day blood pressure ratio Ⅲ population science Ⅲ risk factors A mbulatory monitoring enables recording the blood pressure throughout the entire day, while subjects engage in their usual day-to-day activities. 1,2 The diurnal blood pressure profile normally includes a 10% to 20% fall in blood pressure during sleep, which is driven by physical inactivity and which is largely independent of an endogenous rhythm. 3 Indeed, in shift workers, the 24-hour blood pressure level and the fall in blood pressure during sleep were similar on days with daytime and nighttime work. 3 In 1988, O'Brien et al 4 reported for the first time that patients with an abnormal circadian blood pressure profile with a less marked decrease in the nighttime blood pressure had a more frequent history of stroke. O'Brien and colleagues thereby coined the terms dipping versus nondipping. Subsequent studies of hypertensive cohorts 5-24 and populations [25][26][27][28][29][30] did not all 8,15,18,26,30 corroborate the worse prognosis associated with a high nighttime blood pressure. Moreover, interpretation of these studies is not always easy. First, positive results based on arbitrary and varying definitions of nondipping were sometimes not supported by analysis of the nocturnal blood pressure fall as a continuous variable. 7,15 Second, in some reports signific...

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“…In addition, the study reported “impaired left ventricular geometry and blunted nocturnal blood pressure fall before treatment” as significant predictors of LVH regression. The researchers did not find any correlation with diabetes 12 . However, it is known that hypertensives with diabetes have greater LV mass 13-15 .…”

Section: Discussionmentioning

confidence: 84%

Reversal of hypertensive heart disease: a multiple linear regression model

Ahmed¹,

Jhaj²,

Sadasivam³

et al. 2021

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Background: The development of left ventricular hypertrophy in primary hypertension increases cardiovascular mortality and morbidity. Reversal of left ventricular hypertrophy through therapeutic control of blood pressure reduces the risk of adverse cardiovascular incidents. Objective: In our study, we explored for the determinants of left ventricular hypertrophy regression. Methods: A cohort (n=217) of patients with hypertensive left ventricular hypertrophy was identified by screening consecutive patients in medical outpatient unit. The primary inclusion criteria were (i) Blood pressure more than140/90 mm of Hg (ii) Left Ventricular Mass Index more than 115 and 95 gm/m2 for males and females respectively. Left Ventricular Mass Index was determined by echocardiography at the time of recruitment and after 24 weeks of standard pharmacotherapy. The change in Left Ventricular Mass Index was modelled using multiple linear regression with both categorical and continuous explanatory variables. The effect of drug therapy on change in Left Ventricular Mass Index was tested in the model with dummy coded variables for the treatment categories. Results: In simple linear regression, the variables significantly correlating with change in Left Ventricular Mass Index were baseline Left Ventricular Mass Index (r=0.62, p<0.001), change in systolic blood pressure (r=0.22, p=0.001), change in mean blood pressure (r=0.16, p=0.02), baseline systolic blood pressure (r=0.15, p=0.02), age (r=0.12, p=0.09) and diabetes (r=0.12, p=0.09). The best fit model (r2=0.408) retained baseline Left Ventricular Mass Index (β=0.59, p<0.001), change in systolic blood pressure (β=0.14, p=0.01) and diabetes (β=-0.104, p=0.05) as the significant predictors. Introduction of treatment effect into the model non-significantly increased the fit of the model (r2=0.414, p=0.27-0.98). Conclusions: Pre-treatment Left Ventricular Mass Index and reduction in systolic blood pressure were the major determinants of left ventricular hypertrophy regression. We also observed that there is lesser left ventricular hypertrophy regression in diabetic patients, warranting future research to explore glycaemic control as a modifiable factor in left ventricular hypertrophy reversal.

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Left ventricular (LV) geometry and dipping state are determinants of LV mass reduction with angiotensin-converting enzyme inhibitor antihypertensive treatment

Abstract: In essential hypertension, left ventricular geometry and dipping state are independent determinants of left ventricular mass reduction with angiotensin-converting enzyme inhibitor treatment. All angiotensin-converting enzyme inhibitors are efficient in decreasing left ventricular mass.

Cited by 3 publications

References 34 publications

Acute effects of renin-angiotensin system blockade on arterial function in hypertensive patients

Acute effects of renin-angiotensin system blockade on arterial function in hypertensive patients

Predictive Role of the Nighttime Blood Pressure

Reversal of hypertensive heart disease: a multiple linear regression model

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