Left Ventricular Mass in Dippers and Nondippers with Newly Diagnosed Hypertension

Cicconetti, P.; Morelli, Sergio; Serra, Caterina De; Ciotti, Veronica; Chiarotti, Flavia; Marle, M Giusti De; Ottaviani, Luigi; Riolo, Noemi; Marigliano, Vincenzo

doi:10.1177/000331970305400605

Cited by 17 publications

(13 citation statements)

References 25 publications

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“…Many researchers have evaluated cardiac damage in untreated individuals with essential hypertension and found no significant differences between dippers and nondippers with respect to LV diameter (14,21), LV systolic and diastolic function (21), interventricular septum thickness, posterior wall thickness, relative wall thickness (14,45,56), LV concentric remodelling (45,56), LVH, LVM and LVMI (14,21,45,56), aortic distensibility (21) and atrial dimensions (56). However, in these studies, the classification of dipping status was based on a single ABPM session.…”

Section: Cardiac Geometrymentioning

confidence: 99%

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

Routledge

McFetridge-Durdle

Dean

2007

Canadian Journal of Cardiology

118

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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 Geometrymentioning

confidence: 99%

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

Routledge

McFetridge-Durdle

Dean

2007

Canadian Journal of Cardiology

118

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“…A number of studies have shown that individuals with essential hypertension and a nondipper BP pattern show an increased frequency of target organ damage. In particular, there is some evidence to suggest that they are at increased risk of LVH, left ventricular mass, left ventricular mass index, carotid artery intima to medial thickness, carotid artery plaques, silent cerebral infarct, stroke, cognitive impairment, microalbuminuria, and retinopathy [7][8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…The clinical relevance of establishing a nondipper BP pattern lies in its proven association with more severe hypertensive target organ damage and its improved prediction of an increased cardiovascular (CV) risk, not only in hypertensives, but also in normotensives [4][5][6]. Left ventricular hypertrophy (LVH), carotid intima-media thickening, microalbuminuria and cerebrovascular diseases are much more prevalent in nondippers than in dippers [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Effect of dipping status on QRS morphology in patients with hypertension

Erden

Erden²,

Özhan³

et al. 2010

Blood Pressure Monitoring

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“…With the use of the 24-hour ABPM, researchers have observed that BP usually fluctuates in a diurnal manner [3]. Diurnal refers to the daily variation of BP that is generally higher during the day than at night.…”

Section: Introductionmentioning

confidence: 99%

“…Other studies have failed to discover significant differences in cardiac and extra cardiac damage between night-time BP patterns among persons with essential hypertension. Several researchers have observed no significant differences in left ventricular hypertrophy (LVH) [10,11], left ventricular mass (LVM) [3,12], left ventricular mass index (LVMI) [3,13], carotid artery intimae to medial thickness [14,15], carotid artery plaques [15], cognitive functioning [16], microalbuminuria [17], and retinopathy [17].…”

Section: Introductionmentioning

confidence: 99%

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

Selçoki

Baybek

et al. 2008

Open Medicine

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AbstractIndividuals who do not have a 10% to 20% reduction in blood pressure (BP) during the night are known as ‘nondippers’. Non-dipping patterns in hypertensive patients have been shown to be associated with an excess of target organ damage and other adverse outcomes. The present study was designed to investigate the relationship between nocturnal BP pattern, defined on the basis of the ambulatory blood pressure monitoring (ABPM) recording, and cardiac and renal target organ damage in a population of at least one year treated essential hypertensive subjects. The present analysis involved 123 patients with treated essential hypertension attending the outpatient clinic of our centre. Each patient was subjected to the following procedures: blood sampling for routine blood chemistry, spot urine for proteinuria, 24-hour periods of ABPM, and echocardiography. In the ABPM period, a dipping pattern was observed in 65 of the 123 patients, and a non-dipping pattern in 58 patients. Body mass index was higher in the non-dippers (26 ± 4 versus 28 ± 4, p<0.05). The proteinuria in spot urine was significantly higher in the non-dippers (10 ± 6 versus 24 ± 48, p<0.03). Left ventricular mass, interventricular septum thickness, posterior wall thickness and left ventricular systolic diameter were significantly higher in the non-dippers compared to the dippers. Left ventricular diastolic function was similar in non-dipper cases, except E-wave deceleration time. In treated essential hypertensives the blunted or absent nocturnal fall in blood pressure can be a strong predictor of cardiac and renal events. Hypertensive patients should be evaluated by ambulatory blood pressure monitoring. To prevent patients at risk for morbidity and mortality casualities as a result of hypertension, patients should be evaluated by ambulatory blood pressure monitoring. This method can be utilized for exacting future follow-ups with the patient.

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Left Ventricular Mass in Dippers and Nondippers with Newly Diagnosed Hypertension

Cited by 17 publications

References 25 publications

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

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

Effect of dipping status on QRS morphology in patients with hypertension

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

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