Nocturnal Blood Pressure Pattern Affects Left Ventricular Remodeling and Late Gadolinium Enhancement in Patients with Hypertension and Left Ventricular Hypertrophy

Abstract

BackgroundLeft ventricular hypertrophy (LVH) is an independent predictor of cardiac mortality, regardless of its etiology. Previous studies have shown that high nocturnal blood pressure (BP) affects LV geometry in hypertensive patients. It has been suggested that continuous pressure overload affects the development of LVH, but it is unknown whether persistent pressure influences myocardial fibrosis or whether the etiology of LVH is associated with myocardial fibrosis. Comprehensive cardiac magnetic resonance (CMR) including the late gadolinium enhancement (LGE) technique can evaluate both the severity of changes in LV geometry and myocardial fibrosis. We tested the hypothesis that the nocturnal non-dipper BP pattern causes LV remodeling and fibrosis in patients with hypertension and LVH.MethodsForty-seven hypertensive patients with LVH evaluated by echocardiography (29 men, age 73.0±10.4 years) were examined by comprehensive CMR and 24-h ambulatory blood pressure monitoring (ABPM).Results and ConclusionsAmong the 47 patients, twenty-four had nocturnal non-dipper BP patterns. Patients with nocturnal non-dipper BP patterns had larger LV masses and scar volumes independent of etiologies than those in patients with dipper BP patterns (p = 0.035 and p = 0.015, respectively). There was no significant difference in mean 24-h systolic BP between patients with and without nocturnal dipper BP patterns (p = 0.367). Among hypertensive patients with LVH, the nocturnal non-dipper blood pressure pattern is associated with both LV remodeling and myocardial fibrosis independent of LVH etiology.

Blood Pressure Reverse-Dipping is Associated With Early Formation of Carotid Plaque in Senior Hypertensive Patients

“…In addition, based on previous studies, carotid plaque was divided into 3 groups including no plaque (Grade 0, 0% narrowing), mild stenosis (Grade 1, 1%–24% narrowing), and moderate stenosis (Grade 2, ≥25% narrowing). 29 , 30 Surprisingly, different from other studies on the important prognostic value of nondipper, 17 , 36 , 37 our results showed that reverse-dipper pattern of BP is positively associated with the formation of carotid plaque (the initiation of the carotid narrowing <25%) from Grade 0. In consistency with our previous hypothesis, nondipper pattern of BP failed to promote carotid plaque from Grade 0 to Grade 1.…”

Riser Pattern: Another Determinant of Heart Failure With Preserved Ejection Fraction

“…The riser BP pattern was demonstrated to present a significant risk for hypertensive target organ damage and cardiovascular death. [6][7][8][9] In our previous study, the group of HF patients with the riser BP pattern was more likely to be female and to have hypertension and atrial fibrillation compared with the HF patients without the riser BP pattern. 10 These characteristics of the HF patients with the riser BP pattern were similar to those of the HFpEF patients in previous reports.…”

“…Paradoxical increase in blood pressure (BP) during sleep, exceeding those of awake BP, is called the riser BP pattern, and is known as an abnormal circadian BP rhythm. The riser BP pattern was demonstrated to present a significant risk for hypertensive target organ damage and cardiovascular death …”

From Left Ventricular Hypertrophy to Dysfunction and Failure

“…In a study of AH, patients with nocturnal non-dipper blood pressure patterns had larger LVM and scar volume than those with dipper patterns. 92 In moderate and severe AS, both ischemic subendocardial unrelated to the degree of LVH and cause a reduction in maximum MBF and CFR. 51 In the hypertensive heart there is remodeling of intramural coronary arterioles, because of hypertrophy of smooth muscle cells, and increased collagen deposition in the tunica media, with varying degrees of intimal thickening and perivascular fibrosis.…”