The influence of dipper vs. non-dipper pattern on left ventricular function and ascending aorta dimensions in hypertensive patients in Angola
Abstract
Background. The objective of the present study is to evaluate the effect of the dipper vs. non-dipper patterns on left ventricular function and the dimensions of the ascending aorta in hypertensive patients in Angola.
Material and methods. This is a descriptive, observational study performed at the Department of Cardiology of Luanda Medical Center. For this purpose, information on demographic data, echocardiographic parameters and 24-hour-ambulatory blood pressure measurement parameters was collected. All patients underwent both echocardiographic study and 24-hour-ambulatory blood pressure measurement. Dipper pattern is considered when there is a decrease in the nocturnal BP in relation to the daytime BP greater than 10%; if this decrease is not observed either in the systolic blood pressure or in the diastolic blood pressure, the patients are considered non-dippers.
Results. We enrolled 159 patients, of which 85 (53.46%) were dippers and 74 (46.54%) were non-dippers, and 87 (54.71%) were male. The mean age (SD) was 43.62 (± 10.73) years. The patients with the non-dipper pattern had larger ascending aortic diameters (29.68 ± 4.88 vs. 27.8 ± 5.18, p = 0.001), higher left ventricular diastolic diameters (52.85 ± 9.24 vs. 50.24 ± 4.16, p = 0.027) and greater posterior wall thickness (10.73 ± 1.94 vs. 10.07 ± 1.70, p = 0.024). In addition, the left ventricular diastolic dysfunction (LVDD) (B = 0.103, p = 0.001) and the posterior wall (PW) thickness (B = 0.350, p = 0.001) are significant estimates of non-dipper pattern.
Conclusions. The results show that hypertensive patients with non-dipper pattern have more alterations in left ventricular geometry, but not in left ventricular systolic and diastolic function.
Keywords: essential hypertensionechocardiographyambulatory blood pressure measurementdippernon-dipper
References
- Pires JE, Sebastião YV, Langa AJ, et al. Hypertension in Northern Angola: prevalence, associated factors, awareness, treatment and control. BMC Public Health. 2013; 13: 90.
- Marwick TH, Gillebert TC, Aurigemma G, et al. Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). Eur Heart J Cardiovasc Imaging. 2015; 16(6): 577–605.
- Madin K, Iqbal P. Twenty four hour ambulatory blood pressure monitoring: a new tool for determining cardiovascular prognosis. Postgrad Med J. 2006; 82(971): 548–551.
- Parati G, Stergiou G, O'Brien E, et al. European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability, European Society of Hypertension Working Group on Blood Pressure Monitoring. European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013; 31(9): 1731–1768.
- Cuspidi C, Michev I, Meani S, et al. Non-dipper treated hypertensive patients do not have increased cardiac structural alterations. Cardiovascular Ultrasound. 2003; 1(1).
- Sokmen G, Sokmen A, Aksu E, et al. The influence of ambulatory blood pressure profile on global and regional functions of the left and the right ventricles in orderly treated hypertensive patients. Echocardiography. 2008; 25(5): 465–472.
- Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009; 22(2): 107–133.
- Quiñones M, Otto C, Stoddard M, et al. Recommendations for quantification of Doppler echocardiography: A report from the Doppler quantification task force of the nomenclature and standards committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002; 15(2): 167–184.
- Yokota H, Imai Y, Tsuboko Y, et al. Nocturnal Blood Pressure Pattern Affects Left Ventricular Remodeling and Late Gadolinium Enhancement in Patients with Hypertension and Left Ventricular Hypertrophy. PLoS One. 2013; 8(6): e67825.
- Ferrara LA, Guida L, Mangini FP, et al. Cardiovascular abnormalities in never-treated hypertensives according to nondipper status. Am J Hypertens. 1998; 11(11 Pt 1): 1352–1357.
- Verdecchia P, Schillaci G, Borgioni C, et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation. 1990; 81(2): 528–536.
- Możdżan M, Wierzbowska-Drabik K, Kurpesa M, et al. Echocardiographic indices of left ventricular hypertrophy and diastolic function in hypertensive patients with preserved LVEF classified as dippers and non-dippers. Arch Med Sci. 2013; 9(2): 268–275.
- Ivanovic BA, Tadic MV, Celic VP. To dip or not to dip? The unique relationship between different blood pressure patterns and cardiac function and structure. J Hum Hypertens. 2013; 27(1): 62–70.
- Cuspidi C, Meani S, Salerno M, et al. Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure. J Hypertens. 2004; 22(2): 273–80.
- Karaagac K, Vatansever F, Tenekecioglu E, et al. The Relationship between Non-Dipper Blood Pressure and Thoracic Aortic Diameter in Metabolic Syndrome. Eurasian J Med. 2014; 46(2): 120–125.
- Ozdemir E, Yildirimturk O, Cengiz B, et al. Evaluation of carotid intima-media thickness and aortic elasticity in patients with nondipper hypertension. Echocardiography. 2014; 31(5): 663–668.
- Grandi AM, Broggi R, Jessula A, et al. Relation of extent of nocturnal blood pressure decrease to cardiovascular remodeling in never-treated patients with essential hypertension. Am J Cardiol. 2002; 89(10): 1193–1196.
- Della Mea P, Lupia M, Bandolin V, et al. Adiponectin, insulin resistance, and left ventricular structure in dipper and nondipper essential hypertensive patients. Am J Hypertens. 2005; 18(1): 30–35.
- Ermiş N, Otlu YÖ, Afşin A, et al. Comparison of left atrial volume and function in non-dipper versus dipper hypertensives: A real-time three-dimensional echocardiography study. Anatol J Cardiol. 2016; 16(6): 428–433.
- Chen Y, Liu JH, Zhen Z, et al. Assessment of left ventricular function and peripheral vascular arterial stiffness in patients with dipper and non-dipper hypertension. J Investig Med. 2018; 66(2): 319–324.
- Park CS, An GH, Kim YW, et al. Evaluation of the Relationship between Circadian Blood Pressure Variation and Left Atrial Function Using Strain Imaging. J Cardiovasc Ultrasound. 2011; 19(4): 183–191.
- Açar G, Bulut M, Arslan K, et al. Comparison of left atrial mechanical function in nondipper versus dipper hypertensive patients: a speckle tracking study. Echocardiography. 2013; 30(2): 164–170.
- Tadic M, Cuspidi C, Celic V, et al. Nocturnal hypertension and right heart remodeling. J Hypertens. 2018; 36(1): 136–142.