What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Essential Hypertension (n=361). Intervention: Non-dipper blood pressure pattern vs. Dipper blood pressure pattern. Primary outcome: Inappropriately high left ventricular mass (iLVM) (OR 2.149, 95% CI 1.087-4.249, p=0.028).

January 1, 2011Open Access

Non-Dipper Pattern is a Determinant of the Inappropriateness of Left Ventricular Mass in Essential Hypertensive Patients

BKBae Keun KimSungae Hospital YLYoung‐Hyo LimInterventional Cardiology HLHyung Tak LeeSK Group (South Korea)

Key Result

The non-dipper blood pressure pattern is independently associated with an increased risk of inappropriately high left ventricular mass in hypertensive patients (OR 2.149).

Study Design

Type

Cross-Sectional (n=361)

Multicenter

Structured PICO

Does a non-dipper blood pressure pattern increase the risk of inappropriately high left ventricular mass in hypertensive patients?

Population

361 patients aged 45 and older who underwent ambulatory blood pressure monitoring and echocardiography to evaluate the relationship between nocturnal blood pressure dipping and inappropriately high left ventricular mass.

Exposure

Non-dipper blood pressure pattern (nocturnal systolic blood pressure fall <10% compared to daytime)

Comparator

Dipper blood pressure pattern (nocturnal systolic blood pressure fall ≥10% compared to daytime)

Outcome

Appropriateness of left ventricular mass, calculated as observed/predicted ratio of LV mass (OPR) and inappropriately high LV mass (iLVM)surrogate

A non-dipper blood pressure pattern is independently associated with inappropriately high left ventricular mass in essential hypertensive patients, suggesting an intrinsic non-hemodynamic role in target organ damage.

Main Result

Odds Ratio: 2.149 (95% CI 1.087–4.249)

p-value: p=0.028

Limitations

Details of anti-hypertensive treatment were not fully surveyed due to small sample size and incomplete data.
Patients with clinical cardiovascular diseases were excluded, limiting generalizability to complicated patients.
The reproducibility of the classification of dipper and non-dipper patterns based on a single ABPM is limited.

Abstract

BACKGROUND AND OBJECTIVES: Inappropriately high left ventricular mass (iLVM) is known to be related to cardiovascular prognosis. A non-dipper pattern has a greater mean left ventricular (LV) mass than the dipper pattern in hypertensive patients. However, the appropriateness of LV mass in dipper or non-dipper patterns has not been adequately investigated. The aim of this study was to define the relationship between nocturnal dipping and the appropriateness of LV mass. SUBJECTS AND METHODS: Using the ambulatory blood pressure monitoring (ABPM) database, the data of 361 patients who underwent ABPM and echocardiography was analyzed retrospectively. Appropriateness of LV mass was calculated as observed/predicted ratio of LV mass (OPR) using a Korean-specified equation. Nocturnal dipping was expressed as percent fall in systolic blood pressure (BP) during the night compared to the day. RESULTS: Daytime, nighttime and 24 hours BP in hypertensive patients was 140.4±14.8 mmHg, 143.7±15.2 mmHg and 129.4±20.0 mmHg, respectively. OPR was 106.3±19.9% and nocturnal dipping was 10.2±10.9 mmHg. In a multiple linear regression model, 24 hours systolic BP (β=0.097, p=0.043) and nocturnal dipping (β=-0.098, p=0.046) were independent determinants of OPR as well as age (β=0.130, p=0.025) and body mass index (BMI) (β=0.363, p25 kg/m(2)). CONCLUSION: The non-dipper pattern is independently associated with iLVM in hypertensive patients as well as obesity.

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