Echocardiographic Characteristics and Non-Dipping Blood Pressure Profile: Is There an Association?

Abstract Background The circadian rhythm of blood pressure is a fundamental aspect of cardiovascular physiology in healthy individuals. Beyond nocturnal hypertension, a blunted or impaired BP circadian variation is linked to heightened target organ damage and elevated cardiovascular disease risk. This includes alterations in cardiac structure and function, atherosclerotic cardiovascular disease, dementia and heart failure. Methods A retrospective cohort study involving 1600 participants enrolled between 2021 and 2023 identified 847 as dippers and 753 as non-dippers based on 24-hour ambulatory blood pressure monitoring. Echocardiographic evaluations were performed to assess cardiac structure and function. Results Non-dipping individuals displayed more signs of adverse cardiac remodeling, including a higher rate of eccentric hypertrophy (1.73 vs. 0.47%), increased left ventricular mass index in both men (75.82 vs. 70.10 g/m 2 ) and women (65.44 vs. 63.92 g/m 2 ), left ventricular internal diameter in diastole (4.38 vs. 4.23 cm), and left ventricular posterior wall thickness (0.82 vs. 0.81 cm). Additionally, non-dipping participants exhibited impaired ventricular relaxation, with higher E/e’ ratios medially (9.45 vs. 8.86) and laterally (7.61 vs. 7.23) and rates of type 1 diastolic dysfunction (9.31 vs. 4.49%). These differences persisted when analysing only participants with hypertension. Conclusions Our study highlights the substantial impact of non-dipping blood pressure patterns on cardiac structure and function. It suggests that non-dipping blood pressure patterns may serve as an independent predictor of adverse cardiac remodelling, irrespective of hypertension diagnosis. These results underscore the necessity of devising monitoring strategies and implementing targeted interventions to address the cardiovascular risks associated with non-dipping BP profile. Graphical abstract