What question did this study set out to answer?

To determine the sex-specific effects of circadian arterial pressure variation on systemic hemodynamics, renal hemodynamics, and left ventricular structure in untreated essential hypertension.

December 1, 1995American Journal of Hypertension

Gender-specific cardiovascular adaptation due to circadian blood pressure variations in essential hypertension

Q: What is the clinical evidence from this study?

Study design: Observational. Population: untreated essential hypertension (n=66). Intervention: Nondipping circadian blood pressure pattern vs. Dipping circadian blood pressure pattern. Primary outcome: Left ventricular mass and mass index (p=< .05).

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Key result

A nondipping circadian blood pressure pattern was associated with higher left ventricular mass in women (255 vs 184 g, P<0.05) but not in men (234 vs 240 g, P=NS) with essential hypertension.

Why the study?

Does a nondipping circadian blood pressure pattern affect left ventricular structure differently in women compared to men with untreated essential hypertension?

Population

66 patients (20 women and 46 men) with untreated essential hypertension

Comparison

Nondipping blood pressure pattern vs Dipping blood pressure pattern

Design

Cross-sectional

Authors

RSRoland E. SchmiederFriedrich-Alexander-Universität Erlangen-Nürnberg JRJürgen K. RockstrohUniversity Hospital Bonn FAFranz C. AepfelbacherBeth Israel Deaconess Medical Center

Discussion

Member takes

Implication

Nondipping pattern may warrant sex-specific LV monitoring in hypertension; leaves open causal mechanisms and needs prospective confirmation.

Key Points

To determine the sex-specific effects of circadian arterial pressure variation on systemic hemodynamics, renal hemodynamics, and left ventricular structure in untreated essential hypertension.
Evaluated 20 women and 46 men with untreated essential hypertension using 24-hour ambulatory blood pressure monitoring.
Categorized subjects into dippers and nondippers based on a nocturnal mean arterial pressure decrease of at least 10% from daytime values.
Assessed cardiac output via indocyanine green dye dilution, renal plasma flow via iodine-131 para-aminohippuric acid clearance, and left ventricular structure and function using 2D-guided M-mode echocardiography.
Systemic hemodynamics, renal hemodynamics, and neurohumoral markers (norepinephrine, epinephrine, dopamine, plasma renin activity) did not significantly differ between dippers and nondippers across sexes.
Female nondippers exhibited significantly higher left ventricular mass (255 ± 68 vs 184 ± 81 g, P < .05) and mass index (137 ± 30 vs 102 ± 39 g/m², P < .05) than female dippers, whereas no significant differences were observed in men (234 ± 48 vs 240 ± 54 g; 119 ± 27 vs 121 ± 13 g/m², P = NS).
Relative wall thickness (0.45 ± 0.06 vs 0.39 ± 0.06, P < .05) and posterior wall thickness (1.1 ± 0.1 vs 0.89 ± 0.2 mm, P < .05) were significantly elevated in female nondippers compared with female dippers, but showed no difference in men.

Study Design

Type

Observational (n=66)

Structured PICO

Does a nondipping circadian blood pressure pattern affect left ventricular structure differently in women compared to men with untreated essential hypertension?

Population

66 patients (20 women and 46 men) with untreated essential hypertension

Intervention

Nondipping blood pressure pattern (nocturnal decrease in mean arterial pressure <10% of daytime values)

Comparator

Dipping blood pressure pattern (nocturnal decrease in mean arterial pressure by ≥10% of daytime values)

Outcome

Left ventricular structure and function (left ventricular mass and mass index, relative wall thickness, posterior wall thickness)surrogate

Main Result

p-value: p=< .05

The degree of left ventricular hypertrophy correlates with circadian blood pressure variations in women but not men, suggesting left ventricular structure may be more load-dependent in women with essential hypertension.

Cite This Study

Schmieder et al. (1995) conducted an observational in untreated essential hypertension (n=66). Nondipping circadian blood pressure pattern vs. Dipping circadian blood pressure pattern was evaluated on Left ventricular mass and mass index (p=< .05). A nondipping circadian blood pressure pattern was associated with higher left ventricular mass in women (255 vs 184 g, P<0.05) but not in men (234 vs 240 g, P=NS) with essential hypertension.

synapsesocial.com/papers/6a0eb72c7046b28dbef9a0bc https://doi.org/10.1016/0895-7061(95)00364-9

Topics

Hypertension management Echocardiography

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Implication

Nondipping pattern may warrant sex-specific LV monitoring in hypertension; leaves open causal mechanisms and needs prospective confirmation.

Gender-specific cardiovascular adaptation due to circadian blood pressure variations in essential hypertension

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Gender-specific cardiovascular adaptation due to circadian blood pressure variations in essential hypertension

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider