Influence of an Average Real Blood Pressure Variability on Left and Right Ventricular Function and Morphology in Patients With Normo- And Hypertension

Objective: Aim of the study was to assess an influence of an average real circadian blood pressure variability (CBPV) on left and right ventricular morpho-functional parameters in patients with normal and high blood pressure. Design and method: A total of 75 untreated male hypertensive patients (mean age 57.13± 7.27 years) and 25 voluntary healthy male individuals (mean age 57.56±7.55 years) were included into the study. 24-hour Ambulatory blood pressure measurement (ABPM) was performed by the cuff-oscillometric method to evaluate the real CBPV. Heart ultrasonography was performed in every patient to reveal morpho-functional changes of left and right ventricles in patients with normo- and hypertension. Results: Maximal real CBPV in hypertensives was 1.285 vs 0.434 in normotensives, Minimal -2,571 vs -0.913 in normotensives, Median -0,762 vs -0.13 in normotensives and variation range was 3.856 in hypertensives vs 3.347 in normotensives. Patients with lower real CBPV (<-0.762; n=34) in comparison with those with higher real circadian BP variability (>-0.762, n=41) had significantly lower interventricular septum thickness (1.270±0.134 vs 1.381±0.151; P<0.00001), posterior wall thickness (1.216±0.163 vs 1.355±0.169; P<0.005), left ventricular mass and mass index (252.023±52.086 vs 282.814±52.454, P<0.05 and 121.316±25.005 vs 137.036±27.185, P<0.05, respectively). Relative wall thickness as well as free wall thickness was significantly higher in patients with higher CBPV (0.561±0.073 vs 0.485±0.07; P<0.00001 and 5.653±1.046 vs 4.720±0.473; P<0.0005, consecutively). TAPSE and right ventricular fractional area change, % were significantly higher in patients with lower CBPV (19.147±2.074 vs 17.365±2.629; P<0.05 and 44.17±4.78 vs 38,05±6.064, P<0.005; respectively). Mitral and tricuspid E/A ratio were significantly lower in patients with higher real CBPV (0.741±0.145 vs 0.848±0.120, P<0.05 and 1.107±0.201 vs 0.909±0.164, P<0.0005; respectively). Normotensive individuals with higher and lower CBPV (<-0.13, n=14 vs >-0.13, n=11) did not show any statistically significant difference in regards of all the parameters measured above. Conclusions: Hypertensive patients in comparison with normotensive individuals are prone to more expressed and higher real CBPV. In our study, higher real CBPV was related with well-marked left and right ventricular morpho-functional changes mainly in hypertensive patients.