The influence of dipper/nondipper blood pressure patterns on global left ventricular systolic function in hypertensive diabetic patients

OBJECTIVE: This study was designed to investigate the effects of dipper and nondipper patterns on global longitudinal systolic functions of left ventricle (LV) by means of two-dimensional speckle tracking echocardiography in treated hypertensive diabetic patients with preserved left ventricular ejection fraction. PATIENTS AND METHODS: We enrolled 86 hypertensive diabetic patients. Twenty-four hour ambulatory blood pressure monitoring and echocardiography were performed in each patient. The relationship between dipper/nondipper patterns and global longitudinal strain (GLS) was analyzed. RESULTS: Fifty-one (59.3%) patients had a nondipper pattern. GLS and average global longitudinal strain rate systolic (GLSRs) were significantly decreased (-17.8±1.5, -19.6±1.9; P<0.001 vs. -1.01±0.171, -1.18±0.19; P<0.001) and E/E' was significantly increased (9.7±4.3, 7.7±3.8; P=0.033) in nondippers compared with dippers. Multivariate linear regression analysis showed that the difference between mean arterial pressure (MAP)-asleep and MAP-awake and left ventricular mass index (LVMI) was associated independently with GLS and GLSRs (MAP-asleep-MAP-awake β=-0.292, P=0.004; β=-0.305, P=0.001 and LVMI β=-0.373, P=0.001, β=-0.517, P<0.001; respectively). E/E' was associated independently with MAP-asleep-MAP-awake (β=0.241, P=0.022), age (β=-0.272, P=0.012), male sex (β=0.351, P=0.001), and LVMI (β=0.236, P=0.038). Also, SBP-asleep and LVMI were found to be associated independently with GLS and GLSRs (SBP-asleep β=-0.405, P<0.001; β=-0.271, P=0.004 and LVMI β=-0.339, P=0.002; β=-0.517, P<0.001; respectively). CONCLUSION: This study shows that the nondipper pattern is associated with subclinical LV systolic dysfunction in treated hypertensive diabetic patients with preserved left ventricular ejection fraction. Also, elevated night-time SBP was found to be related to impaired LV systolic functions.