Key result
Reverse dipper BP rhythm linked to ~5-fold higher risk of LVH in older adults.
Why the study?
The correlation between blood pressure fluctuation, including variability and circadian rhythm, and left ventricular remodeling in older adults, as well as the potential mediating role of chronic low-grade inflammation, warranted investigation.
Are 24-hour blood pressure variability and abnormal circadian blood pressure rhythms associated with left ventricular remodeling in community-dwelling older adults, and is this association mediated by chronic low-grade inflammation?
Cross-Sectional (n=548)
Single-blind
Are 24-hour blood pressure variability and abnormal circadian blood pressure rhythms associated with left ventricular remodeling in community-dwelling older adults, and is this association mediated by chronic low-grade inflammation?
In older adults, excessive 24-hour blood pressure variability and abnormal circadian rhythms (particularly reverse dipping) are independently associated with left ventricular remodeling and hypertrophy, an effect partially mediated by chronic low-grade inflammation.
Should not yet change LVH risk assessment in older adults; hypothesis-generating and requires prospective confirmation of reverse dipping's role.
We aimed to investigate the correlation between blood pressure (BP) fluctuation, including BP variability (BPV) and circadian rhythm, and left ventricular remodeling (LVR), and to explore the potential mediating role of chronic low-grade inflammation in these correlations. Between May 2021 and October 2023, 548 community-dwelling adults aged ≥60 years were assessed: BPV and circadian rhythm were evaluated using 24-hour ambulatory BP monitoring, LVR was assessed by echocardiography, and inflammation was measured via hypersensitive C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-α), and monocyte chemotactic protein-1 (MCP-1). Twenty-four-hour systolic (S)BP standard deviation (SD) and coefficient of variation (CV)were showed to be positively correlated with interventricular septal thickness, left ventricular posterior wall thickness, and left ventricular mass index, while SBP and diastolic (D)BP nocturnal dipping rates (NDR) were negatively correlated with these parameters. Left ventricular hypertrophy (LVH) risk showed positive linear dose-response correlations with 24-hour SBP SD and CV, an L-shaped correlation with SBP NDR, and a negative linear correlation with DBP NDR. After adjustment for confunders including 24-hour average SBP and DBP, compared with dipper rhythm, LVH risk was elevated by 0.874-fold (OR: 1.874, 95% CI: 1.113–3.155) in non-dippers and by 3.965-fold (OR: 4.965, 95% CI: 2.847–8.659) in reverse dippers. HsCRP, TNF-α, and MCP-1 collectively mediated the correlation between LVR and BP fluctuation. In conclusion, excessive BPV and abnormal circadian BP rhythms, especially reverse dipper rhythms, are risk factors for LVR in older adults, and chronic low-grade inflammation plays a crucial mediating role in these correlations. Trial registration: Registered number: ChiCTR1900023580
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Liu et al. (2026) conducted a cross-sectional in Left ventricular remodeling and blood pressure fluctuation (n=548). Reverse dipper circadian blood pressure rhythm vs. Dipper circadian blood pressure rhythm was evaluated on Left ventricular hypertrophy (LVMI >95 g/m² in women and >115 g/m² in men) (OR 4.965, 95% CI 2.847-8.659, p=<0.001). Reverse dipper blood pressure rhythm was associated with a 3.965-fold higher risk of left ventricular hypertrophy compared to dipper rhythm (OR 4.965, 95% CI 2.847-8.659; p<0.001) in older adults.
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