Cargando…

Non-dipper treated hypertensive patients do not have increased cardiac structural alterations

BACKGROUND: Non-dipping pattern in hypertensive patients has been shown to be associated with an excess of target organ damage and with an adverse outcome. The aim of our study was to assess whether a reduced nocturnal fall in blood pressure (BP), established on the basis of a single 24-h BP monitor...

Descripción completa

Detalles Bibliográficos
Autores principales: Cuspidi, Cesare, Michev, Iassen, Meani, Stefano, Valerio, Cristiana, Bertazzoli, Giovanni, Magrini, Fabio, Zanchetti, Alberto
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2003
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC153424/
https://www.ncbi.nlm.nih.gov/pubmed/12709263
http://dx.doi.org/10.1186/1476-7120-1-1
_version_ 1782120696131878912
author Cuspidi, Cesare
Michev, Iassen
Meani, Stefano
Valerio, Cristiana
Bertazzoli, Giovanni
Magrini, Fabio
Zanchetti, Alberto
author_facet Cuspidi, Cesare
Michev, Iassen
Meani, Stefano
Valerio, Cristiana
Bertazzoli, Giovanni
Magrini, Fabio
Zanchetti, Alberto
author_sort Cuspidi, Cesare
collection PubMed
description BACKGROUND: Non-dipping pattern in hypertensive patients has been shown to be associated with an excess of target organ damage and with an adverse outcome. The aim of our study was to assess whether a reduced nocturnal fall in blood pressure (BP), established on the basis of a single 24-h BP monitoring, in treated essential hypertensives is related to more prominent cardiac alterations. METHODS: We enrrolled 229 treated hypertensive patients attending the out-patient clinic of our hypertension centre; each patient was subjected to the following procedures : 1) clinic BP measurement; 2) blood and urine sampling for routine blood chemistry and urine examination; 3) standard 12-lead electrocardiogram; 4) echocardiography; 5) ambulatory BP monitoring (ABPM). For the purpose of this study ABPM was carried-out in three subgroups with different clinic BP profile : 1) patients with satisfactory BP control (BP < 140/90 mmHg; group I, n = 58); 2) patients with uncontrolled clinic BP (clinic BP values ≥ 140 and/or 90 mmHg) but lower self-measured BP (< 20 mmHg for systolic BP and/or 10 mmHg for diastolic BP; group II, n = 72); 3) patients with refractory hypertension, selected according to WHO/ISH guidelines definition (group III, n = 99). Left ventricular hypertrophy (LVH) was defined by two gender-specific criteria (LV mass index ≥125/ m(2 )in men and 110 g/m(2 )in women, ≥51/gm(2.7 )in men and 47/g/m(2.7 )in women). RESULTS: Of the 229 study participants 119 (51.9%) showed a fall in SBP/DBP < 10% during the night (non-dippers). The prevalence of non-dippers was significantly lower in group I (44.8%) and II (41.6%) than in group III (63.9%, p < 0.01 III vs II and I). The prevalence of LVH varied from 10.3 to 24.1% in group I, 31.9 to 43.1% in group II and from 60.6 to 67.7% in group III (p < 0.01, III vs II and I). No differences in cardiac structure, analysed as continuous variable as well as prevalence of LVH, were found in relationship to dipping or non-dipping status in the three groups. CONCLUSIONS: In treated essential hypertensives with or without BP control the extent of nocturnal BP decrease is not associated with an increase in LV mass or LVH prevalence; therefore, the non-dipping profile, diagnosed on the basis of a single ABPM, does not identify hypertensive patients with greater cardiac damage.
format Text
id pubmed-153424
institution National Center for Biotechnology Information
language English
publishDate 2003
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-1534242003-04-17 Non-dipper treated hypertensive patients do not have increased cardiac structural alterations Cuspidi, Cesare Michev, Iassen Meani, Stefano Valerio, Cristiana Bertazzoli, Giovanni Magrini, Fabio Zanchetti, Alberto Cardiovasc Ultrasound Research BACKGROUND: Non-dipping pattern in hypertensive patients has been shown to be associated with an excess of target organ damage and with an adverse outcome. The aim of our study was to assess whether a reduced nocturnal fall in blood pressure (BP), established on the basis of a single 24-h BP monitoring, in treated essential hypertensives is related to more prominent cardiac alterations. METHODS: We enrrolled 229 treated hypertensive patients attending the out-patient clinic of our hypertension centre; each patient was subjected to the following procedures : 1) clinic BP measurement; 2) blood and urine sampling for routine blood chemistry and urine examination; 3) standard 12-lead electrocardiogram; 4) echocardiography; 5) ambulatory BP monitoring (ABPM). For the purpose of this study ABPM was carried-out in three subgroups with different clinic BP profile : 1) patients with satisfactory BP control (BP < 140/90 mmHg; group I, n = 58); 2) patients with uncontrolled clinic BP (clinic BP values ≥ 140 and/or 90 mmHg) but lower self-measured BP (< 20 mmHg for systolic BP and/or 10 mmHg for diastolic BP; group II, n = 72); 3) patients with refractory hypertension, selected according to WHO/ISH guidelines definition (group III, n = 99). Left ventricular hypertrophy (LVH) was defined by two gender-specific criteria (LV mass index ≥125/ m(2 )in men and 110 g/m(2 )in women, ≥51/gm(2.7 )in men and 47/g/m(2.7 )in women). RESULTS: Of the 229 study participants 119 (51.9%) showed a fall in SBP/DBP < 10% during the night (non-dippers). The prevalence of non-dippers was significantly lower in group I (44.8%) and II (41.6%) than in group III (63.9%, p < 0.01 III vs II and I). The prevalence of LVH varied from 10.3 to 24.1% in group I, 31.9 to 43.1% in group II and from 60.6 to 67.7% in group III (p < 0.01, III vs II and I). No differences in cardiac structure, analysed as continuous variable as well as prevalence of LVH, were found in relationship to dipping or non-dipping status in the three groups. CONCLUSIONS: In treated essential hypertensives with or without BP control the extent of nocturnal BP decrease is not associated with an increase in LV mass or LVH prevalence; therefore, the non-dipping profile, diagnosed on the basis of a single ABPM, does not identify hypertensive patients with greater cardiac damage. BioMed Central 2003-02-14 /pmc/articles/PMC153424/ /pubmed/12709263 http://dx.doi.org/10.1186/1476-7120-1-1 Text en Copyright © 2003 Cuspidi et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
spellingShingle Research
Cuspidi, Cesare
Michev, Iassen
Meani, Stefano
Valerio, Cristiana
Bertazzoli, Giovanni
Magrini, Fabio
Zanchetti, Alberto
Non-dipper treated hypertensive patients do not have increased cardiac structural alterations
title Non-dipper treated hypertensive patients do not have increased cardiac structural alterations
title_full Non-dipper treated hypertensive patients do not have increased cardiac structural alterations
title_fullStr Non-dipper treated hypertensive patients do not have increased cardiac structural alterations
title_full_unstemmed Non-dipper treated hypertensive patients do not have increased cardiac structural alterations
title_short Non-dipper treated hypertensive patients do not have increased cardiac structural alterations
title_sort non-dipper treated hypertensive patients do not have increased cardiac structural alterations
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC153424/
https://www.ncbi.nlm.nih.gov/pubmed/12709263
http://dx.doi.org/10.1186/1476-7120-1-1
work_keys_str_mv AT cuspidicesare nondippertreatedhypertensivepatientsdonothaveincreasedcardiacstructuralalterations
AT micheviassen nondippertreatedhypertensivepatientsdonothaveincreasedcardiacstructuralalterations
AT meanistefano nondippertreatedhypertensivepatientsdonothaveincreasedcardiacstructuralalterations
AT valeriocristiana nondippertreatedhypertensivepatientsdonothaveincreasedcardiacstructuralalterations
AT bertazzoligiovanni nondippertreatedhypertensivepatientsdonothaveincreasedcardiacstructuralalterations
AT magrinifabio nondippertreatedhypertensivepatientsdonothaveincreasedcardiacstructuralalterations
AT zanchettialberto nondippertreatedhypertensivepatientsdonothaveincreasedcardiacstructuralalterations