Korean Circ J.  2011 Apr;41(4):191-197. 10.4070/kcj.2011.41.4.191.

Non-Dipper Pattern is a Determinant of the Inappropriateness of Left Ventricular Mass in Essential Hypertensive Patients

• Kim BK
• Lim YH
• Lee HT
• Lee JU
• Kim KS
• Kim SG
• Kim JH
• Lim HK
• Shin J

• KMID: 2028943
• DOI: http://doi.org/10.4070/kcj.2011.41.4.191

Abstract

BACKGROUND AND OBJECTIVES
Inappropriately high left ventricular mass (iLVM) is known to be related to cardiovascular prognosis. A non-dipper pattern has a greater mean left ventricular (LV) mass than the dipper pattern in hypertensive patients. However, the appropriateness of LV mass in dipper or non-dipper patterns has not been adequately investigated. The aim of this study was to define the relationship between nocturnal dipping and the appropriateness of LV mass.
SUBJECTS AND METHODS
Using the ambulatory blood pressure monitoring (ABPM) database, the data of 361 patients who underwent ABPM and echocardiography was analyzed retrospectively. Appropriateness of LV mass was calculated as observed/predicted ratio of LV mass (OPR) using a Korean-specified equation. Nocturnal dipping was expressed as percent fall in systolic blood pressure (BP) during the night compared to the day.
RESULTS
Daytime, nighttime and 24 hours BP in hypertensive patients was 140.4+/-14.8 mmHg, 143.7+/-15.2 mmHg and 129.4+/-20.0 mmHg, respectively. OPR was 106.3+/-19.9% and nocturnal dipping was 10.2+/-10.9 mmHg. In a multiple linear regression model, 24 hours systolic BP (beta=0.097, p=0.043) and nocturnal dipping (beta=-0.098, p=0.046) were independent determinants of OPR as well as age (beta=0.130, p=0.025) and body mass index (BMI) (beta=0.363, p<0.001). Odds ratio of the non-dipper pattern was 2.134 for iLVM (p=0.021) and 3.694 for obesity (p<0.001; BMI >25 kg/m2).
CONCLUSION
The non-dipper pattern is independently associated with iLVM in hypertensive patients as well as obesity.

Keyword

Hypertension; Hypertrophy, left ventricular; Blood pressure monitoring, ambulatory

MeSH Terms

Blood Pressure
Blood Pressure Monitoring, Ambulatory
Body Mass Index
Echocardiography
Humans
Hypertension
Hypertrophy, Left Ventricular
Linear Models
Obesity
Odds Ratio
Prognosis
Retrospective Studies

Figure

• 

  Fig. 1 Adjusted Nocturnal dipping by age, BMI and 24 hours systo-lic BP between aLVM (n=302) vs. iLVM (n=59) patients. In all pati-ents, nocturnal dipping (10.8±10.6 vs. 5.7±9.9, p=0.011) was signi-ficantly different in the iLVM group vs. the aLVM group. SBP: sys-tolic blood pressure, BMI: body mass index, aLVM: appropriate left ventricular mass, iLVM: inappropriately high left ventricular mass.

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  Fig. 2 Adjusted nocturnal dipping by age, BMI and 24 hours systolic BP in hypertensive aLVM (n=256) vs. iLVM (n=53) patients. In the hypertensive patients, nocturnal dipping (10.7±11.0 vs. 5.7±10.0, p=0.024) was significantly different in iLVM vs. aLVM groups. SBP: sys-tolic blood pressure, BMI: body mass index, aLVM: appropriate left ventricular mass, iLVM: inappropriately high left ventricular mass.

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