CIRCADIAN BLOOD-PRESSURE CHANGES AND LEFT-VENTRICULAR HYPERTROPHY IN ESSENTIAL-HYPERTENSION

The effects of circadian blood pressure (BP) changes on the echocardiographic parameters of left ventricular (LV) hypertrophy were investigated in 235 consecutive subjects (137 unselected untreated patients with essential hypertension and 98 healthy normotensive subjects) who underwent 24-hour noninvasive ambulatory blood pressure monitoring (ABPM) and cross-sectional and M-mode echocardiography. In the hypertensive group, LV mass index correlated with nighttime (8:00 PM to 6:00 AM) systolic (r = 0.51) and diastolic (r = 0.35) blood pressure more closely than with daytime (6:00 AM to 8:00 PM) systolic (r = 0.38) and diastolic (r = 0.20) BP, or with casual systolic (r = 0.33) and diastolic (r = 0.27) BP. Hypertensive patients were divided into two groups by presence (group 1) and absence (group 2) of a reduction of both systolic and diastolic BP during the night by an average of more than 10% of the daytime pressure. Casual BP, ambulatory daytime systolic and diastolic BP, sex, body surface area, duration of hypertension, prevalence of diabetes, quantity of sleep during monitoring, funduscopic changes, and serum creatinine did not differ between the two groups. LV mass index, after adjustment for the age, the sex, the height, and the daytime BP differences between the two groups (analysis of covariance) was 82.4 g/m2 in the normotensive patient group, 83.5 g/m2 in hypertensive patients of group 1 and 98.3 g/m2 in hypertensive patients of group 2 (normotensive patients vs. group 1, p = NS; group 1 vs. group 2, (p = 0.002). The other echocardiographic parameters of LV anatomy (i.e., interventricular septum and posterior wall thickness, relative wall thickness, cross-sectional area) differed between the groups as did LV mass index. A statistically significant inverse correlation was found between LV mass index and percentage of nocturnal reduction of daytime ambulatory systolic (r = -0.34; p < 0.001) and diastolic (r = -0.30; p < 0.001) BP. These findings suggest that in unselected hypertensive patients, an ambulatory BP decline from day to night is associated with a lower LV muscle mass. In these patients, a nocturnal reduction of systolic and diastolic BP by more than 10% of daytime values could delay or prevent the development of cardiac LV hypertrophy.