title: Reduced nocturnal fall in blood pressure, assessed by two ambulatory blood pressure monitorings and cardiac alterations in early phases of untreated essential hypertension.
abstract: To investigate whether in recently diagnosed essential hypertensives a reduced nocturnal fall in blood pressure (BP), established on the basis of two 24-h ambulatory blood pressure monitorings (ABPM) is related to a greater cardiovascular damage. In all, 355 consecutive, recently diagnosed, never-treated essential hypertensives referred for the first time to our outpatient clinic were included in the study. Each patient underwent the following procedures: (1) two 24-h ABPMs performed within 3 weeks, (2) 24-h urinary collection for microalbuminuria, (3) nonmydriatic photography of ocular fundi, (4) echocardiography, (5) carotid ultrasonography. We defined nondipping profile as a night-day systolic and diastolic fall < or =10 % (mean of two ABPMs). A dipper BP profile was found in 238 patients, whereas in 117 patients a nondipper profile was present. The two groups were similar for age, gender, body mass index, smoking habit, clinic BP, 48-h BP and heart rate, while, by definition, night-time systolic and diastolic BP were significantly higher in nondippers than in dippers (130/81 vs 121/74 mmHg, P < 0.0001).The prevalence of left ventricular hypertrophy (LVH) defined by four different criteria: (a) LV mass index (LVMI) > or = 125 g/m(2) in both genders; (b) LVMI > or = 134 gm(2) in men and > or = 110 in women; (c) LVMI> or = 125 g/m(2) in men and > or = 110 g/m(2) in women; (d) LVMI > or = 51 g/m(2.7) in men and > or = 47 g/m(2.7) in women was significantly higher in nondippers than in dippers (a: 12 vs 7%, P < 0.05; b: 16 vs 7%, P < 0.01; c: 20 vs 11%, P < 0.01; d: 35 vs 23% P < 0.02) and this finding was associated with a significant increase in aortic root and left atrium dimensions. There were no differences between the two groups in the prevalence of carotid and retinal changes and microalbuminuria. In conclusion our findings suggest that never-treated hypertensives with a reduced BP fall in the night time, defined on the basis of two ABPMs, have a higher prevalence of TOD than dippers, in terms of echocardiographic LVH. In this population setting, cardiac structural alterations are a more sensitive marker of the impact of the nocturnal BP load on cardiovascular system than other extracardiac signs of TOD.
authors.affiliation: Istituto di Clinica Medica e Terpia Medica and Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Università di Milano, Ospedale Maggiore IRCCS, Milano, Italy. dhipertensione@libero.it
authors.forename: C
authors.initials: C
authors.lastname: Cuspidi
authors.forename: I
authors.initials: I
authors.lastname: Michev
authors.forename: S
authors.initials: S
authors.lastname: Meani
authors.forename: B
authors.initials: B
authors.lastname: Severgnini
authors.forename: V
authors.initials: V
authors.lastname: Fusi
authors.forename: C
authors.initials: C
authors.lastname: Corti
authors.forename: M
authors.initials: M
authors.lastname: Salerno
authors.forename: C
authors.initials: C
authors.lastname: Valerio
authors.forename: F
authors.initials: F
authors.lastname: Magrini
authors.forename: A
authors.initials: A
authors.lastname: Zanchetti
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D001827:Body Height / Q000502:physiology; D001830:Body Surface Area; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000503:physiopathology; D002940:Circadian Rhythm / Q000502:physiology*; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D007558:Italy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012164:Retinal Diseases / Q000503:physiopathology; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D013997:Time Factors; D018084:Ultrasonography, Interventional; D016277:Ventricular Function, Left / Q000502:physiology