The dominant role of the systolic component of nondipping status on target-organ damage in never-treated hypertensives.
BACKGROUND
Blood pressure (BP) nondipping has been associated with target-organ damage (TOD) and adverse outcomes in hypertension. Diverse definitions of nondipping status appear in the literature, regarding the BP components taken into account. Aim of this study was to compare the effects of isolated nondipping of systolic, diastolic and combined systolic and diastolic BP on various indices of TOD.


METHODS
From 630 consecutive subjects with never-treated essential hypertension stage I-II, we selected 279 subjects who were consistently isolated systolic nondippers (SND, n=76) isolated diastolic nondippers (DND, n=64) and combined systolic and diastolic nondippers (SDND, n=139) in two ambulatory BP monitoring sessions. All three subgroups were subjected to echocardiographic examination, carotid-femoral pulse wave velocity (PWV(c-f)) and albumin-to-creatinine ratio (ACR) determination. Metabolic profile was determined in a morning blood sample.


RESULTS
SND compared to DND and SDND exhibited higher left ventricular mass/height(2.7) (42.4 ± 9.9 vs. 38.0 ± 9.1 vs. 40.9 ± 11.0 g/m(2.7), P < 0.05), higher log(10)(PWV(c-f)) (0.94 ± 0.07 vs. 0.86 ± 0.05 vs. 0.91 ± 0.07 m/s, P < 0.005), and higher log(10)(ACR) (1.2 ± 0.5 vs. 0.9 ± 0.3 vs. 1.1 ± 0.4 mg/g, P < 0.05). Isolated systolic BP nondipping was an independent determinant of all the studied indices of TOD whereas isolated diastolic BP nondipping was not.


CONCLUSIONS
Isolated systolic as compared to diastolic and to combined systolic/diastolic BP nondipping is associated with higher left ventricular mass, stiffer arteries, and pronounced urinary albumin excretion.
First Cardiology Clinic, University of Athens, Hippokration Hospital, Greece.
Dimitris
D
Syrseloudis
Costas
C
Tsioufis
Dimitris
D
Aragiannis
Dimitris
D
Soulis
Elli
E
Stefanadi
Anastasios
A
Spanos
Costas
C
Mihas
Dimitris
D
Tousoulis
Ioannis
I
Kallikazaros
Christodoulos
C
Stefanadis
D000328:Adult; D000419:Albuminuria / Q000209:etiology*; D001011:Aorta / Q000503:physiopathology; D002940:Circadian Rhythm / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D013599:Systole