title: The influence of dipper/nondipper blood pressure patterns on global left ventricular systolic function in hypertensive diabetic patients: a speckle tracking study.
abstract: OBJECTIVE
  This study was designed to investigate the effects of dipper and nondipper patterns on global longitudinal systolic functions of left ventricle (LV) by means of two-dimensional speckle tracking echocardiography in treated hypertensive diabetic patients with preserved left ventricular ejection fraction.
  
  
  METHODS
  We enrolled 86 hypertensive diabetic patients. Twenty-four hour ambulatory blood pressure monitoring and echocardiography were performed in each patient. The relationship between dipper/nondipper patterns and global longitudinal strain (GLS) was analyzed.
  
  
  RESULTS
  Fifty-one (59.3%) patients had a nondipper pattern. GLS and average global longitudinal strain rate systolic (GLSRs) were significantly decreased (-17.8±1.5, -19.6±1.9; P<0.001 vs. -1.01±0.171, -1.18±0.19; P<0.001) and E/E' was significantly increased (9.7±4.3, 7.7±3.8; P=0.033) in nondippers compared with dippers. Multivariate linear regression analysis showed that the difference between mean arterial pressure (MAP)-asleep and MAP-awake and left ventricular mass index (LVMI) was associated independently with GLS and GLSRs (MAP-asleep-MAP-awake β=-0.292, P=0.004; β=-0.305, P=0.001 and LVMI β=-0.373, P=0.001, β=-0.517, P<0.001; respectively). E/E' was associated independently with MAP-asleep-MAP-awake (β=0.241, P=0.022), age (β=-0.272, P=0.012), male sex (β=0.351, P=0.001), and LVMI (β=0.236, P=0.038). Also, SBP-asleep and LVMI were found to be associated independently with GLS and GLSRs (SBP-asleep β=-0.405, P<0.001; β=-0.271, P=0.004 and LVMI β=-0.339, P=0.002; β=-0.517, P<0.001; respectively).
  
  
  CONCLUSIONS
  This study shows that the nondipper pattern is associated with subclinical LV systolic dysfunction in treated hypertensive diabetic patients with preserved left ventricular ejection fraction. Also, elevated night-time SBP was found to be related to impaired LV systolic functions.
authors.affiliation: aDepartment of Cardiology, Ahi Evren Chest and Cardiovascular Surgery Education and Research Hospital, Trabzon bDepartment of Cardiology, Kocaeli Derince Education and Research Hospital, Kocaeli cDepartment of Cardiology, Gaziemir Nevvar Salih İşgören State Hospital, İzmir, Turkey.
authors.forename: Ezgi
authors.initials: E
authors.lastname: Kalaycıoğlu
authors.forename: Tayyar
authors.initials: T
authors.lastname: Gökdeniz
authors.forename: Ahmet Çağrı
authors.initials: AÇ
authors.lastname: Aykan
authors.forename: İlker
authors.initials: İ
authors.lastname: Gül
authors.forename: Murat
authors.initials: M
authors.lastname: Uğur
authors.forename: Ozan Mustafa
authors.initials: OM
authors.lastname: Gürsoy
authors.forename: Faruk
authors.initials: F
authors.lastname: Boyacı
authors.forename: Şükrü
authors.initials: Ş
authors.lastname: Çelik
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D009038:Motion; D015588:Observer Variation; D015203:Reproducibility of Results; D016037:Single-Blind Method; D012890:Sleep / Q000502:physiology; D013318:Stroke Volume; D013599:Systole / Q000502:physiology; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*