Extreme-Dipper Profile, Increased Aortic Stiffness, and Impaired Subendocardial Viability in Hypertension.
BACKGROUND
In treated hypertensives, extreme-dippers with stable coronary artery disease (CAD) exhibit more severe nighttime cardiac ischemia than dippers. After excluding confounding factors such as diabetes, CAD or chronic kidney disease (CKD), we assessed whether subendocardial viability, determined by the Buckberg index, was more significantly impaired in extreme-dippers than in dippers.


METHODS
Two hundred thirteen consecutive treated hypertensives (156 dippers, 57 extreme-dippers), were included. After 24-hour ambulatory blood pressure (BP) monitoring, patients underwent radial applanation tonometry (with determination of: subendocardial viability ratio [SEVR], central augmentation index [AIx], and pulse pressure amplification [PPamp]), carotid-femoral pulse wave velocity (cfPWV) measurement, and cycle ergometer stress testing.


RESULTS
Extreme-dippers showed higher cfPWV (8.99 ± 2.16 vs. 8.29 ± 1.69 m/s, P = 0.014), higher AIx (29.7 ± 9.4 vs. 26.4 ± 10.4%, P = 0.042), lower PPamp (1.22 ± 0.14 vs. 1.30 ± 0.15, P < 0.001), lower SEVR (146 ± 23% vs. 157 ± 26%, P = 0.007), and lower nighttime diastolic BP (DBP) (70 ± 9 vs. 75 ± 9 mm Hg, P < 0.001) than dippers. SEVR and cfPWV were inversely correlated. Among extreme-dippers, women exhibited lower SEVR (138 ± 21% vs. 161 ± 23%, P = 0.004), PPamp (1.16 ± 0.10 vs. 1.31 ± 0.15, P < 0.001), and nighttime DBP (67 ± 8 mm Hg vs. 72 ± 8 mm Hg, P = 0.017) than men.


CONCLUSIONS
Extreme-dipper treated hypertensives with no history of CAD, diabetes or CKD, present increased aortic stiffness and low PPamp. Furthermore, this is the first demonstration of the greater likelihood of these patients to exhibit impaired subendocardial viability compared to dippers. Extreme-dipper hypertensive patients, women in particular, may have a significantly higher risk of silent myocardial ischemia, thus justifying systematic screening.
AP-HP, Hôpital Lariboisière, Physiologie Clinique-Explorations Fonctionnelles, Paris, France.
Guy
G
Amah
AP-HP, Hôpital Lariboisière, Physiologie Clinique-Explorations Fonctionnelles, Paris, France.
Rahma
R
Ouardani
AP-HP, Hôpital Lariboisière, Physiologie Clinique-Explorations Fonctionnelles, Paris, France.|CART, UMR965, Univ Paris Diderot, Sorbonne Paris Cité, INSERM, Hôpital Lariboisière, Paris, France.
Adrien
A
Pasteur-Rousseau
AP-HP, Hôpital Lariboisière, Physiologie Clinique-Explorations Fonctionnelles, Paris, France.|CART, UMR965, Univ Paris Diderot, Sorbonne Paris Cité, INSERM, Hôpital Lariboisière, Paris, France.
Sebastian
S
Voicu
APHP, Hôpital Hôtel-Dieu, Centre de Diagnostic, Paris, France.
Michel E
ME
Safar
AP-HP, Hôpital Lariboisière, Physiologie Clinique-Explorations Fonctionnelles, Paris, France.|CART, UMR965, Univ Paris Diderot, Sorbonne Paris Cité, INSERM, Hôpital Lariboisière, Paris, France.
Nathalie
N
Kubis
AP-HP, Hôpital Lariboisière, Physiologie Clinique-Explorations Fonctionnelles, Paris, France.|CART, UMR965, Univ Paris Diderot, Sorbonne Paris Cité, INSERM, Hôpital Lariboisière, Paris, France.
Philippe
P
Bonnin
D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology / Q000503:physiopathology*; D063177:Pulse Wave Analysis; D059289:Vascular Stiffness / Q000502:physiology*
blood pressure; coronary microcirculation; extreme dippers; hypertension; subendocardial viability.