The influence of dipper and nondipper blood pressure patterns on left ventricular functions in hypertensive patients: a tissue Doppler study [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2009; 37(2): 101-106

The influence of dipper and nondipper blood pressure patterns on left ventricular functions in hypertensive patients: a tissue Doppler study

Kürsat Tigen1, Tansu Karaahmet1, Hakan Fotbolcu1, Emre Gürel1, Cihan Cevik2, Çetin Geçmen1, Atilla Bitigen1, Bülent Mutlu1, Yelda Başaran1
1Department of Cardiology, Kartal Koşuyolu Heart and Research Hospital, İstanbul
2Texas Tech University Health Sciences Center, Internal Medicine, Lubbock, TX, USA


OBJECTIVES
We investigated the effect of dipper and non-dipper blood pressure patterns on left ventricular diastolic filling parameters in hypertensive patients.

STUDY DESIGN
Fifty-five hypertensive patients (37 women, 18 men; mean age 55±10 years) were evaluated with echocardiography and ambulatory 24-hour blood pressure monitoring. All the patients received antihypertensive drug therapy for at least three months prior to the evaluations. Tissue Doppler-derived systolic and diastolic parameters were compared.

RESULTS
Dipper and nondipper blood pressure patterns were found in 22 patients (40%) and 33 patients (60%), respectively. Both groups had similar left ventricular systolic and diastolic diameters. Dipper patients had significantly lower values for left atrial diameter (p<0.0001), interventricular septum (p=0.001) and posterior wall (p=0.012) thickness, left ventricular mass (p=0.017) and mass index (p=0.021). Both groups had similar mitral E and A waves, E/A ratio, E-wave deceleration time, isovolumetric relaxation time, and tissue Doppler-derived A’ wave. Dipper patients had a significantly lower E/E’ ratio (10.8±3.4 vs. 14.1±3.6; p=0.002) and significantly higher systolic (S’) (p=0.05) and early diastolic (E’) (p=0.027) tissue velocities. Based on the E/E’ ratios being <15 or ≥15, the frequency of dipper hypertension was significantly higher in patients with E/E’ <15 (48.8% vs. 9.1%; p=0.019). The frequency of dippers was also higher among patients having an E/E’ ratio of <8, compared to those having an E/E’ ratio of ≥8 to <15 (90% vs. 35.3%; p=0.019).

CONCLUSION
Nondipper blood pressure pattern may be associated with increased left ventricular mass, impaired left ventricular systolic and diastolic dysfunction, and higher left ventricular filling pressures.

Keywords: Blood pressure monitoring, ambulatory, circadian rhythm; echocardiography, Doppler; hypertension; ventricular dysfunction, left.

How to cite this article
Kürsat Tigen, Tansu Karaahmet, Hakan Fotbolcu, Emre Gürel, Cihan Cevik, Çetin Geçmen, Atilla Bitigen, Bülent Mutlu, Yelda Başaran. The influence of dipper and nondipper blood pressure patterns on left ventricular functions in hypertensive patients: a tissue Doppler study. Turk Kardiyol Dern Ars. 2009; 37(2): 101-106

Corresponding Author: Cihan Cevik, United States
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