Abstract 11737: Nocturnal Non-Dipper Blood Pressure Pattern Affects Left Ventricular Remodeling and Late Gadolinium Enhancement in Patients with Hypertension and Left Ventricular Hypertrophy Evaluated by Cardiac Magnetic Resonance
Introduction: Left ventricular hypertrophy (LVH) is an independent predictor of cardiac mortality, regardless of its etiology. Previous studies have shown that high nocturnal blood pressure (BP) affects LV geometry in hypertensive patients. It was suggested that continuous pressure overload affected the development of LVH, but it is unknown whether persistent pressure influences myocardial fibrosis and whether etiology of LVH is associated with myocardial fibrosis. Comprehensive cardiac magnetic resonance (CMR) including late gadolinium enhancement (LGE) technique can evaluate both severity of changes in LV geometry and myocardial fibrosis.
Hypothesis: We tested the hypothesis that nocturnal non-dipper BP pattern causes LV remodeling and fibrosis in patients with hypertension and LVH.
Methods: Seventeen hypertensive patients with LVH evaluated by echocardiography (9 men, age 74 ± 7 years) were examined by comprehensive CMR and 24-h ambulatory blood pressure measurement (ABPM). Hypertensive patients were defined either by taking antihypertensive agents or with systolic BP > 140 mmHg in the clinic. Nocturnal dipper BP pattern was defined as mean nocturnal BP decline > 10% compared with mean daytime BP.
Results: Etiologies of LVH were determined with 3 different form of LGE (arterial hypertension: n = 9, hypertrophic cardiomyopathy: n = 6, aortic stenosis: n = 2). Among 17 patients, eleven had nocturnal non-dipper BP patterns. Patients with nocturnal non-dipper BP pattern had larger LV mass and scar volume independent of etiologies, compared with the patients with dipper BP pattern (90.7 ± 34.3 g/m2 vs. 58.8 ± 16.2 g/m2, p = 0.01; and 54.3 ± 7.2 cm2 vs. 0.87 ± 1.2 cm2, p = 0.01, respectively). There was no significant difference in mean 24-h systolic BP between the patients with and without nocturnal dipper BP patterns (135 ± 9 mm Hg vs. 128 ± 14 mm Hg, p = 0.108).
Conclusions: Among hypertensive patients with LVH, nocturnal non-dipper blood pressure pattern is associated with both LV remodeling and myocardial degeneration independent of LVH etiology.
- © 2011 by American Heart Association, Inc.