The Dipper-shape Relationship Between Left Ventricular Hypertrophy And24-hour Systolic Blood Pressure Variability In Patients With Hypertension

Objective To study the relationship between left ventricular hypertrophy (LVH) andblood pressure variability (BPV) and circadian rhythm in patients with hypertension.Methods A total of603hypertensive patients were enrolled from the First AffiliatedHospital of Fujian Medical University from January2008to June2012. According toblood pressure circadian rhythm, all study patients were divided into the dippergroup (n=130), the non-dipper group (n=313) and the reverse-dipper group (n=160).BPV was classified into8subgroups (octiles) based on the standard deviation of24-hour systolic blood pressure (SBP), and left ventricular mass index (LVMI) andthe incidence rate of LVH were compared across subgroups. Pearson correlation andmultiple linear regression analyses were used to test the relationship between BPVand LVMI.Results The standard deviation of24-hour SBP in mm Hg was reduced in the non-dipper(13.1±2.8) and reverse-dipper (14.1±3.6) groups compared with that in the dippergroup (16.1±3.2). Contrastingly, there was higher LVMI in kg/m2(96.9±22.6and103.8±28.6versus91.2±21.4) and incidence rate of LVH (18.8%and33.8%versus8.5%) in the non-dipper and reverse-dipper groups than in the dipper group,respectively. Across the octiles of BPV, LVMI and the incidence rate of LVH wereboth lowest in the second subgroup. With the increase in standard deviation of24-hour SBP, the levels of24-hour SBP, diurnal SBP and nocturnal SBP exhibited anescalating trend, where there was no observable change for diastolic blood pressure.Correlation analysis showed that LVMI was positively associated with the standarddeviations of24-hour SBP, diurnal SBP and nocturnal SBP, as well as weighted meanvalue of diurnal and nocturnal standard deviation, whereas LVMI was negativelyassociated with nocturnal blood pressure decline. In multivariable stepwiseregression analysis, nocturnal SBP, blood creatinine and the course of hypertensionwere found to be independent and significant risk factors for LVMI.Conclusion The incidence rate of LVH is lowest in the dipper group relative to the non-dipper and the reverse-dipper groups, but higher in hypertensive patients withthe disappearance of nocturnal blood pressure decline. Moreover, there is adipper-shape relationship between24-hour systolic blood pressure variability andLVH.Smaller BPV can also lead to higher risk of LVH.