The aim of the study was to examine the association between ambulatory blood pressure monitoring (ABPM) indices and left ventricular (LV) and left atrium (LA) remodelling in patients with hypertension (HT).Design and method:
60 patients (males – 40) with HT aged (59,5 ± 2,8) years were divided into 2 groups after 24 h ABPM. Patients with decrease BP during the night (night-day BP ratio < 0.9) defined as ’dippers’, composed the 1st group (n = 33) and patients without sufficient nocturnal BP drop (nondippers) composed the 2nd group (n = 27). Using M-,2D- and speckle-tracking echocardiography with ultrasound scanner Aplio Artida we studied LV hypertrophy (LVH), values of LV longitudinal global systolic strain (LGSS) and LGSS rate, also left atrium (LA) systolic deformation (SD), early diastolic deformation rate (EDDR) and late diastolic deformation rate (LDDR) as a parameters of accordingly LA reservoir, conduit and contractile function.Results:
In the 2nd as compared to the 1st group pts had more severe LVH: more common concentric (60,0% vs 40,0%) and eccentric (66,7% vs 33,3%) LVH. In the 2nd group we found 17,4 and 13,5 % reduced absolute values of LGSS and LGSS rate accordingly (P < 0.05) as compared to the 1st group. The insufficient decline of nighttime BP was associated with a 21,0 % decrease of LA EDDR and 16,9 % decrease of LA SD (P < 0.05) in the 2nd vs the 1st group, this indicated the impairment in conduit and reservoir LA function in nondipper patients. The inverse correlation was found in the 2nd group between 24 h BP and values of LGSS (r = -0,40, p < 0.01) and LGSS rate (r = -0,31, p < 0.05), also with decreased LA EDDR (r = -0,33, p < 0.05). Decreased values of LA LDDR associated with systolic (r = -0,44, p < 0.01) and diastolic (r = -0,37, p < 0.01) BP variability at nighttime.Conclusions:
In nondipper HT patients it was rotined more expressed decrease in LV global systolic deformation and impairment of LA reservoir, conduit and contractile function compared to the dipper pts. A strong relationship between ABPM indices, insufficient nighttime BP reduction and the structural and functional state of the left heart was found.