Abstract
Background: Decreased blood pressure (BP) during the night may serve as a means of recovery
for the cardiovascular system. No such decrease may represent a burden, possibly related
to end organ damage not recognized by casual measurements. The purpose of this study
was to evaluate the relationship of circadian BP to left ventricular hypertrophy (LVH)
in hypertensives as documented by echocardiography and/or 12-lead electrocardiogram
(ECG). Methods: The subjects were 26 hypertensive patients who had been followed-up and treated
at the University Hospital in Basel for 3-18 years and whose ECGs were suitable for
determining the presence or progression of LVH. Ambulatory BP was taken in all patients,
and echocardiographical measures could be obtained in 20 patients. Signs of LVH in
ECG and echocardiography were correlated with circadian BP. Results: Eight of the 26 patients had ECG signs of LVH although their office BP did not differ
from that in the group without ECG evidence of LVH. Ambulatory BP recordings followed
a different pattern in that only patients with ECG signs of LVH showed no reduction
in night-time BP; daytime BPs were similar in both groups. The 10 patients who had
echocardiographic signs of LVH did not show a night-time reduction in BP while those
without did, and a significant one. Conclusions: Lack of night-time BP reduction may be important for the development of, or the
lack of regression of, LVH in hypertensives despite apparently good control during
office measurements.
Keywords
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References
- Determinants of sensitivity and specificity of electrocardiographic criteria for left ventricular hypertrophy.Circulation. 1990; 81: 815-820
- A prognostic comparison of asymptomatic left ventricular hypertrophy and unrecognized myocardial infarction: the Framingham Study.Am. Heart J. 1986; 111: 391-397
- Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings.Circulation. 1987; 75: 565-572
- The heart in hypertension.New Engl. Med. J. 1992; 327: 998-1008
- Is the electrocardiogram still useful for detection of left ventricular hypertrophy.Circulation. 1990; 81 (Editorial Comment): 1144-1146
- Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study.New Engl. J. Med. 1990; 322: 1561-1566
- Nocturnal blood pressure fall on ambulatory monitoring in a large international database.Hypertension. 1997; 29: 30-39
G. Mancia, S. Omboti, G. Parati, Lessons to be learned from 24-hour ambulatory blood pressure monitoring, Kidney Int. (Suppl.) (1996) 63–68.
- Echocardiographic detection of pressure-overload left ventricular hypertrophy: effect of criteria and patient population.J. Clin. Hypertens. 1987; 3: 66-78
- Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension.Circulation. 1990; 81: 528-536
- Ambulatory 24-hour blood pressure monitoring: correlation between blood pressure variability and left ventricular hypertrophy in untreated hypertensive patients.G. Ital. Cardiol. 1998; 28: 38-44
- A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy.Circulation. 1969; 40: 185-195
- The Committee on M-Mode Standardization of the American Society of Echocardiography: results of a survey of echocardiographic measurements.Circulation. 1978; 58: 1072-1083
- Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings.Am. J. Cardiol. 1986; 57: 450-458
- The variability of arterial pressure.Am. Heart J. 1979; 97: 35-37
- Blood pressure during normal daily activities, sleep and exercise.JAMA. 1982; 247: 992-996
- Sleep, circadian rhythms and cardiovascular disease.Cardiovasc. Rev. Rep. 1980; 1: 37-47
- The clinical significance of diurnal blood pressure variations. Dippers and non dippers.Circulation. 1990; 81 (Editorial): 700-702
- Blunted nocturnal fall in blood pressure in hypertensive women.Circulation. 1994; 89: 1912
- Diurnal blood pressure profile in older patients with isolated systolic hypertension.J. Hum. Hypertens. 1995; 9: 917-924
- Day–night blood pressure variation in normotensive, normoalbuminuric type I diabetic subjects: dippers and non-dippers.Diabetes Care. 1994; 17: 824-827
- Clinic and 24 hour ambulatory blood pressure in dialysis patients compared with measures of end organ hypertensive damage.Eur. J. Intern. Med. 1995; 6: 37-41
- CAPD patients exhibit a nocturnal fall in blood pressure: a single-centre study.Neth. J. Med. 1995; 46: 225-231
- Sleep apnea syndrome and hypertension: lack of nocturnal blood pressure reduction.Eur. J. Intern. Med. 1993; 4: 131-136
- Prevalence of hypertension in acromegalic patients: clinical measurement versus 24-hour ambulatory blood pressure monitoring.Clin. Endocrinol. 1998; 48: 149-152
- Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly hypertensive patients: advance silent cerebrovascular damage in extreme dippers.Hypertension. 1996; 27: 130-135
- Loss of nocturnal blood pressure fall after liver transplantation during immunosuppressive therapy.Am. J. Hypertens. 1995; 8: 598-605
- Nocturnal decline in blood pressure is attenuated by NaCl loading in salt-sensitive patients with essential hypertension: noninvasive 24-hour ambulatory blood pressure monitoring.Hypertension. 1997; 30: 163-167
- Quantitative assessment of day-to-day spontaneous variability in non-invasive ambulatory blood pressure measurements in essential hypertension.J. Hypertens. 1991; 9 (Suppl. 6): S322-S323
- The prevalence and correlates of echocardiography in left ventricular hypertrophy among employed patients with uncomplicated hypertension.J. Am. Coll. Cardiol. 1986; 7: 639-650
- The spectrum of left ventricular hypertrophy in a general population sample: the Framingham Study.Circulation. 1987; 75 (Suppl. 1): 26-33
- Reversal of left ventricular hypertrophy in hypertensive patients.Am. J. Hypertens. 1992; 5: 95-110
- Blunted nocturnal blood pressure fall and cardiac function in hypertension.J. Cardiovasc. Diagn. Proc. 1997; 14: 223-228
Is the absence of a normal nocturnal fall in blood pressure (nondipping) associated with cardiovascular target organ damage? J. Hypertens. 15 (1997) 969–978.
- Silent cerebrovascular disease in the elderly: correlation with ambulatory blood pressure.Hypertension. 1990; 16: 692-699
- Dippers and non-dippers.Lancet. 1988; 2 (letter to the editor): 397
Article info
Publication history
Accepted:
January 8,
1999
Identification
Copyright
© 1999 Published by Elsevier Inc.
