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The influence of ambulatory blood pressure profile on left ventricular geometry
AJH–May 2003–VOL. 16, NO. 5, PART 2
ORALS: Blood Pressure Monitoring: Diagnostic and Prognostic Implications
OR-68 THE ESTROGEN-INDUCED ALTERATIONS IN LARGE ARTERY STIFFNESS ARE NOT ATTENUATED BY THE NON-DIPPING STATUS IN UNTREATED HYPERTENSIVE POSTMENOPAUSAL WOMEN K. Tzioumis, C. Tsioufis, E. Vezali, L. Naoumidou, A. Hatziyianni, K. Dimitriadis, I. Kallikazaros, C. Stefanadis, P. Toutouzas. Department of Cardiology, University of Athens, Hippokration Hospital, Athens, Greece. Large artery stiffness is an emerging risk marker for cardiovascular events in hypertensive subjects and deteriorates after menopause. This study was undertaken in order to assess the possible modification of the potential beneficial effects of hormonal replacement therapy (HRT) on arterial compliance in postmenopausal hypertensive women who exhibit an absence of normal circadian blood pressure (BP) variability. For this purpose, we evaluated, non-invasively, segmental aortic compliance on the basis of pulse wave velocity (PWV) measurements in 62 postmenopausal women (age 53.5 years, 3.4 years after menopause) with untreated, essential hypertension at baseline and after 12 weeks treatment with conjugated estrogen. All women underwent 24h ambulatory BP monitoring and were classified to non-dippers (defined by a reduction in the night mean systolic and diastolic BP ⬍10% from day values) and dippers (the remaining subjects). For the pooled population, office BP was 146/93mmHg, BMI was 28.7Kgr/m2, LVMI was 115 g/m2 and aortic PWV was 237cm/sec. Non dippers (20 subjects) compared to dippers (42 subjects) had significantly greater 24h-systolic BP (132 vs130 mmHg), 24h-diastolic BP (82 vs 80 mmHg) and significantly less systolic and diastolic (daytime-nighttime) fall (5.5 vs 21 and 7 vs 19 mmHg, respectively), p⬍0.05 for all the above comparisons. In contrast, dippers and non-dippers at baseline did not differ regarding age (54 vs 53 years), BMI (28.4 vs 28.9), LVMI (114 vs 116 gr/m2) and PWV (239 vs 235 cm/sec), p⫽NS for all cases. After 12 weeks of treatment, conjugated estrogen induced a significant reduction in aortic PWV in both groups of dippers and non-dippers while office BP and heart rate did not change significantly. Furthermore, the degree of reduction in PWV did not differ in dippers (by 27 cm/sec) and non-dippers (by 25 cm/sec) (p⫽NS). In conclusion, the beneficial results of HRT therapy on large artery rigidity are present in both dippers and non-dippers. These findings suggest clearly that abnormal circadian BP variability does not attenuate the estrogen-induced favorable modification of large artery elasticity in hypertensive postmenopausal women. Key Words: postmenopausal hypertensive women
31A
OR-69 THE INFLUENCE OF AMBULATORY BLOOD PRESSURE PROFILE ON LEFT VENTRICULAR GEOMETRY Bahattin Balci, Ozcan Yilmaz, Osman Yesildag. Cardiology, Ondokuz Mayis University, Samsun, Turkey. Background: Besides causing a hypertrophy in the left ventricle, hypertension results in a change in the geometry of the left ventricle. The blood pressure not decreasing enough during the night, leads to structural changes in the left ventricle. In this study, the influence of 24 h blood pressure profile on the left ventricular geometry was examined. Methods: Ambulatory blood pressure monitoring was applied to 60 patients with mild to moderate hypertension who had never been treated and standard echocardiographic evaluation was conducted thereafter. The patients were divided into two groups with respect to the ambulatory blood pressure profiles: The patients whose night blood pressure levels decreased by 10% compared to their daytime blood pressure levels (dipper) and those whose levels did not decrease that much (non-dipper). The left ventricle mass index and the relative wall thickness of the patients were calculated. With respect to the left ventricle geometry, mass index and relative wall thickness of the patients were determined as: having normal geometry, concentric remodelling, eccentric hypertrophy and concentric hypertrophy. Results: Age, gender, systolic and diastolic blood pressure were similar within the dipper and non-dipper groups. Normal geometry, concentric remodelling and concentric hypertrophy ratios were similar in both groups. Eccentric hypertrophy was higher in the non-dipper group compared to the dipper group (Table 1). Conclusion: Patients with mild to moderate hypertension, whose blood pressure does not decrease enough, develop eccentric hypertrophy. Key Words: left ventricular geometry, dipper, nondipper The Distribution of the LV Geometric Patterns in the Dipper and Nondipper Groups
Normal geometry, % Concentric remodeling, % Eccentric hypertrophy, % Concentric hypertrophy, %
Dipper (nⴝ28)
Nondipper (nⴝ32)
25.0 25.0 6.3 43.8
14.3 21.4 42.9 21.4
P 0.3 0.5 ⬍0.03 0.1
ORALS: Blood Pressure Monitoring: Diagnostic and Prognostic Implications
OR-68 THE ESTROGEN-INDUCED ALTERATIONS IN LARGE ARTERY STIFFNESS ARE NOT ATTENUATED BY THE NON-DIPPING STATUS IN UNTREATED HYPERTENSIVE POSTMENOPAUSAL WOMEN K. Tzioumis, C. Tsioufis, E. Vezali, L. Naoumidou, A. Hatziyianni, K. Dimitriadis, I. Kallikazaros, C. Stefanadis, P. Toutouzas. Department of Cardiology, University of Athens, Hippokration Hospital, Athens, Greece. Large artery stiffness is an emerging risk marker for cardiovascular events in hypertensive subjects and deteriorates after menopause. This study was undertaken in order to assess the possible modification of the potential beneficial effects of hormonal replacement therapy (HRT) on arterial compliance in postmenopausal hypertensive women who exhibit an absence of normal circadian blood pressure (BP) variability. For this purpose, we evaluated, non-invasively, segmental aortic compliance on the basis of pulse wave velocity (PWV) measurements in 62 postmenopausal women (age 53.5 years, 3.4 years after menopause) with untreated, essential hypertension at baseline and after 12 weeks treatment with conjugated estrogen. All women underwent 24h ambulatory BP monitoring and were classified to non-dippers (defined by a reduction in the night mean systolic and diastolic BP ⬍10% from day values) and dippers (the remaining subjects). For the pooled population, office BP was 146/93mmHg, BMI was 28.7Kgr/m2, LVMI was 115 g/m2 and aortic PWV was 237cm/sec. Non dippers (20 subjects) compared to dippers (42 subjects) had significantly greater 24h-systolic BP (132 vs130 mmHg), 24h-diastolic BP (82 vs 80 mmHg) and significantly less systolic and diastolic (daytime-nighttime) fall (5.5 vs 21 and 7 vs 19 mmHg, respectively), p⬍0.05 for all the above comparisons. In contrast, dippers and non-dippers at baseline did not differ regarding age (54 vs 53 years), BMI (28.4 vs 28.9), LVMI (114 vs 116 gr/m2) and PWV (239 vs 235 cm/sec), p⫽NS for all cases. After 12 weeks of treatment, conjugated estrogen induced a significant reduction in aortic PWV in both groups of dippers and non-dippers while office BP and heart rate did not change significantly. Furthermore, the degree of reduction in PWV did not differ in dippers (by 27 cm/sec) and non-dippers (by 25 cm/sec) (p⫽NS). In conclusion, the beneficial results of HRT therapy on large artery rigidity are present in both dippers and non-dippers. These findings suggest clearly that abnormal circadian BP variability does not attenuate the estrogen-induced favorable modification of large artery elasticity in hypertensive postmenopausal women. Key Words: postmenopausal hypertensive women
31A
OR-69 THE INFLUENCE OF AMBULATORY BLOOD PRESSURE PROFILE ON LEFT VENTRICULAR GEOMETRY Bahattin Balci, Ozcan Yilmaz, Osman Yesildag. Cardiology, Ondokuz Mayis University, Samsun, Turkey. Background: Besides causing a hypertrophy in the left ventricle, hypertension results in a change in the geometry of the left ventricle. The blood pressure not decreasing enough during the night, leads to structural changes in the left ventricle. In this study, the influence of 24 h blood pressure profile on the left ventricular geometry was examined. Methods: Ambulatory blood pressure monitoring was applied to 60 patients with mild to moderate hypertension who had never been treated and standard echocardiographic evaluation was conducted thereafter. The patients were divided into two groups with respect to the ambulatory blood pressure profiles: The patients whose night blood pressure levels decreased by 10% compared to their daytime blood pressure levels (dipper) and those whose levels did not decrease that much (non-dipper). The left ventricle mass index and the relative wall thickness of the patients were calculated. With respect to the left ventricle geometry, mass index and relative wall thickness of the patients were determined as: having normal geometry, concentric remodelling, eccentric hypertrophy and concentric hypertrophy. Results: Age, gender, systolic and diastolic blood pressure were similar within the dipper and non-dipper groups. Normal geometry, concentric remodelling and concentric hypertrophy ratios were similar in both groups. Eccentric hypertrophy was higher in the non-dipper group compared to the dipper group (Table 1). Conclusion: Patients with mild to moderate hypertension, whose blood pressure does not decrease enough, develop eccentric hypertrophy. Key Words: left ventricular geometry, dipper, nondipper The Distribution of the LV Geometric Patterns in the Dipper and Nondipper Groups
Normal geometry, % Concentric remodeling, % Eccentric hypertrophy, % Concentric hypertrophy, %
Dipper (nⴝ28)
Nondipper (nⴝ32)
25.0 25.0 6.3 43.8
14.3 21.4 42.9 21.4
P 0.3 0.5 ⬍0.03 0.1