Koroboki Eleni, Manios Efstathios, Michas Fotios, Vettou Charitini, Toumanidis Savvas, Pamboukas Constantinos, Tsouma Iliana, Zakopoulos Nikolaos
Department of Clinical Therapeutics, Hypertensive Center, University of Athens, Athens, Greece.
Blood Press Monit. 2015 Jun;20(3):121-6. doi: 10.1097/MBP.0000000000000103.
Ambulatory blood pressure monitoring provides a unique tool in the evaluation of night-time blood pressure (BP), having a critical role in the detection of a blunted nocturnal fall and of elevated night-time BP. Both nondipping status and nocturnal hypertension are associated with increased cardiovascular risk and target organ damage. The aim of our study was to investigate the impact of both nondipping status and nocturnal hypertension on left ventricular mass (LVM), assessed by means of echocardiography in a consecutive cohort of untreated participants.
A total of 937 individuals were assessed by means of ambulatory blood pressure monitoring and echocardiography. Participants were divided into dippers and nondippers with or without systolic nocturnal hypertension (SNH). SNH was defined as night-time systolic blood pressure of 120 mmHg or more, and nondipping status was defined as an average reduction in systolic blood pressure at night less than 10% compared with the daytime BP.
Dippers and nondippers with SNH presented significantly higher values of left ventricular mass index compared with dippers and nondippers without SNH, respectively. Multiple regression analysis revealed that age (β=0.182, P<0.001), male gender (β=0.168, P<0.001), body mass index (β=0.080, P=0.011), and nocturnal SBP (β=0.174, P=0.037) were significant and independent determinants of LVM. Nondipping status was not found as an independent factor associated with LVM (P=0.136).
Nocturnal hypertension rather than nondipping status seems to be an independent factor associated with left ventricular mass index. The concomitant presence of both nondipping status and nocturnal hypertension is associated with higher LVM, indicating an enhanced cardiovascular risk.
动态血压监测为评估夜间血压提供了一种独特的工具，在检测夜间血压下降减弱和夜间血压升高方面起着关键作用。非勺型血压状态和夜间高血压均与心血管风险增加及靶器官损害相关。我们研究的目的是在未经治疗的连续队列参与者中，通过超声心动图评估非勺型血压状态和夜间高血压对左心室质量（LVM）的影响。
共有937名个体接受了动态血压监测和超声心动图评估。参与者被分为勺型和非勺型，有无夜间收缩期高血压（SNH）。SNH定义为夜间收缩压120 mmHg或更高，非勺型血压状态定义为夜间收缩压较白天平均下降小于10%。
与无SNH的勺型和非勺型相比，有SNH的勺型和非勺型的左心室质量指数值显著更高。多元回归分析显示，年龄（β = 0.182，P < 0.001）、男性（β = 0.168，P < 0.001）、体重指数（β = 0.080，P = 0.011）和夜间收缩压（β = 0.174，P = 0.037）是LVM的显著且独立的决定因素。未发现非勺型血压状态是与LVM相关的独立因素（P = 0.136）。
夜间高血压而非非勺型血压状态似乎是与左心室质量指数相关的独立因素。非勺型血压状态和夜间高血压同时存在与更高的LVM相关，表明心血管风险增加。
