Interdependence of Left and Right Ventricular Remodeling in Hypertensive Patients With Different Circadian Blood Pressure Pattern

Objective: We hypothesized that patients with arterial hypertension (AH) have more pronounced right ventricular (RV) hypertrophy, systolic-diastolic dysfunction and significantly changed geometry of the right heart compared to normotensive individuals and there is interdependence between left and right ventricular remodeling in hypertensive patients with different circadian blood pressure (BP) patterns. Design and method: A total of 75 untreated male hypertensive patients (mean age 57.13± 7.27 years) and 25 voluntary healthy male individuals (mean age 57.56±7.55 years) were included in the study. All the patients underwent to 24-hour Ambulatory BP measurement (ABPM) and heart ultrasonography. Results: Non-dipper hypertensive patients (n=48) in comparison with dippers (n=27) had significantly higher posterior wall, interventricular septal and relative wall thickness (1.344±0.160 vs 1.313±0.182, P<0.001, 1.391±0.127 vs 1.224±0.139, P<0.00001, 0.543±0.080 vs 0.497±0.079, P<0.001, respectively), left atrial diameter (4.479±0.685 vs 3.622±0.571, P<0.0001), left ventricular mass and mass index (287.347±53.487 vs 236.129±38.504; P<0.00001 and 138.711±27.562 vs 114.783±18.762, P<0.00001, respectively). Hypertensive non-dippers also had lower E/A (0.759±0.140 vs 0.936±0.123; P<0.00001). In normotensive individuals these discrepancies were not found. Non-dipper hypertensives had significantly lower RV mid-cavity diameter and TAPSE (26.158±2.563 vs 28.318±2.519, P<0.001 and 17.708±2.857 vs 19±1.586; P<0.05) and higher RV fractional area change (RVFAC%) and right atrial diameter (35.95±5.86 vs 38.57±3.28, P<0.05, 38.57±3.28 vs 3.206±0.327; P<0.05, respectively). Hypertensive non-dippers had significantly higher E/E’ (7.25±1.09 vs 5.81±0.87; P< 0.00001). Normotensive dipper subjects in comparison with non-dippers had higher RVFAC% (47.12±2.91 vs 41.27±4.75; P<0.05). RVFAC(%) and TAPSE were in negative correlation with left ventricular mass, relative wall thickness, interventricular septum and posterior wall thickness (P:<0.05), as well as right atrial diameter, which was in positive correlation with left atrial diameter in non-dipper hypertensives. RV diameter was negatively correlated with septal, posterior and free wall thickness. In dipper hypertensives and normotensive patients irrespective of circadian BP pattern, correlations were very scarce. Conclusions: Our study showed, that hypertensive patients with non-dipper circadian BP pattern have significant morpho-functional changes of both ventricles. Therefore, Pearson correlation analyses showed strong interdependence between left and right ventricular morpho-functional parameters especially in non-dipper hypertensives.