The influence of night-time hypertension on left ventricular mechanics.

OBJECTIVE: The aim of this study was to evaluate left ventricular (LV) mechanics in individuals with daytime, night-time and day-nighttime hypertension.

METHODS: This cross-sectional study included 272 untreated subjects who underwent 24-hour ambulatory blood pressure monitoring and complete two-dimensional echocardiographic examination including strain analysis. According to current guidelines, night-time hypertension was defined as nocturnal systolic blood pressure≥120mmHg and/or diastolic blood pressure≥70mmHg and day-time hypertension as systolic blood pressure≥135mmHg and/or diastolic blood pressure≥85mmHg.

RESULTS: The study sample included 61 normotensive subjects (22%), 77 isolated daytime hypertension (28%), 40 isolated night-time hypertension (15%) and 94day-nighttime hypertension (35%). LV longitudinal and circumferential strain gradually and significantly decreased from normotensive subjects across patients with isolated daytime and night-time hypertension to hypertensive individuals with persistent hypertension. Radial strain was similar between the observed groups. LV twist increased from normotensive subjects across isolated daytime and night-time hypertensive patients to day-nighttime hypertensive individuals. Hypertensive patients with day-nighttime and night-time hypertension are significantly more associated with decreased longitudinal and circumferential strain than hypertensive patients with isolated day-time hypertension and normotension.

CONCLUSION: LV mechanics gradually deteriorated from normotensive controls, across isolated day- and night-time hypertension, to day-nighttime hypertension. Patients with night-time and day-nighttime hypertension are associated with higher risk of LV mechanical dysfunction than normotensives and day-time hypertensives.