New European, American and International guidelines for hypertension management: agreement and disagreement

Atherosclerosis in SLE: a potential role for serum parathormone levels

Objective

A link between bone metabolism and cardiovascular (CV) disease has been suggested mainly in the general population. In the current study we explored whether altered bone metabolism influence CV risk in patients with SLE.

Methods

In 138 consecutive patients with SLE, atherosclerosis was assessed by the presence of plaque and/or arterial wall thickening in carotid/femoral arteries by ultrasound. Bone mineral density (BMD) levels and hip/spinal cord fractures together with classical CV disease and osteoporosis risk factors including serum 25(OH) vitamin D₃ and parathormone (PTH) levels were recorded in all patients. Serum osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-Β ligand were quantitated by commercial ELISA. Statistical analysis included both univariate and multivariate models.

Results

Abnormal PTH serum concentrations (>65 pg/mL)—but not 25(OH) vitamin D₃ serum levels—were identified as a risk factor for both plaque formation and arterial wall thickening in patients with SLE (ORs (95% CIs): 8.2 (1.8 to 37.4) and 3.9 (1.3 to 11.8), respectively). This association remained significant following adjustment for vitamin D₃ levels and classical CV risk factors. Moreover, an independent association between osteoporosis with plaque formation and arterial wall thickening was detected following adjustment for total steroid dose, premature menopause and disease duration (ORs (95% CIs): 5.3 (1.1 to 26.2) and 3.5 (1.1 to 11.4), respectively). An inverse correlation between femoral neck BMD values and intima–medial thickness scores was also observed (r: −0.42, p=0.008).

Conclusions

These findings further strengthen the concept of shared pathophysiological mechanisms between atherogenesis and altered bone metabolism in autoimmune populations, revealing heightened PTH levels as a potential marker for atherosclerosis among patients with SLE.

Acute psychological stress, autonomic function, and arterial stiffness among women

This study aimed to investigate the effect of acute psychological stress on autonomic function and arterial stiffness, and to test a mediating role of changes in autonomic function between acute stress and arterial stiffness. Eighty-five healthy female adults were randomized into either an experimental or control group. The Trier Social Stress Test (TSST) was used to induce acute psychological stress. Autonomic function (measured by pre-ejection period [PEP] from cardiac impedance and high frequency [HF] of heart rate variability [HRV]) and arterial stiffness (measured by carotid and femoral pulse wave velocity [cfPWV] and augmentation index [AIx]) were assessed before and after the TSST. The mean age of the participants was 28.78 (±9.84) years old. Experimental group participants had a significant increase in cfPWV (p = .025) and AIx (p = .017) following the stressor, compared with those in the control group, after controlling for age, body mass index, and systolic blood pressure. However, no significant group differences were observed in changes in PEP (p = .181) and HF (p = .058). Changes in PEP and HF were neither associated with changes in cfPWV (p = .975 and p = .654, respectively), nor in AIx (p = .376 and p = .323, respectively). The results suggest that even a brief period of mild to moderate stress, which does not cause sustainable changes in autonomic function, may still exert significant adverse effects on arterial stiffness. The changes in arterial stiffness were not related to changes in autonomic function. Future experimental studies with several measurement points are recommended to identify distinct effects of stress on autonomic function and arterial stiffness.

Morning blood pressure surge is associated independently with orthostatic hypotension in hypertensive patients under treatment

OBJECTIVE

Morning blood pressure surge (MBPS) and orthostatic hypotension (OH) play a role in the occurrence of cardiovascular events. We aimed to investigate the association between MBPS and OH in hypertensive patients under treatment.

PATIENTS AND METHODS

We prospectively included 297 patients (mean age: 53.8±10.7 years, male/female: 101/196) with essential hypertension. Tilt table testing was performed for the diagnosis of OH. OH was classified into three groups as initial OH (0-15 s), classical OH (15 s to 3 min), and delayed OH (3-30 min). Patients were categorized into two main groups: patient with OH or without OH. We used sleep-through MBPS. The MBPS was calculated as the difference between the average blood pressure (BP) during the 2 h after awakening and the lowest night-time BP.

RESULTS

We detected initial OH in two patients, classic OH in seven patients, delayed OH in 20 patients, and delayed OH with syncope in two patients. MBPS, thiazide diuretic, and α-blocker treatments were found to be associated independently with the occurrence of OH. Every 10 mmHg increase in MBPS was found to increase the rate of development of OH by 29.6%. The cut-off value of MBPS obtained by the receiver operator characteristic curve analysis was 35 mmHg for the prediction of OH occurrence (sensitivity: 58.0%, specificity: 68.0%). The area under the curve was 0.657 (95% confidence interval: 0.553-0.771, P=0.004).

CONCLUSION

OH is a major problem in hypertensive patients. Increased MBPS, which can be detected easily by 24-h ambulatory BP monitor, predicts the occurrence of OH independently.

There is a significant relationship between morning blood pressure surge and increased abdominal aortic intima-media thickness in hypertensive patients

PURPOSE

There are limited data about increased aortic intima-media thickness (A-IMT) in the presence of subclinical target organ damage in hypertensive (HT) patients. In this study, we aimed to determine the frequency of increased A-IMT, the parameters determining increased A-IMT, and the relationship between increased A-IMT and other vascular IMT measurements.

MATERIALS AND METHODS

We prospectively included 265 patients (mean age 54.1 ± 10.6 years, male/female 91/174) with essential HT. Physical examination of all patients was performed. Laboratory data and antihypertensive treatments were recorded. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed. Bilateral carotid, brachial, and femoral artery and abdominal A-IMT values were measured by B-mode ultrasonography (USG). Patients were categorized into two main groups: patients with increased A-IMT (≥ 3 mm) or normal A-IMT (< 3 mm).

RESULTS

Increased A-IMT was detected in 55 patients (20.8%). There was a close relationship between increased A-IMT and advanced age, presence of coronary artery disease, high morning blood pressure surge (MBPS), and bilateral carotid and femoral IMT. Parameters associated with increased A-IMT in univariate analysis were assessed by regression analysis. Left femoral IMT and MBPS were independently associated with increased A-IMT. In the regression model, each 5-mmHg elevation in MBPS increased the risk of increased A-IMT by 34.2%. The cutoff value of MBPS obtained by the ROC curve analysis was 32 mmHg for the prediction of increased A-IMT (sensitivity 76.3%, specificity 63.5%). The area under the curve was 0.784 (95% CI 0.720-0.847, p < 0.001).

CONCLUSION

Abdominal A-IMT increased at a significant rate in patients with HT. An independent association was found between MBPS and A-IMT, which can both be easily detected by ABPM and B-mode USG. The high MBPS level was considered to be a simple and inexpensive method for detecting subclinical target organ damage. A-IMT measurement should also be a part of abdominal USG, which is a routine examination in HT patients.

Effect of Disease Improvement with Self-Measurement Compliance (Measurement Frequency Level) in SmartCare Hypertension Management Service

BACKGROUND

This study's purpose was to analyze the effect of the SmartCare pilot project, which was conducted in 2011 in South Korea. Recent studies of telehealth mostly compare the intervention group and the control group. Therefore, it is necessary to analyze the disease improvement effect depending on the self-measurement compliance (measurement frequency level) of patients who are receiving the hypertension management services.

MATERIALS AND METHODS

In the SmartCare center, health managers (nurses, nutritionists, and exercise prescribers) monitored the measurement data transmitted by participants through the SmartCare system. The health managers provided the prevention, consultation, and education services remotely to patients. Of the 231 participants who were enrolled in the study, the final analysis involved 213 individuals who completed their blood pressure measurements and SmartCare services until the end of a 6-month service period. The evaluated measurement group was classified into three groups (Low, Middle, and High) by evenly dividing the monthly average frequency of measurement for 6 months. The evaluation indices were systolic blood pressure (SBP), diastolic blood pressure (DBP), weight, and body mass index (BMI); this information was transmitted through the SmartCare system.

RESULTS

For changes in the evaluation indices after 6 months compared with the initial baseline, in the Low Group, SBP and DBP slightly decreased, and weight and BMI slightly increased (difference not statistically significant). In the Middle Group, SBP and DBP decreased slightly (difference not statistically significant); however, both weight and BMI decreased (difference statistically significant). In the High Group, SBP, DBP, weight, and BMI decreased (difference statistically significant).

CONCLUSIONS

Patients who received the SmartCare services with higher measurement frequency levels at home showed greater effectiveness regarding the provided services compared with those patients with lower levels of BP, weight, and BMI control.

Subclinical atherosclerosis and impaired bone health in patients with primary Sjogren's syndrome: prevalence, clinical and laboratory associations

Introduction

To determine the prevalence and clinical/laboratory associations of subclinical atherosclerosis and impaired bone health in primary Sjogren’s syndrome (SS).

Methods

64 consecutive patients with primary SS, 77 with rheumatoid arthritis (RA) and 60 healthy controls (HC) οf similar age and sex distribution were enrolled. Demographics, clinical/laboratory features, classical risk factors for atherosclerosis and osteoporosis (OP) were recorded. Intima-medial thickness scores (IMT) and carotid/femoral (C/F) plaque formation, as well as bone mineral density (BMD) and fractures were evaluated. Determinants of IMT/BMD levels and the presence of plaque were assessed by univariate and multivariate models. Serum levels of the Wnt signaling mediators Dickkopf-related protein 1(DKK1) and sclerostin were determined in primary SS patients and HC.

Results

Increased arterial wall thickening (IMT > 0.90 mm) and impaired bone health (defined as OP or osteopenia), were detected in approximately two-thirds of primary SS and RA patients, with a mean IMT value being significantly increased compared to HC. The presence of primary SS emerged as an independent risk factor for arterial wall thickening when traditional risk factors for cardiovascular disease (CVD) including age, sex, hypertension, smoking (pack/years), LDL and HDL levels were taken into account in a multivariate model [adjusted OR 95% (CI): 2.8 (1.04-7.54)]. In primary SS, age was revealed as independent predictor of increased IMT scores; age and lymphopenia as well as increased urine pH as independent determinants of C/F plaque formation and OP/osteopenia, respectively. An independent association of OP/osteopenia with plaque formation was observed when independent predictors for both variables were considered, with low DKK1 levels being associated with both plaque formation and lower BMD levels.

Conclusions

Comorbidities such as subclinical atherosclerosis and impaired bone health occur frequently in primary SS, in association with disease related features and traditional risk factors. Wnt signaling mediators are potentially involved in the pathogenesis of both entities.

Electronic supplementary material

The online version of this article (doi:10.1186/s13075-015-0613-6) contains supplementary material, which is available to authorized users.

Clinical determinants of left ventricular ejection fraction deterioration in patients suffered from complete left bundle branch block

Background:

Recently, the deleterious effects of left bundle branch block (LBBB) on left ventricular systolic function have been taken into consideration.

Objectives:

The present study aimed to identify underlying factors that predict left ventricular ejection fraction (LVEF) deterioration in patients suffered from complete LBBB.

Patients and Methods:

In a retrospective case-control study, the data of 220 consecutive patients diagnosed with LBBB on their electrocardiograms were assessed. They were referred to Isfahan Heart Center in Isfahan Province, Iran in 2013. LVEF deterioration was defined as a decrease in LVEF at least 10% between the baseline and follow-up echocardiography study. Thus, achieving the LVEF values ≤ 40% in patients with an initial EF of > 50% was considered LVEF deterioration.

Results:

Among 220 patients, 40% of LBBB patients suffered LVEF deterioration within 3 months of initial assessment. The group with LVEF deterioration had higher male to female ratio, had higher NYHA score, and suffered more from systolic hypertension than another group. Those with coronary artery disease (CAD) had also significantly lower LVEF than non-CAD ones. Adverse associations were revealed between systolic blood pressure and LVEF measurement (r = -0.193, P = 0.006) as well as between NYHA score and LVEF (r = -0.215, P = 0.002). A multivariable logistic regression model showed that among baseline variables, male gender (OR = 3.218, P < 0.001), history of systolic hypertension (OR = 2.012, P = 0.029), higher NYHA score (OR = 1.623, P = 0.005), and the presence of coronary artery disease (OR = 2.475, P = 0.028) could effectively predict LVEF deterioration in patients with LBBB.

Conclusions:

Male gender, history of hypertension, high NYHA score, and the presence of CAD predict LVEF deterioration in patients with LBBB.

Relationship between mean platelet volume and morning blood pressure surge in newly diagnosed hypertensive patients

OBJECTIVE

Morning blood pressure surge (MBPS) is an independent predictor of atherothrombotic cardiovascular events in hypertensive patients. There is evidence from studies supporting the validity of mean platelet volume (MPV) as a marker of vascular risk and predictor of thrombotic complications. The aim of this study is to investigate the relationship between MPV and MBPS in hypertensive patients.

METHODS

Measurements were obtained from 298 patients with newly diagnosed essential hypertension (Mean age: 51.9 ± 11.7 years). The patients were divided into two groups (MPV(low) group; <10.8 fL, MPV(high) group; ≥ 10.8 fL). The MBPS was calculated as mean systolic BP during the 2 hours after awaking minus the mean systolic BP during the 1 hour that included the lowest sleep BP.

RESULTS

MPV was independently associated with MBPS (β=0.554, p<0.001) and hs-CRP level (β=0.286, p<0.001).

CONCLUSION

Finally, higher MPV values related to enhanced MBPS which are associated with atherothrombotic cardiovascular events.

Gamma Glutamyl Transferase Activity is Associated With Both Paraoxonase Activity and Aortic Stiffness in Hypertensive Patients

BACKGROUND

We aimed to investigate relationship between gamma glutamyl transferase (GGT) activity with paraoxonase 1 (PON1) activity and aortic stiffness (AS) parameters such as pulse wave velocity (PWV) and augmentation index (AIx).

METHODS

Measurements were obtained from 324 patients with newly diagnosed essential hypertension (mean age: 55.0 ± 8.2 years). The patients were divided into two groups according to their median GGT values. PWV and AIx were calculated using the single-point method via the Mobil-O-Graph® ARCsolver algorithm.

RESULTS

PWV, Aix, and high-sensitive C-reactive protein (hs-CRP) values were higher and PON1 activity values were lower in GGThigh group compared with GGTlow group (P < 0.05, for all). Multiple linear regression analysis showed that GGT activity was independently associated with PWV (β = 0.496, P < 0.001) and PON1 activity (β = -0.343, P < 0.001) as well as hs-CRP (β = 0.334, P < 0.001).

CONCLUSION

These results may support that increased GGT activity would be associated with both impaired antioxidant system and increased AS in hypertensive patients.

Oxidized-low density lipoprotein in gingival crevicular fluid of patients with chronic periodontitis: a possible link to atherogenesis

OBJECTIVE

To investigate a possible link between periodontitis and atherogenesis by examining the levels of anti-oxidized low density lipoprotien (ox LDL) and low density lipoprotien (LDL) in gingival crevicular fluid (GCF) and serum of healthy subjects and chronic periodontitis patients.

METHODS

Sixty male subjects (35-55 years) were grouped into 30 healthy individuals and 30 subjects with chronic periodontitis. Serum and GCF samples were obtained from each subject and were assessed for anti-ox LDL and LDL levels.

RESULTS

A significant difference (p < 0.001) was found between the anti-ox-LDL levels in GCF of healthy vs chronic periodontitis groups. Also the ratio of GCF anti-ox LDL to GCF LDL was significantly higher (p < 0.001) in chronic periodontitis patients as compared to the healthy group.

CONCLUSIONS

A significant rise in ox LDL level in otherwise systemically healthy chronic periodontitis patients may put these subjects at an increased risk of developing atherosclerosis.

High-sensitivity cardiac troponin T predicts nondipper hypertension in newly diagnosed hypertensive patients

The increased prognostic accuracy of the high-sensitivity cardiac troponin T (hs-cTnT) assay vs the conventional cTnT assay has recently been reported in hypertensive patients. The authors aimed to investigate the significance of serum hs-cTnT marker for prediction of nondipper hypertension (HTN) in hypertensive patients. A total of 317 patients with newly diagnosed HTN were studied. The patients were divided into two groups: 198 dipper hypertensive patients (mean age, 51.7 ± 5.1 years) and 119 nondipper hypertensive patients (mean age, 53.4 ± 7.6 years). Hs-cTnT and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured in all patients. hs-cTnT and NT-proBNP were independent predictors for nondipper HTN (P<.05 for all). The cutoff value of hs-cTnT obtained by the receiver operator curve analysis was 7.55 ng/L for the prediction of nondipper HTN (sensitivity: 79%, specificity: 70%; 95% confidence interval, 0.769-0.860; P<.001). In patients with HTN, higher serum concentration of hs-cTnT even within normal range is an independent predictor of nondipper HTN.

DNA damage and oxidative status in newly diagnosed, untreated, dipper and non-dipper hypertensive patients

DNA damage occurs more often in hypertensive patients than in non-hypertensive individuals. We sought to investigate lymphocyte DNA damage and total antioxidant status (TAS) levels in patients with dipper hypertension (DH) and non-dipper hypertension (NDH). Thirty-three patients with NDH (NDH group), 31 patients with DH (DH group) and 20 healthy volunteers (control group) were included in the study. Measurements from ambulatory blood pressure monitoring were obtained for all subjects. DNA damage was assessed in peripheral lymphocytes by comet assay, and plasma TAS levels were determined using an automated measurement method. The mean DNA damage value of the NDH group was higher than that of both the DH and control groups (P=0.002 and P<0.001, respectively). The mean DNA damage value of the DH group was higher than that of the control group (P<0.001). The mean TAS level of the NDH group was lower than that of both the DH and control groups (P=0.001 and P<0.001, respectively), and the mean TAS level of the DH group was lower than that of the control group (P<0.001). DNA damage was negatively associated with TAS level (r=-0.692, P<0.001) and positively associated with high sensitive c-reactive protein level (r=0.315, P=0.012). DNA damage increased in the NDH group compared with both the DH group and control group. This condition may be related to increased oxidative stress in the NDH group compared with the DH and control groups.

Safety, tolerability and pharmacokinetics of phenoprolamine hydrochloride floating sustained-release tablets in healthy Chinese subjects

The present study was designed to assess the safety, tolerability and pharmacokinetics of phenoprolamine hydrochloride floating sustained tablets (PHFST) in healthy Chinese subjects. 116 volunteers were randomized into single- or multiple-dose groups for oral administration 30-240 mg of PHFST once or 60-120 mg twice daily. Safety and tolerability were appraised by monitoring adverse events and laboratory parameters. Pharmacokinetics was assessed by determining the plasma concentrations of phenoprolamine hydrochloride with a validated HPLC method. In single-dose studies, no severe adverse events were observed in volunteers, and all adverse events were mild; the percentages of treatment-emergent events judged to be possibly related to the drug were 3/6 in the 240 mg dose group, 1/6 in the 180-210 mg dose groups, and none in the 30-150 mg dose groups; system exposure (AUC, C(max)) increased with respect to dose at 30-120 mg, whereas AUC raised disproportionately with dose escalating from 120 to 240 mg; the absorption of phenoprolamine hydrochloride was unaffected by food. In multiple studies, no safety concerns were revealed up to 7 days; steady-state plasma concentration was achieved after approximately 4-5 days of repeated twice-daily dosing. PHFST is safe and well tolerated in healthy Chinese subjects. The mean C(max) of PHFST is proportional to dose, but not the AUC. Oral dosing regimen selected for subsequent Phase II/III clinical trials was 60 mg of PHFST, b.i.d., and dose up to 120 mg, b.i.d. - may be used to achieve better antihypertensive effect.

Combination pharmacotherapy in hypertension

Combination pharmacotherapy with two or more drugs is required in order to reach the currently recommended blood pressure goals in the majority of hypertensive patients, particularly those with a goal of <130/80 mm Hg. Further to the potentiation of the antihypertensive effects, benefits of combination therapy include the potential of fewer adverse affects and of improvement of patients' compliance. Current guidelines recommend that combination pharmacotherapy might also be considered as initial treatment in patients with significant elevation of blood pressure and evidence of complications. Several effective and well-tolerated antihypertensive drug classes available today offer multiple options for combination therapy. The choice of antihypertensive agents should be made on the basis of current recommendations regarding first line drugs and compelling indications. Specific drug combinations might have additional beneficial or detrimental long-term metabolic effects, beyond their effects on blood pressure. However, more outcome data comparing antihypertensive drug combinations are required. The implementation of an intensive up-titration treatment strategy, together with a systematic use of full doses of multiple drug combinations, is expected to achieve optimal blood pressure control in the vast majority of hypertensive patients.

Aortic elastic properties and left ventricular diastolic function in white-coat hypertensive individuals

OBJECTIVES

Although white-coat hypertension may be present in 25% or more of hypertensive individuals, its prognostic significance and predisposition to end organ damage is unknown. To evaluate whether white-coat hypertension is associated with end organ damage, we compared prognostically relevant measures of target-organ damage among 35 individuals with white-coat hypertension and age and sex-matched groups of sustained hypertension and normotensive individuals classified by clinical and 24-h ambulatory blood pressures.

METHODS

We evaluated left ventricular diastolic function and aortic elastic properties of 35 individuals with white-coat hypertension, 50 patients with sustained hypertension, and 35 normotensive healthy volunteers using transthoracic Doppler echocardiography. None of the study participants with sustained hypertension and white-coat hypertension, who were newly diagnosed and never treated, had any systemic disease or coronary risk factor except hypertension.

RESULTS

Age, sex, and body mass indexes were similar among the three groups. Left ventricular diastolic function was more significantly impaired in the sustained hypertension and white-coat hypertension groups than in the control group, but it was not significantly different between the white-coat hypertension and sustained hypertension groups. Aortic distensibility was significantly lower, and aortic stiffness index was significantly higher in the sustained hypertension group than in the white-coat hypertension and control groups. Furthermore, aortic elastic properties were slightly impaired in the white-coat hypertension group compared with those in the control group. We also found a significant correlation between aortic elastic properties and left ventricular diastolic function.

CONCLUSIONS

White-coat hypertension may alter left ventricular diastolic function and aortic elastic properties. These alterations, however, might not be as remarkable as those caused by sustained hypertension. In this respect, individuals with white-coat hypertension are not at such a risk for end organ damage as patients with sustained hypertension.

Role of magnesium in hypertension

Magnesium affects blood pressure by modulating vascular tone and reactivity. It acts as a calcium channel antagonist, it stimulates production of vasodilator prostacyclins and nitric oxide and it alters vascular responses to vasoactive agonists. Magnesium deficiency has been implicated in the pathogenesis of hypertension with epidemiological and experimental studies demonstrating an inverse correlation between blood pressure and serum magnesium levels. Magnesium also influences glucose and insulin homeostasis, and hypomagnesemia is associated with metabolic syndrome. Although most epidemiological and experimental studies support a role for low magnesium in the pathophysiology of hypertension, data from clinical studies have been less convincing. Furthermore, the therapeutic value of magnesium in the management of hypertension is unclear. The present review addresses the role of magnesium in the regulation of vascular function and blood pressure and discusses the implications of magnesium deficiency in experimental and clinical hypertension, in metabolic syndrome and in pre-eclampsia.

Molecular genetics of human hypertension

EH (essential hypertension) is a major public health problem in many countries due to its high prevalence and its association with coronary heart disease, stroke, renal disease, peripheral vascular disease and other disorders. Epidemiological studies have demonstrated that EH is heritable. Owing to the fact that blood pressure is controlled by cardiac output and total peripheral resistance, many molecular pathways are believed to be involved in the disease. In this review, recent genetic studies investigating the molecular basis of EH, including different molecular pathways, will be highlighted.

The influence of circadian blood pressure changes on aortic distensibility and left ventricular diastolic function in hypertensive individuals

BACKGROUND

Failure to decrease blood pressure (BP) normally during nighttime, which is called non-dipper, in hypertensive individuals is associated with higher cardiovascular morbidity and mortality. In addition, non-dipper BP leads to structural changes in the left ventricle; however, the influences of non-dipper BP on aortic elastic properties and left ventricular diastolic function have not been studied yet.

METHODS

In this study, we evaluated aortic elastic properties and left ventricular diastolic function of 22 subjects with non-dipper hypertension, and 15 subjects with dipper hypertension using transthoracic second harmonic standard and tissue Doppler echocardiography (Acuson Sequoia C256). None of the subjects had any systemic disease or coronary risk factor except hypertension.

RESULTS

Age, gender, body mass index, lipids, and standard echocardiographic findings including left ventricular mass index were similar between the groups. Office BP recordings were similar between non-dipper and dipper groups (147.9+/-6.1/93.9+/-4.3 vs. 144.0+/-8.0/93.0+/-3.7). Daytime and 24-h ambulatory BP measurements were similar within the groups, but nighttime BPs were significantly greater in non-dipper group than those were in dipper group. Left ventricular diastolic parameters obtained by both standard and tissue Doppler did not differ between the non-dipper and dipper groups. However, aortic distensibility was found to be slightly lower (4.1+/-2.4 vs. 4.9+/-1.9, p=0.08), and aortic stiffness index (6.3+/-0.5 vs. 6.1+/-0.4, p=0.08) and elastic modulus (6.2+/-2.5 vs. 4.8+/-2.3, p=0.08; groups non-dipper and dipper respectively) higher in non-dipper group than in dipper group. However, these differences were not statistically significant.

CONCLUSION

Left ventricular remodeling and diastolic function were similar in patients with non-dipper and dipper hypertension. However, aortic elastic properties were slightly impaired in non-dipper hypertensives than those were in dipper ones, but these differences did not reach statistically significance.