A dipper-shaped relationship was found between left ventricular hypertrophy and 24-hour systolic blood pressure variability in patients with hypertension

Objective To investigate the relationship between left ventricular hypertrophy(LVH)and blood pressure variability(BPV)and circadian rhythm in patients with hypertension. Methods A total of 603 hypertensive patients were enrolled from the First Affiliated Hospital of Fujian Medical University from January 2008 to June2012. According to blood pressure circadian rhythm,patients were divided into the dipper group(n=130),the non-dipper group(n=313)and the reverse-dipper group(n=160). BPV was classified into 8subgroups(octiles)based on the standard deviation of 24-hour systolic blood pressure(SBP). The left ventricular mass index(LVMI)and the incidence of LVH were compared among the subgroups. Pearson correlation and multiple linear regression analysis were performed to test the relationship between BPV and LVMI. Results The standard deviation of 24-hour SBP was reduced in the non-dipper[(13.1±2.8)mm Hg]and reverse-dipper[(14.1±3.6)mm Hg]groups compared with that in the dipper group [(16.1±3.2)mm Hg]. Contrastingly,LVMI[(96.9±22.6),(103.8±28.6)vs(91.2±21.4)g/m2]and the incidence of LVH(18.8%,33.8% vs 8.5%)in the non-dipper and reversedipper groups were increased than those in the dipper group. Across the octiles of BPV,LVMI and the incidence rate of LVH were both the lowest in the second subgroup. With the increase in standard deviation of 24-hour SBP,the levels of 24-hour SBP,diurnal SBP exhibited an escalating trend,while the diastolic blood pressure had no significant difference. LVMI was positively associated with the standard deviations of 24-hour SBP,diurnal SBP and nocturnal SBP,as well as weighted mean value of diurnal and nocturnal standard deviation,whereas LVMI was negatively associated with nocturnal SBP decline by correlation analysis. Multivariable stepwise regression analysis indicated nocturnal SBP,blood creatinine and the course of hypertension were the independent and significant risk factors for LVMI. Conclusion The frequency of LVH is the lowest in the dipper group. The BPV is reduced in nondipper group,while the incidence of LVH is increased in non-dipper group. There is a dipper-shape relationship between 24-hour systolic blood pressure variability and LVH. Smaller BPV can lead to the higher risk of LVH.