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Do reverse dippers have the highest risk of right ventricular remodeling?

Hypertension Research volume 43, pages 213–219 (2020)Cite this article

Abstract

We aimed to evaluate right ventricular (RV) deformation in recently diagnosed untreated hypertensive patients with different 24-h blood pressure (BP) patterns (dipping, nondipping, extreme dipping and reverse dipping). This cross-sectional study involved 190 untreated hypertensive patients who underwent 24-h ambulatory BP monitoring and a detailed two-dimensional echocardiographic examination, including the assessment of layer-specific strain. We found that 24-h and daytime BP values did not differ between the four groups. Nighttime BP significantly and gradually increased from extreme dippers across dippers and nondippers to reverse dippers. RV structure and systolic and diastolic function did not significantly differ among the four groups. However, RV global and RV free wall longitudinal strains were significantly lower in nondippers and reverse dippers than in dippers and extreme dippers. The endocardial and epicardial RV longitudinal strains of the whole RV and free wall RV were the lowest in reverse dippers and highest in extreme dippers. Multivariate logistic regression analysis demonstrated that only reverse dipping patterns were associated with reduced RV global longitudinal strain [OR 2.9 (95% CI: 1.5–8.2)], independent of age, sex, 24-h systolic BP, LV mass index, RV wall thickness and E/e’t. Similarly, the reverse dipping pattern was associated with reduced RV free wall longitudinal strain, independently of the mentioned parameters [OR 3.8 (95% CI: 1.8–8.5)]. In conclusion, in the hypertensive population, the reverse dipping BP pattern had an adverse effect on RV deformation. RV remodeling progressively deteriorated from extreme dippers to reverse dippers, but only the reverse dipping BP pattern was independently associated with the reduction in RV longitudinal strain.

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Authors and Affiliations

  1. Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje”, Heroja Milana Tepica 1, Belgrade, 11000, Serbia

    Marijana Tadic, Aleksandra Sljivic, Biljana Pencic, Vesna Kocijancic & Vera Celic

  2. Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, Berlin, 13353, Germany

    Marijana Tadic

  3. University of Milan-Bicocca and Istituto Auxologico Italiano IRCCS, Clinical Research Unit, Viale della Resistenza 23, Meda, 20036, Italy

    Cesare Cuspidi

  4. Clinica Medica, Department of Medicine and Surgery, University Milano-Bicocca, Milano, Italy

    Giuseppe Mancia, Michele Bombelli & Guido Grassi

  5. Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy

    Maurizio Galderisi

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  1. Marijana Tadic
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  2. Cesare Cuspidi
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  3. Aleksandra Sljivic
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  4. Biljana Pencic
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  5. Giuseppe Mancia
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  6. Michele Bombelli
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  7. Guido Grassi
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  9. Vesna Kocijancic
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  10. Vera Celic
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Correspondence to Marijana Tadic.

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Tadic, M., Cuspidi, C., Sljivic, A. et al. Do reverse dippers have the highest risk of right ventricular remodeling?. Hypertens Res 43, 213–219 (2020). https://doi.org/10.1038/s41440-019-0351-2

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