To dip or not to dip? The unique relationship between different blood pressure patterns and cardiac function and structure.

Dipping and nondipping blood pressure (BP) patterns are associated with different levels of target organ damage and cardiovascular risk. The aim of our investigation was to determine the relationship between different BP patterns (dipping, nondipping, extreme dipping and reverse dipping type) and cardiac structure, and function in hypertensive patients. This cross-sectional study included 376 hypertensive patients. All subjects underwent 24-h ambulatory BP monitoring, and complete two-dimensional, pulsed and tissue Doppler echocardiography. Most of the parameters of the left ventricular (LV) diastolic function (E/A, e'/a', E/e') significantly and progressively deteriorated from the extreme dippers to the dippers and nondippers, and finally to the reverse dippers. In contrast, LV structural parameters (IVS, RWT, LV mass index) showed a statistically important difference only by comparing the dippers and the extreme dippers with the rest of the patients. Simultaneously, the right ventricular (RV) structural parameter (RVT, right ventricular thickness), and most RV diastolic parameters significantly and progressively worsened from the extreme dippers, over the dippers and the nondippers, to the reverse dippers. Daytime and night time systolic BP, nocturnal systolic BP fall, and the nondipping and the reverse dipping status were independently associated with LV and RV structure, as well as with diastolic function. LV and RV structure, and diastolic function were significantly more impaired with the nondippers and the reverse dippers compared with others.