Association of Nighttime Systolic Blood Pressure With Left Atrial-Left Ventricular-Arterial Coupling in Hypertension

Qiaobing Sun; Yu Pan; Yixiao Zhao; Yan Liu; Yinong Jiang

doi:10.3389/fcvm.2022.814756

Association of Nighttime Systolic Blood Pressure With Left Atrial-Left Ventricular-Arterial Coupling in Hypertension

Front Cardiovasc Med. 2022 Feb 24:9:814756. doi: 10.3389/fcvm.2022.814756. eCollection 2022.

Authors

Qiaobing Sun¹, Yu Pan¹, Yixiao Zhao², Yan Liu¹, Yinong Jiang¹

Affiliations

¹ Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
² Department of Geriatric Cerebrovasology, Baoji Central Hospital, Baoji, China.

Abstract

Objective: Hypertension (HT) induces left atrial (LA) and left ventricular (LV) dysfunction, and an increase in arterial stiffness. In this study, we investigated the association between LA-LV-arterial coupling and nighttime systolic blood pressure (BP) as well as BP circadian rhythm in essential hypertension.

Methods: We enrolled 290 HT patients. All subjects were evaluated by 2- dimensional speckle tracking echocardiography (2DSTE), ambulatory 24 h BP monitoring (ABPM), and brachial-ankle pulse wave velocity (PWV). According to BP patterns, these patients were divided into two groups, which included dippers (n = 111), patients with a >10% reduction in BP at nighttime; non-dippers (n = 179), patients with a <10% reduction in BP at nighttime. 2D-STE based LA and LV strains were studied and the following parameters were measured, LV global longitudinal strain (GLS), LA reservoir strain (LA_S-S), LA conduit strain (LA_S-E), and LA booster pump strain (LA_S-A). LA stiffness index (LASI) defined as the ratio of E/e' to LA_S-S, and PWV-to-GLS ratio (PWV/GLS) were calculated to reflect LA-LV-arterial coupling. Furthermore, we also explored the correlation between LASI (or PWV/GLS) and ambulatory blood pressure indexes.

Results: Left atrial stiffness index was significantly higher in non-dippers [0.29 (0.21, 0.41)] than in dippers [0.26 (0.21, 0.33)] (P < 0.05). PWV/GLS was significantly higher in non-dippers [-80.9 (-69.3, -101.5)] than in dippers [-74.2 (-60.2, -90.6)] (P < 0.05). LA_S-S, LA_S-E, LA_S-A,and LV GLS were significantly lower in non-dippers than in dippers (P < 0.05). Multivariate linear regression analysis revealed that nighttime systolic BP was independently correlated with LASI and PWV/GLS, even adjusted for multiple clinical risk factors, LVMI, and LVEF.

Conclusions: The dipping pattern of BP was related to the abnormalities of myocardial mechanics and LA-LV-arterial coupling. However, absolute nocturnal systolic BP value maybe more important than BP circadian profile in the progression of abnormal LA-LV-arterial coupling.

Keywords: 2 dimensional speckle tracking echocardiography; circadian blood pressure pattern; left atrial stiffness; left atrial-left ventricular-arterial coupling hypertension; nighttime systolic blood pressure.