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

Marijana Tadic, Cesare Cuspidi, Aleksandra Sljivic, Biljana Pencic, Giuseppe Mancia, Michele Bombelli, Guido Grassi, Maurizio Galderisi, Vesna Kocijancic, Vera Celic

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)213-219
Number of pages7
JournalHypertension Research
Issue number3
Publication statusPublished - Mar 1 2020


  • Blood pressure patterns
  • Hypertension
  • Right ventricle
  • Strain

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Do reverse dippers have the highest risk of right ventricular remodeling?'. Together they form a unique fingerprint.

Cite this