Non-Dipping Pattern and Subclinical Cardiac Damage in Untreated Hypertension

A Systematic Review and Meta-Analysis of Echocardiographic Studies

Cesare Cuspidi, Carla Sala, Marijana Tadic, Marta Rescaldani, Guido Grassi, Giuseppe Mancia

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

AIM The association of non-dipping (ND) pattern with cardiac damage is debated. We performed a meta-analysis in order to provide comprehensive information on subclinical cardiac alterations in untreated ND hypertensives. DESIGN A computerized search was performed using PubMed, OVID, EMBASE, and Cochrane library databases from 1 January 1990 up to 31 October 2014. Full articles published in English language providing data on subclinical cardiac damage in ND as compared to dipper (D) hypertensives, as assessed by echocardiography, were considered. Results A total of 3,591 untreated adult subjects (1,291 ND and 2,300 D hypertensives) included in 23 studies were considered. Left ventricular (LV) mass index (LVMI) was higher in ND than in D hypertensives (122±3.8g/m2 vs. 111±3.3g/m2, standardized mean difference, SMD: 0.40±0.07, confidence interval (CI): 0.26-0.53, P <0.001); relative wall thickness (RWT) and left atrium (LA) diameter were greater (SMD: 0.14±0.005, CI: 0.05-0.23, P = 0.002; 0.36±0.10, CI: 0.16-0.56, P <0.001, respectively), while mitral E/A ratio was lower in ND than in D counterparts (SMD:-0.23±0.08, CI:-0.39 to-0.08, P = 0.003). After assessing data for publication bias, the difference between groups was still significant, with the exception of E/A ratio. Conclusiins Our meta-analysis supports an association between ND pattern and increased risk of LV structural alterations in untreated essential hypertensives. This observation supports the view that an effective BP control throughout the entire 24-hour cycle may have a key role in preventing or regressing subclinical cardiac damage associated to ND pattern.

Original languageEnglish
Pages (from-to)1392-1402
Number of pages11
JournalAmerican Journal of Hypertension
Volume28
Issue number12
DOIs
Publication statusPublished - Oct 8 2015

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Meta-Analysis
Confidence Intervals
Hypertension
Publication Bias
Heart Atria
PubMed
Libraries
Echocardiography
Language
Databases

Keywords

  • blood pressure
  • essential hypertension
  • hypertension
  • nondipping
  • subclinical cardiac damage

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Non-Dipping Pattern and Subclinical Cardiac Damage in Untreated Hypertension : A Systematic Review and Meta-Analysis of Echocardiographic Studies. / Cuspidi, Cesare; Sala, Carla; Tadic, Marijana; Rescaldani, Marta; Grassi, Guido; Mancia, Giuseppe.

In: American Journal of Hypertension, Vol. 28, No. 12, 08.10.2015, p. 1392-1402.

Research output: Contribution to journalArticle

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