966-40 The Impact of Ambulatory Blood Pressure on Diastolic Dysfunction in Uncomplicated Hypertension

Although arterial hypertension is the main determinant of diastolic dysfunction, few data exist about the relations between 24-h BP profile and LV filling. We examined Doppler echocardiography and ambulatory BP (ABP) in 101 subjects (60 men, 41 women, age 46.3 ± 9.9 years) free of cardiac drugs. Subjects were excluded for coronary artery and valvular disease, heart failure and diabetes. Based on clinic BP levels 18 subjects were considered normotensive and 83 to have borderline or established hypertension. The subjects were divided into 2 group according to the level of Doppler-derived ratio of peak early to atrial velocity (E/A): 50 with E/A g 1 (normal diastole) (ND) and 51 with E/A l 1 (impaired diastole) (ID). The 2 groups were comparable for gender, body mass index, clinical BP and heart rate (HR) while age was higher in ID (p l 0.0001). No significant difference was found in LV mass/height (LVM/HT) between the 2 groups. ID had comparable awake BP but higher nocturnal (either systolic or diastolic) BP and lower day-night BP drop (all p l 0.01) in comparison with ND. Potential determinants of E/A were analysed by a multivariate model, including age, HR, LVM/HT, awake and nocturnal BP. Age (beta coefficient = -0.49, p l 0.0001), nocturnal diastolic BP (beta = -0.39, p l 0.0001) and HR (beta = -0.17, P = 0.02) were independent predictors of E/A ratio in the pooled population (multiple R = 0.66, P l 0.0001). In conclusion, high nocturnal BP is a powerful marker of LV filling impairment and ABP monitoring provides prognostic information about subjects who progress from hypertension to diastolic dysfunction.