Article Text

Download PDFPDF

Original research
Assessment of left ventricular function and peripheral vascular arterial stiffness in patients with dipper and non-dipper hypertension
  1. Yan Chen1,2,
  2. Ju-Hua Liu1,3,
  3. Zhe Zhen1,
  4. Yuan Zuo1,
  5. Qingshan Lin4,
  6. Mingya Liu2,
  7. Chunting Zhao2,
  8. Min Wu2,
  9. Gaozhen Cao2,
  10. Run Wang2,
  11. Hung-Fat Tse1,2,5,
  12. Kai-Hang Yiu1,2,5
  1. 1 Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
  2. 2 Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, ShenZhen, China
  3. 3 Department of Geriatric, Affiliated Hospital of North Sichuan Medical College, Hong Kong, China
  4. 4 Division of Radiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Hong Kong, China
  5. 5 Faculty of Medicine, Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Hong Kong, China
  1. Correspondence to Dr Kai-Hang Yiu, Cardiology Division, Department of Medicine, The University of Hong Kong, Kai-Hang, China; khkyiu{at}


A non-dipper pattern of high blood pressure is associated with increased risk of organ damage and cardiovascular disease in patients with hypertension. The aim of the study was to evaluate the left ventricular (LV) remodeling and function and arterial stiffness in a dipper/non-dipper pattern of high blood pressure in patients with hypertension. A total of 183 hypertensive patients with no history of adverse cardiovascular events were divided into two groups based on 24 hours ambulatory blood pressure monitoring (ABPM): 66 patients with a dipper pattern and 117 patients with non-dipper pattern. Detailed transthoracic echocardiogram was performed and analyzed with advance speckle tracking 3-orthogonal direction strain analysis to assess LV systolic function and tissue Doppler-derived E/E′ for LV diastolic function assessment. Cardio ankle vascular index (CAVI) was used to evaluate arterial stiffness. Compared with patients with dipper hypertension, those with non-dipper hypertension had increased LV mass index, higher prevalence of eccentric and concentric LV hypertrophy, more impaired LV diastolic and systolic function and peripheral arterial stiffness. Multivariable analysis revealed that a non-dipper pattern was independently associated with LV systolic dysfunction evaluated by speckle tracking-derived strain analysis. In conclusion, a non-dipper pattern of hypertension is an independent risk factor for LV systolic dysfunction. Treatment that could reverse this non-dipper pattern may reduce cardiac damage in these patients.

  • non-dipper hypertension
  • speckle tracking strain
  • cardiac function
  • arterial stiffness

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • YC and J-HL contributed equally.

  • Contributors All authors listed in the paper have significant contribution to the designs, data collection and analysis of this study.

  • Funding This study was partially supported by the Research & Development Grant Council of Shenzhen, China: Innovation Research Fund (no. JCYJ20140414090541809).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Ethics committee of the University of Hong Kong Shenzhen Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.