GENDER, DAY-NIGHT BLOOD-PRESSURE CHANGES, AND LEFT-VENTRICULAR MASS IN ESSENTIAL-HYPERTENSION - DIPPERS AND PEAKERS

The finding of increased left ventricular (LV) mass in hypertensive su bjects with blunted nocturnal fall in blood pressure (BF) might be an artifact of matching patients for daytime BP, with resulting higher 24 -h BP in nondippers. Therefore, we compared a large number (n = 1048) of hypertensive dippers and nondippers in their LV mass at echocardiog raphy before and after adjustment for 24-h, daytime, and nighttime amb ulatory BP. In men, the difference between dippers and nondippers was not significant before and after adjustment for 24-h BP, but after adj ustment for nighttime BP LV mass was greater in dippers (more properly ''peakers''). In women, LV mass was greater in nondippers than in dip pers both before and after adjustment for 24-h BP, while the differenc e between the two groups disappeared after adjustment for nighttime BP . Thus, for any given level of mean 24-h BP, a flattened diurnal BP pr ofile is associated with a greater LV mass in hypertensive women. Dayt ime hypertension, either associated or not with a blunted nocturnal fa ll in BP, may be a sufficient determinant of LV wall thickening in men .