The evaluation of left ventricular and left atrial functions in patients with nondipper and dipper hypertension via strain and strain rate echocardiographic methods

Hypertension is the worldwide major etiologic factor of the serebrovascular disease, ischemic hearth disease, renal failure and hearth failure. Treatment of this disease causes a %40 decrease for serebrovascular disease and a %15 decrease for myocardial infarction.The new publications show that the ambulatory blood pressure measurement is not just equivalant to medical office measurements but superior to them. According to the classification for ambulatory blood pressure measurement, more than or equal to %10 decrease of night interval blood pressures in comparison to day intervals means dipper hypertesnion (DHT) and less than or equal to %10 of decrease of night interval blood pressures in comparison to day intervals means nondipper hypertesnion (NDHT). An increase in the percent of serebrovascular disease, left ventricle mass, cardiovascular mortality and morbidity is observed in patients with non-dipper hypertension.Strain and strain rate are echocardiographic parameters that is derived from Doppler measurements which shows quantitative functions of miocardial functions. This technique is widely used for the diagnosis of many hearth disease and it is supposed to be widely used for the quantitative analysis of global or segmenter fuctions of the myocardium.The target of this project is to search the subclinical cardiac effect of NDHT and DHT with S and SR echocardiographic techniques. Our Project is carried out in Afyon Kocatepe University between november 2011 and April 2012. Patients that have been taken to the scope of this project have normal physical examination, laboratory paramaters and conventional radiologic diagnostic tests. Patients divided to two groups as NDHT and DHT according to the ambulatory blood pressure measurements. 2D transthracic echocardiography, tissue Doppler and strain methods are applied.This study compared two patient groups with three mehods. No meaningfull difference obsrved among each of the three groups for genus, age, smoking, weight, height, body mass index, hypertension and lipid profile parameters, and among two patient groups for duration of hypertension and medical office blood pressure mesurements. ACEI/ARB and diuretic use was more observed in NDHT group.In 2D echocardiographic method the end-diastolic interventricular septum and posterior wall thickness was observed to be increased in dipper group in comparison to the control group. Mitral E wave was decreased, A wave was increased, E/A rate was decreased in patients group when mitral wave velocities were applied. These values shows that NDHT group has significant negative consequences in comparison to the NDHT group. Tissue doppler examination of the patient group showed an decrease for lateral mitral annular systolic tissue doppler velocity and septal and lateral mitral early diastolic tissue doppler velosity and it was more prominent for NDHT group.Compared to the septal and lateral left ventricle S values were significantly lower in the control group and it was worse in the NDHT group. In the same way as compared to the value of the left Ventricular septal SR, SR values were significantly low in the patient group and it was worse in the NDHT group.The left atrium function in patients group and control group were examined with 2D echocardiography. There was difference between supero-inferior diameters. Significant increase was observed in patient group and it was more siginificant in NDHT group.From the left atrium and SR values more pronounced to the patient group NDHT group with the meaningful difference between the control group had significantly lower patient group.As a result, we found NDHT has siginificant value changes by means of ecgocaridography. S and SR are important parameters which gathers detailed information with conventional methods.