Are insulin metabolism and night-time blood pressure related to left ventricular hypertrophy?

Essential hypertensives in whom blood pressure does not fall during sleep (non-dippers) are thought to be at greater risk of cardiovascular morbidity. Insulin resistance is also suggested to be a risk factor for cardiovascular morbidity. The purpose of the present study was to evaluate the relationship of insulin metabolism to left ventricular hypertrophy in dippers and non-dippers. Thirty male, non-diabetic out-patients with newly diagnosed arterial hypertension were included in the study: 21 dippers (mean age 45±13 years; body mass index 28.2±4.0 kg/m2) and nine non-dippers (mean age 48±10 years, body mass index 28.6±3.9 kg/m2). Patients were subdivided into dippers and non-dippers on the basis of 24-h ambulatory blood pressure monitoring. Insulin and glucose responses to an oral glucose load have been evaluated. C-peptide levels were determined. Left ventricular mass was assessed by echocardiography. Non-dippers had significantly higher mean night-time systolic (non-dippers: 148±9; dippers: 123±16 mmHg; P<0.001), diastolic blood pressure (non-dippers: 90±8; dippers: 77±8 mmHg; P<0.001) and non-significantly higher left ventricular mass (279±92 g) and left ventricular mass index (135±46 g/m2). No significant difference was found between C-peptide, insulin, glucose levels and incremental areas between the two groups. Night-time blood pressure, insulin, C-peptide and glucose did not correlate with left ventricular mass in non-dippers. Dippers showed a positive correlation between fasting C-peptide and left ventricular mass (r=0.48, P=0.02) and between glucose and left ventricular mass (r=0.42, P=0.05). Our data indicate that night-time blood pressure and insulin are not related to left ventricular hypertrophy in patients with essential hypertension.