CARDIAC REMODELING IN RUGBY AND FOOTBALL LINE PLAYERS IS ASSOCIATED WITH BOTH SUBCLINICAL SYSTOLIC AND DIASTOLIC DYSFUNCTION

BACKGROUND: The purpose of this analysis was to determine the difference in LV diastolic function in the normotensive and controlledhypertensive population depending on their nighttime dipper and non-dipper feature as determined by 24hr ABPM. METHODS: Our cardiology database, CARDIOfile was searched for all patients who underwent a 24hr ABPM and an ECHO within 180 days. A night time dipper was defined as a >10% fall in average nighttime systolic BP when compared to average daytime systolic BP. Normal systolic BP was defined as an average 24hr systolic BP of 130mmHg. Patients were further defined as either normotensive or controlled hypertensive with antihypertensive drugs. Normal diastolic function was defined as an E/e’ 55% and absence of valve disease were included. ANOVA was used to determine differences between the means and Tukey-Kramer inter-comparisons testing was carried out if the P value for ANOVA was <0.05. Chi-squared analysis was used to determine differences between proportions. RESULTS: See Table 1 and bar graph. There were 752 patients who met the entry criteria. Two hundred and nineteen were normotensive. Of these 127 were nighttime dippers and 92 were non-dippers. Five hundred and thirty-three were controlled hypertensives on medication. Of these, 254 were nighttime dippers and 279 were non-dippers. ANOVA showed no significant difference in LVEF or average 24hr SBP, but a highly significant difference in age (P<0.0001) between the 4 groups, Table 1. There was a highly significant difference in the proportion of patients with abnormal diastolic function between the 4 groups, Chi-squared, P<0.0001, figure1. CONCLUSION: Only 24hr ABPM can be used to classify patients with normal systolic BP or controlled hypertension as either nighttime dippers or non-dippers. Overall, there is a gradual increase in the proportion with abnormal diastolic function within the four groups defined. There is a correlation between loss of nocturnal dipping and worsening diastolic function. The lowest incidence of diastolic dysfunction is in the normotensive dippers with the highest incidence of diastolic dysfunction found in the treated and controlled nondippers. Assessment of both diastolic function using ECHO and nighttime BP with 24hr ABPM may be useful in elderly patients with treated and controlled hypertension.