Association between blood pressure fluctuation and left ventricular remodeling and the mediation role of chronic low-grade inflammation in older adults: A community-based cross-sectional study

Abstract We aimed to investigate the correlation between blood pressure (BP) fluctuation, including BP variability (BPV) and circadian rhythm, and left ventricular remodeling (LVR), and to explore the potential mediating role of chronic low-grade inflammation in these correlations. Between May 2021 and October 2023, 548 community-dwelling adults aged ≥60 years were assessed: BPV and circadian rhythm were evaluated using 24-hour ambulatory BP monitoring, LVR was assessed by echocardiography, and inflammation was measured via hypersensitive C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-α), and monocyte chemotactic protein-1 (MCP-1). Twenty-four-hour systolic (S)BP standard deviation (SD) and coefficient of variation (CV)were showed to be positively correlated with interventricular septal thickness, left ventricular posterior wall thickness, and left ventricular mass index, while SBP and diastolic (D)BP nocturnal dipping rates (NDR) were negatively correlated with these parameters. Left ventricular hypertrophy (LVH) risk showed positive linear dose-response correlations with 24-hour SBP SD and CV, an L-shaped correlation with SBP NDR, and a negative linear correlation with DBP NDR. After adjustment for confunders including 24-hour average SBP and DBP, compared with dipper rhythm, LVH risk was elevated by 0.874-fold (OR: 1.874, 95% CI: 1.113–3.155) in non-dippers and by 3.965-fold (OR: 4.965, 95% CI: 2.847–8.659) in reverse dippers. HsCRP, TNF-α, and MCP-1 collectively mediated the correlation between LVR and BP fluctuation. In conclusion, excessive BPV and abnormal circadian BP rhythms, especially reverse dipper rhythms, are risk factors for LVR in older adults, and chronic low-grade inflammation plays a crucial mediating role in these correlations. Trial registration: Registered number: ChiCTR1900023580