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Left ventricular changes in isolated office hypertension: a blood pressure-matched comparison with normotension and
A M Grandi1, R Broggi, S Colombo
1Department of Clinical and Biological Sciences, Faculty of Medicine, University of Insubria, Varese, Italy. amgrandi@libero.it
Insights
Isolated office hypertension is not benign, showing left ventricular changes similar to sustained hypertension. This suggests increased cardiovascular risk, contrary to previous beliefs.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Isolated office hypertension (IOH) is debated regarding its cardiovascular risk.
- Some researchers consider IOH benign, while others link it to cardiovascular abnormalities.
- This study investigates left ventricular (LV) morphofunctional characteristics in IOH.
Purpose of the Study:
- To compare LV morphofunctional characteristics in three groups: IO hypertensives, normotensives, and sustained hypertensives.
- To assess if IOH is associated with subclinical cardiovascular changes.
- To determine if IOH poses a similar cardiovascular risk as sustained hypertension.
Main Methods:
- Recruited 42 IO hypertensives, 42 sustained hypertensives, and 42 normotensives.
- Matched groups by age, sex, BMI, and relevant blood pressure metrics.
- Assessed LV morphology and function using digitized M-mode echocardiography.
Main Results:
- IO hypertensives exhibited thicker LV walls, increased LV mass, reduced diastolic function, and higher prevalence of LV hypertrophy compared to normotensives.
- Sustained hypertensives showed significantly thicker LV walls, higher LV mass, and lower diastolic function than IO hypertensives.
- Prevalence of LV hypertrophy and preclinical diastolic dysfunction was greater in sustained hypertensives than IO hypertensives, though not statistically significant.
Conclusions:
- IO hypertensives display LV morphofunctional characteristics distinct from normotensives.
- These characteristics are qualitatively similar to those observed in sustained hypertensives.
- IO hypertension should not be regarded as a benign condition due to associated LV changes.
Background:
Isolated office (IO) hypertension is a benign condition according to some researchers, whereas others believe it is associated with cardiovascular abnormalities and increased cardiovascular risk. The aim of this study is to compare morphofunctional characteristics of the left ventricle (LV) in IO hypertensive subjects, normotensive subjects (hereafter, hypertensives and normotensives), and never-treated sustained hypertensives. The 3 groups were matched not only by age, sex, and body mass index but also by clinic blood pressure (BP) (IO hypertensives and sustained hypertensives) and daytime BP (IO hypertensives and normotensives).
Methods:
We enrolled 42 IO hypertensives (clinic BP > 140 and/or 90 mm Hg and daytime BP < or = 130/80 mm Hg), 42 sustained hypertensives (clinic BP > 140 and/or 90 mm Hg and daytime BP > or = 140 and/or 90 mm Hg) and 42 normotensives (clinic BP < 135 and/or 85 mm Hg and daytime BP < or = 130/80 mm Hg). Left ventricular morphologic features and function were assessed using digitized M-mode echocardiography.
Results:
Compared with normotensives, IO hypertensives had significantly thicker LV walls, increased LV mass, reduced diastolic function, increased prevalence of LV hypertrophy, and preclinical diastolic dysfunction. Sustained hypertensives, compared with IO hypertensives, had significantly thicker LV wall, higher LV mass, and lower diastolic function, whereas the prevalence of LV hypertrophy and preclinical diastolic dysfunction was greater than in IO hypertensives, but the difference did not reach statistical significance (P = .29).
Conclusions:
Comparing matched BP groups, IO hypertensives have LV morphofunctional characteristics considerably different from normotensives and qualitatively similar to sustained hypertensives. Therefore, our results support the hypothesis that IO hypertension should not be considered as simply a benign condition.