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Impact of the time rate of blood pressure variation on left ventricular mass
Nikolaos A Zakopoulos1, Georgios Tsivgoulis, Gerassimos Barlas
1Department of Clinical Therapeutics, Alexandra Hospital, Greece. nzakop@med.uoa.gr
Insights
Steeper blood pressure (BP) variations, measured by ambulatory blood pressure monitoring (ABPM), are linked to increased left ventricular mass (LVM) in hypertensive individuals. This finding suggests BP fluctuation rate is an important factor in cardiac hypertrophy detection.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Measurement
Background:
- Blood pressure (BP) changes are more pronounced in hypertensive individuals.
- Increased BP fluctuation rates correlate with carotid artery medial hypertrophy.
- The relationship between BP variation rate and left ventricular mass (LVM) requires further investigation.
Purpose of the Study:
- To evaluate the association between the rate of BP variation, derived from ambulatory blood pressure monitoring (ABPM) data, and left ventricular mass (LVM).
Main Methods:
- Ambulatory blood pressure monitoring (ABPM) and echocardiography were used to measure LVM.
- The study included 365 normotensive, 185 white-coat hypertensive (WCH), and 448 uncomplicated hypertensive individuals.
Main Results:
- Hypertensive individuals exhibited significantly higher rates of systolic and diastolic BP variation compared to normotensive and WCH individuals.
- Independent determinants of LVM included body mass index, daytime SBP, sex, age, daytime heart rate, daytime SBP variation rate, and SBP dipping status.
- A 0.1 mmHg/min increase in daytime SBP variation rate correlated with a 7.087 g increment in LVM.
Conclusions:
- Steeper BP variations may increase stress on the left ventricular wall, contributing to cardiac hypertrophy.
- The rate of BP variation may play an additive role alongside BP levels, dipping status, and heart rate in detecting target-organ damage.
- BP oscillation rate could be a significant factor in hypertensive target-organ damage, beyond traditional BP measures.
Objectives:
Blood pressure (BP) changes are steeper in hypertensive than in normotensive individuals, whereas an increased rate of BP fluctuations is associated with medial hypertrophy of the carotid arteries. We evaluated the association between the rate of BP variation derived from ambulatory blood pressure monitoring (ABPM) data analysis and left ventricular mass (LVM).
Methods:
ABPM and echocardiographic measurements of LVM were performed in 365 normotensive, 185 white-coat hypertensive (WCH) and 448 uncomplicated hypertensive individuals.
Results:
The daytime and night-time rate of systolic blood pressure (SBP) and diastolic BP variation were significantly higher in hypertensive than in normotensive (P < 0.001) and WCH (P < 0.05) individuals. In the entire study population multiple linear regression models revealed independent determinants of LVM in the following rank order: body mass index (beta + 0.266, P < 0.001), daytime SBP (beta + 0.264, P < 0.001), male sex (beta +0.220, P < 0.001), age (beta + 0.203, P < 0.001), daytime heart rate (HR; beta - 0.191, P < 0.001), daytime rate of SBP variation (beta + 0.167, P < 0.001), and SBP dipping (beta - 0.132, P < 0.001). A 0.1 mmHg/min increase in the daytime rate of SBP variation correlated with an increment of 7.087 g (95% confidence interval 4.775-9.399) in the LVM. The addition of the daytime rate of SBP variation in the multiple regression model for the prediction of LVM significantly increased the adjusted model R [R change 0.024 (2.4%); P for change < 0.001].
Conclusion:
Steeper BP variations may produce a greater stress on the left ventricular wall and may have an additive role to body habitus, BP and HR levels in the detection of cardiac hypertrophy. Target-organ damage in hypertensive patients, in addition to BP levels, dipping status and BP variability, may also be related to a steeper rate of BP oscillations.
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