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Casual, ambulatory and stress blood pressure: relationships with left ventricular mass and filling
C Marabotti1, A Genovesi-Ebert, C Palombo
1C.N.R. Institute of Clinical Physiology, Pisa, Italy.
Insights
Ambulatory blood pressure monitoring and stress tests better predict heart changes in hypertension than casual readings. This study highlights how dynamic blood pressure levels impact cardiac function and structure.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Casual blood pressure measurements show a weak correlation with cardiac involvement in arterial hypertension.
- Understanding predictors of hypertensive heart disease is crucial for effective management.
Purpose of the Study:
- To evaluate if ambulatory blood pressure monitoring and stress test blood pressure are stronger predictors of cardiac changes than casual blood pressure.
- To assess the relationship between different blood pressure measurements and left ventricular anatomical and functional alterations in hypertensive patients.
Main Methods:
- 29 untreated essential hypertension patients underwent echo-Doppler evaluation for left ventricular (LV) mass and diastolic function (A/E ratio).
- Simultaneous measurements included casual blood pressure, mental arithmetic stress test, handgrip test, and 24-hour ambulatory blood pressure monitoring.
- Correlations were analyzed between blood pressure metrics and LV parameters.
Main Results:
- Left ventricular mass correlated with night-time systolic blood pressure and peak systolic pressure during mental stress.
- The A/E ratio (diastolic function) showed significant associations with casual, daytime, and night-time blood pressure readings, as well as peak systolic pressure during mental arithmetic.
- Transmitral flow appears influenced by ambulatory blood pressure levels and mental stress systolic pressure.
Conclusions:
- Ambulatory blood pressure monitoring and stress-induced blood pressure elevations are more indicative of left ventricular diastolic function than casual readings.
- The link between blood pressure and left ventricular anatomy appears weak, suggesting other factors may influence structural changes.
Abstract:
In arterial hypertension, casual blood pressure seems to be weakly related to the level of cardiac involvement. The aim of the present study was to assess if blood pressure during ambulatory monitoring, and during different stress tests, is a stronger predictor of anatomical and functional changes observed in hypertensive heart disease. To this aim, 29 untreated patients with borderline-to-moderate essential hypertension underwent an echo-Doppler evaluation to determine left ventricular thickness and mass. From transmitral flow, the ratio between late and early filling velocities (A/E ratio) was used to assess left ventricular diastolic behaviour. On the same day that ultrasonic study was carried out, we also measured a set of casual blood pressures; conducted a mental arithmetic test (standardized series of mental subtractions); a handgrip test (30% of maximum voluntary contraction for 3 minutes); and performed noninvasive ambulatory monitoring of blood pressure (Spacelabs 5200). Significant relationships were observed between left ventricular mass and both night-time systolic blood pressure (r = 0.46, P less than 0.02) and peak systolic blood pressure during mental stress (r = 0.39, P less than 0.05). The A/E ratio was significantly associated with casual systolic and diastolic blood pressure (r = 0.45, P less than 0.02; r = 0.38, P less than 0.05, respectively); day-time diastolic blood pressure (r = 0.47, P less than 0.02); night-time systolic and diastolic blood pressure (r = 0.44, P less than 0.05; r = 0.42, P less than 0.05 respectively); and peak systolic blood pressure during the mental arithmetic test (r = 0.44, P less than 0.05). Our results seem to confirm the presence of a relationship between causal blood pressure and left ventricular filling. Moreover, the transmitral flow seems to be dependent on both mean levels of blood pressure on ambulatory monitoring and systolic blood pressure during mental stress. As concerns left ventricular mass, the correlations observed support the weakness of the links between blood pressure and left ventricular anatomy.