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Blood pressure pattern importance in the development of left ventricular hypertrophy in hypertension
G Cerasola1, G D'Ignoto, S Cottone
1Cattedra di Medicina Interna e Centro Ipertensione, Università Degli Studi di Palermo.
Insights
Twenty-four-hour blood pressure monitoring, not office readings, effectively correlates with left ventricular mass in essential hypertension. Nocturnal systolic pressure and its decline are key factors in left ventricular hypertrophy development.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Arterial hypertension is linked to left ventricular hypertrophy (LVH), but correlations with blood pressure measurements vary.
- Existing research shows inconsistent relationships between blood pressure and left ventricular mass.
Purpose of the Study:
- To investigate the relationship between office and 24-hour ambulatory blood pressure (BP) patterns and left ventricular mass in newly diagnosed essential hypertension.
- To determine if 24-hour BP monitoring provides better insights into cardiac afterload and LVH than traditional office BP measurements.
Main Methods:
- Fifty-three patients with newly diagnosed essential hypertension (WHO stage I-II) underwent 24-hour ambulatory blood pressure monitoring.
- M-mode echocardiography was used to assess left ventricular mass.
- Office BP and 24-hour BP (average, daytime, nighttime) were analyzed against left ventricular mass.
Main Results:
- No significant correlation was found between office blood pressure and left ventricular mass.
- Average 24-hour systolic and diastolic blood pressures were significantly correlated with left ventricular mass (r = 0.36 and 0.40, respectively).
- In patients with LVH, left ventricular mass correlated with nocturnal systolic BP (r = 0.46) and inversely with the nocturnal systolic pressure decrease rate (r = -0.60).
Conclusions:
- Twenty-four-hour ambulatory blood pressure monitoring is superior to office BP for assessing cardiac afterload in essential hypertension.
- Nocturnal systolic blood pressure and its diurnal variation play a crucial role in the development of left ventricular hypertrophy.
Abstract:
Heterogeneous results regarding correlations between blood pressure, (measured by various methods and in different conditions), and left ventricular mass in arterial hypertension have been reported. Fifty-three essential hypertensives, I-II WHO stage, have been studied in order to verify the relationship between office and average 24-hour blood pressure, and its day- and night-time pattern with left ventricular hypertrophy. All patients had newly diagnosed essential hypertension, and no subject had received any antihypertensive therapy before entry. The subjects underwent 24-hour blood pressure monitoring, evaluating the average of 24 hours, day- and night-time blood pressures, and M-mode echocardiography. Neither subjects with nor without left ventricular hypertrophy showed correlations between office blood pressure and left ventricular mass. On the contrary, average 24-hour systolic and diastolic blood pressure resulted related to left ventricular mass (r = 0.36 and 0.40, p less than 0.01 respectively). Furthermore, in the subgroup with left ventricular hypertrophy, left ventricular mass was correlated directly with nocturnal systolic blood pressure (r = 0.46) and inversely with the rate of nocturnal decrease in systolic pressure (r = -0.60, p less than 0.01). These results appear to confirm the usefulness of 24-hour blood pressure monitoring in evaluating cardiac afterload in essential hypertension, and the important role that the 24-hour systolic pressure has in the development of left ventricular hypertrophy in these subjects.