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Relationship between the level, pattern and variability of ambulatory blood pressure and target organ damage in
1Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021.
Insights
Left ventricular mass, measured by echocardiography, strongly predicts cardiovascular events in preclinical hypertension. Ambulatory blood pressure monitoring is key, with systolic and daytime pressures showing stronger links to hypertensive heart disease.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Preclinical cardiovascular disease is a critical link between hypertension and adverse events.
- Left ventricular mass (LVM) is a potent predictor of cardiovascular mortality and morbidity, surpassing arterial pressure except for age.
- Ambulatory blood pressure (ABP) measurements correlate better with LVM and hypertensive heart disease than clinic readings.
Purpose of the Study:
- To investigate which specific measures of ambulatory blood pressure are most strongly associated with left ventricular mass and other indicators of hypertensive target organ damage.
- To clarify the relative importance of systolic versus diastolic and daytime versus nighttime ambulatory blood pressure in preclinical cardiovascular disease.
Main Methods:
- The study analyzed data from large, well-defined populations.
- Standardized components of ambulatory blood pressure monitoring were utilized.
- Well-validated measures of hypertensive target organ damage, including echocardiographic left ventricular mass, were assessed.
Main Results:
- Evidence suggests a stronger association between ambulatory blood pressure and left ventricular mass compared to clinic blood pressure.
- Systolic ambulatory pressure appears more strongly related to left ventricular mass than diastolic pressure.
- Daytime ambulatory pressures show a stronger relationship with hypertensive heart disease than nighttime pressures.
Conclusions:
- Left ventricular mass is a crucial predictor of cardiovascular outcomes in hypertensive individuals.
- Ambulatory blood pressure monitoring is essential for assessing cardiovascular risk in hypertension.
- Further research is needed to fully elucidate the role of specific ambulatory blood pressure parameters in hypertensive target organ damage.
Abstract:
Certain forms of preclinical cardiovascular disease are critical to the transition between hypertension and the development of cardiovascular morbid events. The level of the echocardiographic left ventricular mass is a stronger predictor of death or non-fatal events than arterial pressure or any other risk factor except advancing age. While the evidence shows a closer relationship between ambulatory compared with clinic blood pressure measurements and left ventricular mass or other measures of hypertensive disease, it is not clear which measures of ambulatory blood pressure are the most important. Present evidence weakly favors systolic over diastolic ambulatory pressure and daytime over night-time pressures. Further studies of large, well defined populations with standardized components of ambulatory blood pressure and well validated measures of hypertensive target organ damage are needed.