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Left ventricular diastolic function evaluated by the E/e' ratio is impaired in patients with masked uncontrolled

Takahiro Komori1, Kazuo Eguchi, Tomoyuki Kabutoya

  • 1Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine , Shimotsuke, Tochigi , Japan.

Clinical and Experimental Hypertension (New York, N.Y. : 1993)
|February 5, 2014
PubMed

Insights

Masked uncontrolled hypertension (MUH) and uncontrolled hypertension (UH) are linked to greater diastolic dysfunction than controlled hypertension (CH). Monitoring out-of-office blood pressure (BP) is crucial for cardiovascular risk assessment in treated patients.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Diagnostic Echocardiography

Background:

  • Masked uncontrolled hypertension (MUH) is defined as controlled office blood pressure (BP) but uncontrolled out-of-office BP in treated hypertensive individuals.
  • MUH is recognized as a significant risk factor for cardiovascular disease (CVD).
  • The study investigates the association between MUH and diastolic dysfunction compared to other hypertension categories.

Purpose of the Study:

  • To test the hypothesis that masked uncontrolled hypertension (MUH) is associated with increased diastolic dysfunction.
  • To compare the degree of diastolic dysfunction in patients with MUH, uncontrolled hypertension (UH), controlled hypertension (CH), and treated white-coat hypertension (WCH).

Main Methods:

  • A study cohort of 299 treated hypertensive patients with at least one cardiovascular risk factor was analyzed.
  • Patients were categorized into UH (94), MUH (46), treated white-coat hypertension (WCH) (56), and CH (103) groups.
  • Methods included office and home BP monitoring, electrocardiography, echocardiography (measuring E/e' ratio for diastolic dysfunction), and blood tests.

Main Results:

  • The E/e' ratio, indicative of diastolic dysfunction, was higher in the MUH (8.3 ± 2.7) and UH (8.3 ± 2.7) groups compared to the CH group (7.3 ± 2.3).
  • Multivariable analysis revealed that MUH was independently associated with a significantly higher likelihood of diastolic dysfunction than CH (OR 2.90, p < 0.01).
  • The study included a diverse group of treated hypertensive patients, with an average age of 63 years and 43% male.

Conclusions:

  • Both masked uncontrolled hypertension (MUH) and uncontrolled hypertension (UH) are associated with a greater degree of diastolic dysfunction than controlled hypertension (CH).
  • Out-of-office blood pressure monitoring is essential for accurate cardiovascular disease risk stratification, even in patients receiving treatment for hypertension.
  • These findings underscore the clinical importance of identifying and managing MUH to mitigate cardiovascular risks.
Abstract

Keywords:
Blood pressurediastolic functionechocardiographyhypertension

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