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Comparing Office, Central, Home and Ambulatory Blood Pressure in Predicting Left Ventricular Mass
Lucas Sebastian Aparicio1, Jessica Barochiner1, Veronica A Peuchot1
1Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Insights
Home and 24-hour ambulatory blood pressure monitoring better predict left ventricular mass than clinic measurements. Central blood pressure measurement in the clinic showed no advantage over brachial readings for predicting left ventricular mass.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Methods
Background:
- The optimal method for measuring blood pressure to predict left ventricular mass remains debated.
- Existing evidence on the superiority of central over brachial blood pressure measurements is conflicting.
- Left ventricular mass is a key indicator of cardiovascular risk in hypertensive patients.
Purpose of the Study:
- To compare various clinic and out-of-clinic blood pressure measurement methods against left ventricular mass.
- To evaluate the predictive accuracy of central, brachial, home, and 24-hour ambulatory blood pressure readings.
- To assess the independent relationship between different blood pressure measurements and left ventricular mass.
Main Methods:
- Analysis of correlations between left ventricular mass and blood pressure measurements (central, brachial, home, 24-h ambulatory).
- Inclusion of 824 treated and 123 untreated hypertensive patients from a specialized hypertension center.
- Linear regression analysis to determine independent associations of blood pressure readings with left ventricular mass.
Main Results:
- Home blood pressure readings showed the strongest correlations with left ventricular mass, though not statistically significant.
- In adjusted models, a 10 mmHg increase in home systolic blood pressure correlated with a 10 g/m² increase in left ventricular mass.
- 24-hour ambulatory systolic blood pressure also showed a significant association with left ventricular mass (2.3 g/m² per 10 mmHg increase).
Conclusions:
- Home and 24-hour ambulatory blood pressure monitoring are superior to clinic-based measurements for explaining left ventricular mass.
- Central blood pressure measurement in a clinical setting did not offer advantages over brachial blood pressure measurement.
- Out-of-clinic blood pressure monitoring provides more accurate insights into cardiac structural changes like left ventricular mass.
Abstract:
The blood pressure measurement method that more accurately predicts a left ventricular mass is controversial, and the evidence suggesting superiority of central over brachial measurements is contradictory. The aim of this study was to compare the relationship between the different clinic and out-of-clinic blood pressure measurements methods with left ventricular mass in patients who attended a specialised hypertension centre for a central blood pressure measurement. An analysis was performed on the correlations between left ventricular mass and central and brachial blood pressure measurements made in the clinic, and home, as well as 24-h systolic blood pressure measurements. A linear regression analysis was then performed to assess the independent relationship of each blood pressure measurement with left ventricular mass. The results on 824 treated and 123 untreated patients showed no significant differences between correlations, although home readings tended to have the best correlations. In regression adjusted models, for each 10 mmHg increase in systolic home blood pressure the left ventricular mass increased 10 g/m2 (95% CI; 3.7-27, p=.01, adjR2 0.38), and for 24-h ambulatory systolic blood pressure it increased 2.3 g/m2 (95% CI 0.76-3.9, p<.01, adjR2 0.15) in treated and untreated patients, respectively. The association of systolic blood pressure with left ventricular mass was better explained by home and 24-h ambulatory monitoring than to clinic-based measurements in treated and untreated patients, respectively. In the clinic, however, the central measurement was not superior to brachial blood pressure.
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