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Published on: February 20, 2017
Association between ambulatory blood pressure monitoring parameters and left ventricular hypertrophy in an Ecuadorian
Patricia Delgado Cedeño1, José Espinoza-Plaza1, Estefanía Arteaga Herrera1
1Instituto Ecuatoriano del Corazón (IECOREC), Guayaquil, Ecuador.
Insights
Ambulatory blood pressure monitoring (ABPM) showed modest accuracy in detecting left ventricular hypertrophy (LVH) in Ecuadorian hypertensives. Daytime systolic blood pressure offered the best diagnostic balance, but ABPM is best used as a complementary tool for risk stratification.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Accuracy Studies
Background:
- Systemic arterial hypertension (SAH) is a leading global cardiovascular risk factor and cause of hypertension-mediated organ damage (HMOD), notably left ventricular hypertrophy (LVH).
- Ambulatory blood pressure monitoring (ABPM) offers superior hemodynamic load and circadian variability assessment compared to traditional office measurements.
- The diagnostic utility of ABPM for LVH detection remains understudied in Latin American populations.
Purpose of the Study:
- To assess the cross-sectional diagnostic performance of ABPM-derived blood pressure parameters for identifying echocardiographic LVH.
- To evaluate ABPM's role in risk stratification within an Ecuadorian hypertensive cohort.
Main Methods:
- A cross-sectional study involving 110 Ecuadorian adults who underwent 24-h ABPM and 3D echocardiography.
- LVH was defined using established sex-specific left ventricular mass index thresholds.
- Receiver operating characteristic (ROC) curves were employed to determine the discriminative ability and optimal cut-offs of ABPM parameters.
Main Results:
- LVH was identified in 34.5% of participants.
- Higher median systolic blood pressure (SBP) was observed across 24-h, daytime, and nighttime periods in the LVH group.
- ABPM parameters demonstrated modest discriminative performance (AUCs < 0.65), with daytime SBP showing the best balance (AUC=0.620).
Conclusions:
- ABPM parameters exhibited limited cross-sectional diagnostic discrimination for LVH in this Ecuadorian cohort.
- Daytime SBP provided the best diagnostic balance, but ABPM is not recommended as a standalone LVH screening tool.
- ABPM serves as a valuable complementary tool for cardiovascular risk stratification and guiding echocardiographic evaluation, particularly in resource-limited settings.
Background:
Systemic arterial hypertension (SAH) is the leading modifiable cardiovascular risk factor worldwide and a major cause of hypertension-mediated organ damage (HMOD), including left ventricular hypertrophy (LVH). Ambulatory blood pressure monitoring (ABPM) provides a more accurate assessment of hemodynamic load and circadian blood pressure variability than office measurements. However, its diagnostic performance for LVH detection has not been well studied in Latin American populations.
Objective:
To evaluate the cross-sectional diagnostic discrimination of ABPM-derived blood pressure parameters for detecting echocardiographic LVH in an Ecuadorian hypertensive cohort.
Methods:
We conducted a cross-sectional study including 110 adults who underwent 24-h ABPM and three-dimensional echocardiography from October 2021 to June 2022 at the Instituto Ecuatoriano del Corazón (IECOREC), Guayaquil, Ecuador. LVH was defined using sex-specific left ventricular mass index thresholds (>115 g/m2 men; >95 g/m2 women). Receiver operating characteristic (ROC) curves were generated for ABPM parameters, and optimal cut-off values were determined using Youden's index. All cut-offs are presented as exploratory and sample-dependent, requiring external validation.
Results:
LVH was present in 34.5% (n = 38) of participants. Median systolic blood pressure (SBP) values were higher in the LVH group across all periods: 24-h SBP (128 vs. 125 mmHg; p = 0.038), daytime SBP (133 vs. 130 mmHg; p = 0.043), and nighttime SBP (119 vs. 115 mmHg; p = 0.011). ROC analysis showed modest discriminative performance for all ABPM parameters (all AUCs <0.65). Daytime SBP demonstrated the best diagnostic balance (AUC = 0.620; 95% CI: 0.523-0.717; p = 0.047) with an optimal cut-off of ≥134 mmHg (sensitivity 45.0%, specificity 77.8%, Youden's J = 0.228). Nighttime diastolic load >30% showed high sensitivity (89.5%) but low specificity (29.2%; Youden's J = 0.19), suggesting potential utility for triage rather than confirmation. Diastolic parameters showed poor discrimination (AUCs 0.515-0.607).
Conclusion:
In this Ecuadorian cohort, ABPM-derived parameters showed modest cross-sectional discrimination for LVH detection, with daytime SBP demonstrating the best diagnostic balance. These findings are hypothesis-generating and do not support the use of individual ABPM parameters as stand-alone screening tools for LVH. Instead, ABPM should be regarded as a complementary tool for cardiovascular risk stratification and for prioritizing echocardiographic evaluation in resource-limited settings. The proposed thresholds are exploratory and require validation in larger, prospective, multicenter Latin American studies.
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