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[Blood pressure variability during rest and left ventricular hypertrophy in the hypertensive patients. A spectrum
Objective:
To study the relationship between spectral analysis measurement of blood pressure (BP) and heart rate (HR) at rest, in untreated essential hypertension, and their relationship with the development of left ventricular hypertrophy (LVH).
Design And Methods:
41 untreated hypertensives (25M/16W, age 50 +/- 12, range 23-73) were measured at rest (WHO criteria DBP > 90 mmHg) by digital continuous photoplethysmography (Finapres 2300 (F), 6 mn of measurement in the dorsal decubitus position and standing up). Measurement of LVH (Devereux criteria, left ventricular mass index LVMI, g/m2) to analyse two groups (LVMI+: LVMI > 107 if women and 120 if men; n = 19; LVMI = 137 +/- 25), and (LVMI-; n = 22; LVMI = 92 +/- 17). The overall variability is standard deviation (SD), spectral analysis variability (SA) is FFT of 256 points over 3 periods low (LF: 0.004-0.07Hz), medium (MF: 0.07-0.13Hz), high (HF: 0.13-0.5Hz). Comparisons by Wilcoxon test and Anova (age, sex) (* p < 0.05, ** p < 0.01).
Results:
By WHO criteria, the SBP was significantly lower in the LVMI-group (153 +/- 10 vs 165 +/- 18**), the DBP was not significantly different (94 +/- 6 vs 96 +/- 10). By continuous measure (F) at rest there was no significant difference for SBP or DBP. On standing up the SBP was significantly lower in the LVMI-group (148 +/- 20 vs 162 +/- 22**). The SD of the DBP at rest was more elevated in the LVMI-group (3.34 vs 3.06*), but not significantly different standing up. There was no significant difference in SBP at rest (6.7 vs 6.32) or standing (9.13 vs 11.5). The Spectral analysis of the MF was significantly elevated in the LVMI-group at rest for SBP (3.56 vs 3.01*), DBP (1.99 vs 1.19*), and HR (1.79 vs 1.77*). This was not significantly different in the LF and HF for SBP, DBP, HR.
Conclusion:
These results are different from those obtained by invasive ambulatory measures. The spontaneous variability in BP and HR at rest is increased when there is no cardiac effect (LVMI-). SA gives additional information in showing that the increase in variability is due to an increase in the Mayer waves, suggesting the existence of an elevation in adrenergic tone in hypertensive patients not having LVH.