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Left ventricular mass in hypertension: correlation with casual, exercise and ambulatory blood pressure
E Grossman1, Y Alster, J Shemesh
1Chorley Hypertension Unit, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Insights
Blood pressure load, not casual readings, best predicts left ventricular hypertrophy (LVH) in hypertension. Ambulatory blood pressure monitoring (ABPM) reveals diastolic pressure load as a key indicator for LVH development.
Area of Science:
- Cardiology
- Hypertension Research
- Medical Diagnostics
Background:
- Essential hypertension is a leading cause of cardiovascular disease.
- Left ventricular hypertrophy (LVH) is a significant predictor of adverse cardiac events.
- Understanding the determinants of LVH is crucial for effective hypertension management.
Purpose of the Study:
- To identify the most significant hemodynamic determinant of left ventricular hypertrophy (LVH).
- To compare the predictive power of casual, exercise, and ambulatory blood pressure monitoring (ABPM) for LVH.
- To assess the role of diastolic hypertensive load in LVH development.
Main Methods:
- Studied 60 newly diagnosed patients with mild to moderate essential hypertension.
- Assessed relationships between left ventricular mass (LVM) and casual, exercise, and 24-hour ABPM.
- Calculated diastolic hypertensive load as the percentage of diastolic measurements > 90 mmHg.
Main Results:
- Left ventricular mass (LVM) showed weak correlation with casual and exercise blood pressure.
- LVM was significantly related to average 24-hour ABPM values.
- Diastolic hypertensive load emerged as the strongest predictor of LVH (r = 0.51, P < 0.001).
- A high diastolic load (>50%) was present in all patients with LVH, while a low load (<10%) was associated with minimal LVH.
Conclusions:
- In mild to moderate essential hypertension, ABPM is superior to casual or exercise blood pressure for assessing LVH determinants.
- Diastolic blood pressure load is the primary hemodynamic factor driving LVH.
- Blood pressure load analysis during ABPM is recommended for comprehensive LVH risk assessment.
Abstract:
The purpose of this work was to assess the best haemodynamic determinant of left ventricular hypertrophy (LVH) in patients with essential hypertension. We studied the relationships between left ventricular mass (LVM) and casual, exercise and 24h ambulatory blood pressure monitoring (ABPM) in 60 newly discovered patients with mild to moderate essential hypertension. LVM was only weakly related to both casual and exercise blood pressure, while it was significantly related to average ABPM values. Diastolic hypertensive load, calculated as the percentage of diastolic measurements > 90 mmHg, was the best predictor of the development of LVH (r = 0.51, P < 0.001). Six of six patients with a diastolic load > 50% had LVH, whereas only two of 18 patients (11%) with a diastolic load < 10% had LVH (P < 0.001). In conclusion, in patients with mild to moderate essential hypertension, LVM is poorly related to both casual and exercise blood pressure, but is related to ABPM. Blood pressure load is the best determinant of LVH. These findings suggest that blood pressure load should be considered when analysing ABPM.