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Clinical correlates of left ventricular mass in elderly hypertensives
M A James1, M D Fotherby, J F Potter
1University Department of Medicine for the Elderly, Glenfield General Hospital, Leicester, UK.
Insights
Left ventricular hypertrophy (LVH) is common in elderly hypertensives, with nighttime blood pressure strongly linked to left ventricular mass index (LVMI). A greater drop in blood pressure at night correlates with lower LVMI.
Area of Science:
- Cardiology
- Gerontology
- Hypertension Research
Background:
- Left ventricular hypertrophy (LVH) is a significant predictor of cardiovascular events.
- Elderly individuals with hypertension often exhibit LVH, but its prevalence and determinants in untreated populations require further investigation.
Purpose of the Study:
- To determine the prevalence of echocardiographically-defined LVH in untreated elderly hypertensives.
- To explore the relationship between left ventricular mass index (LVMI) and 24-hour ambulatory blood pressure (BP), urinary electrolytes, microalbumin excretion, and ECG findings.
Main Methods:
- 52 untreated elderly hypertensive patients (mean age 76) without stroke or heart disease were studied.
- 24-hour ambulatory BP monitoring, 24-hour urine collection for electrolytes and microalbumin, standard ECG, and echocardiography for LVMI calculation were performed.
Main Results:
- 83% of subjects had LVH, with a mean LVMI of 168 g/m2 in men and 153 g/m2 in women.
- LVMI was significantly associated with clinic SBP, daytime SBP, and nighttime SBP and DBP.
- A greater nocturnal fall in systolic blood pressure (SBP) was linked to significantly lower LVMI.
Conclusions:
- LVH is highly prevalent in untreated elderly hypertensives.
- Nighttime blood pressure measures are most closely related to LVMI in this population.
- Reduced nocturnal blood pressure fall is associated with lower LVMI, suggesting a role for 24-hour BP load.
Abstract:
We set out to examine the prevalence of echocardiographically-determined left ventricular hypertrophy (LVH) in a hospital-based population of untreated elderly hypertensives and to study the relationship between left ventricular mass index and clinic and 24h ambulatory BP, urinary electrolyte and microalbumin excretion and ECG changes. We studied 52 untreated elderly hypertensives, mean age 76 years, with no evidence of stroke or heart disease. Subjects underwent 24h ambulatory BP recording together with 24h urine collection for electrolytes and microalbumin estimation. A standard ECG was examined for LVH by commonly used criteria. Subjects were examined by 2-dimensional guided M-mode echocardiography; left ventricular mass was calculated from the formula of Devereux and Riechek and corrected for body surface area (left ventricular mass index, LVMI). Mean LVMI was 168 +/- 39 g/m2 for men and 153 +/- 36 g/m2 for women; 43 (83%) subjects had LVH. LVMI was significantly related to clinic SBP (r = 0.27, P = 0.05), ambulatory daytime SBP (r = 0.27, P = 0.05), nighttime SBP (r = 0.41, P = 0.003) and nighttime DBP (r = 0.29, P = 0.04). LVMI was also related to the difference in mean SBP between day and night (r = -0.32, P = 0.02) and subjects with a day-night SBP difference of > or = 10 mmHg (n = 27) had significantly lower LVMI than those with a day-night SBP difference < 10 mmHg (141 +/- 32 g/m2 vs. 176 +/- 35 g/m2, respectively; P = 0.0005). Fifteen subjects had LVH by ECG criteria giving a sensitivity of 28% and specificity of 66%. LVMI was not related to urinary sodium, potassium or albumin excretion. This study shows that in elderly hypertensives it is measures of nighttime BP which are most closely related to LVMI and subjects with a greater nocturnal fall in BP have lower LVMI, presumably reflecting differences in 24h BP load.