Circadian blood pressure changes and cardiac geometry in essential arterial hypertension

To study a relationship between ambulatory blood pressure (BP) and left ventricular geometry in mild to moderate arterial hypertension, 24 h ambulatory blood pressure monitoring (ABPM) at half-hourly intervals in the daytime and hourly at night (Spacelabs 90207) and echocardiographic examinations were performed in 60 hypertensives aged 42 +/- 7.9 years and in eight normotensives. The patients were subdivided into four groups according to the relative wall thickness (RWT) and left ventricular mass index (LVMI). Concentric remodelling was identified on the basis of increased RWT, eccentric hypertrophy in case of increased left ventricular mass, and concentric hypertrophy when both parameters were increased. Group I consisted of 15 patients with normal left ventricle; group II, 19 patients with concentric remodelling; group III, 7 patients with eccentric hypertrophy; and group IV, 19 patients with concentric hypertrophy. Analysis of correlations of maximal and mean systolic (SBP) and diastolic BP (DBP) values and BP variability with left ventricular mass and relative wall thickness revealed the strongest correlation in group IV between concentric hypertrophy and peak SBP in the entire 24 h and in the daytime, mean SBP in the daytime and SBP variability in the entire 24 h. No significant correlations were found in groups I, II, III or controls. In conclusion, SBP variability assessed non-invasively with ABPM correlates positively with left ventricular mass. BP variability seems insignificant for left ventricular geometry.