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Ambulatory blood pressure and echocardiographic left ventricular dimensions in elderly hypertensive subjects
V Rizzo1, G Piccirillo, P Cicconetti
1Chair of Gerontology, Institute I Clinica Medica Generale e Terapia Medica, La Sapienza University, Rome, Italy.
Insights
Elderly hypertensive patients with a greater decline in blood pressure at night had less left ventricular mass. This suggests nocturnal blood pressure patterns are linked to cardiac changes in older adults.
Area of Science:
- Cardiology
- Hypertension Research
- Geriatric Medicine
Background:
- Hypertension in the elderly is associated with left ventricular hypertrophy (LVH).
- Circadian variations in blood pressure, including nocturnal decline, are important in managing hypertension.
- The relationship between blood pressure patterns and cardiac structure in older adults requires further investigation.
Purpose of the Study:
- To investigate the association between circadian blood pressure variations and echocardiographic parameters of left ventricular hypertrophy in elderly hypertensive subjects.
- To compare left ventricular mass index (LVMI) in hypertensive elderly individuals with and without nocturnal blood pressure decline.
Main Methods:
- Ambulatory blood pressure monitoring (ABPM) and B- and M-mode echocardiography were performed on 62 hypertensive elderly subjects.
- Subjects were categorized into two groups based on the presence or absence of nocturnal blood pressure decline.
- Left ventricular mass index (LVMI) was calculated and compared between groups.
Main Results:
- Left ventricular mass index (LVMI) was more strongly correlated with systolic than diastolic ambulatory blood pressure.
- Casual blood pressure measurements showed weaker correlations with LVMI compared to ambulatory readings.
- Subjects with a nocturnal blood pressure decline had significantly lower LVMIs compared to those without, with an inverse correlation observed between LVMI and nocturnal blood pressure reduction.
Conclusions:
- Nocturnal blood pressure decline is associated with reduced left ventricular mass in elderly hypertensive patients.
- Circadian blood pressure patterns, particularly nocturnal dipping, may play a role in the development of left ventricular hypertrophy in older adults.
- These findings highlight the importance of assessing 24-hour blood pressure profiles in elderly hypertensive individuals for cardiovascular risk stratification.
Abstract:
In a consecutive series of 62 hypertensive elderly subjects, the authors studied the relation of blood pressure circadian variations with echocardiographic parameters of left ventricular (LV) hypertrophy. All the subjects were submitted to an ambulatory blood pressure monitoring (ABPM) and to B- and M-mode echocardiography. In the elderly hypertensive group, LV mass index (LVMI) was more strongly related to twenty-four-hour, daytime and nighttime systolic ambulatory blood pressure (r = 0.52, r = 0.37, r = 0.51) than diastolic ambulatory blood pressures were (r = 0.32, r = 0.18, r = 0.33). Casual systolic and diastolic blood pressure (CBP) was found more weakly related to LVMI than ambulatory blood pressures were (r = 0.35, r = 0.26). Elderly hypertensive subjects were divided into two subgroups in relation to the presence (group 1) or absence (group 2) of blood pressure nocturnal decline. No differences were found between these two subgroups in regard to: casual blood pressure values, ambulatory blood pressures in the diurnal period, sex, body surface area, height, weight, and age. LVMIs were computed in all three groups and showed the following results: 89.32 +/- 19.76 in elderly normotensives, 91.21 +/- 31.32 in group 1, and 99.80 +/- 18.21 in group 2. Echocardiographic parameters of LV dimensions and LVMIs were different in group 1 and 2. An inverse correlation, statistically significant, was observed between LVMIs and the nocturnal blood pressure reduction (systolic: r = -0.36, P < 0.05; diastolic: r = -0.29, P < 0.05). These results suggest an association between a smaller LV mass and nocturnal blood pressure decline in elderly hypertensive patients.