Casual, ambulatory and stress blood pressure: relationships with left ventricular mass and filling

Abstract

In arterial hypertension, casual blood pressure seems to be weakly related to the level of cardiac involvement. The aim of the present study was to assess if blood pressure during ambulatory monitoring, and during different stress tests, is a stronger predictor of anatomical and functional changes observed in hypertensive heart disease. To this aim, 29 untreated patients with borderline-to-moderate essential hypertension underwent an echo-Doppler evaluation to determine left ventricular thickness and mass. From transmitral flow, the ratio between late and early filling velocities ( A E ratio) was used to assess left ventricular diastolic behaviour. On the same day that ultrasonic study was carried out, we also measured a set of casual blood pressures; conducted a mental arithmetic test (standardized series of mental subtractions); a handgrip test (30% of maximum voluntary contraction for 3 minutes); and performed noninvasive ambulatory monitoring of blood pressure (Spacelabs 5200). Significant relationships were observed between left ventricular mass and both night-time systolic blood pressure ( r = 0.46, P < 0.02) and peak systolic blood pressure during mental stress ( r = 0.39, P < 0.05). The A E ratio was significantly associated with casual systolic and diastolic blood pressure ( r = 0.45, P < 0.02; r = 0.38, P < 0.05, respectively); day-time diastolic blood pressure ( r = 0.47, P < 0.02); night-time systolic and diastolic blood pressure ( r = 0.44, P < 0.05; r = 0.42, P < 0.05 respectively); and peak systolic blood pressure during the mental arithmetic test ( r = 0.44, P < 0.05). Our results seem to confirm the presence of a relationship between casual blood pressure and left ventricular filling. Moreover, the transmitral flow seems to be dependent on both mean levels of blood pressure on ambulatory monitoring and systolic blood pressure during mental stress. As concerns left ventricular mass, the correlations observed support the weakness of the links between blood pressure and left ventricular anatomy.