Increased short-term blood pressure variability is associated with early left ventricular systolic dysfunction in newly diagnosed untreated hypertensive patients

Background and aim:Twenty-four-hour blood pressure (BP) variability, by ambulatory BP monitoring (ABPM), has been related to left ventricular hypertrophy, independent of mean BP values. We tested the hypothesis that short-term BP variability (BPV) is also related to subclinical left ventricular systolic dysfunction.Methods:We assessed 24-h SBP and DBP variabilities, quantified as standard deviation (SD) of daytime (awake) BP values and as weighted SD of 24-h BP (24-h-weighted BPV), in 309 recently (<6 months) diagnosed, prospectively recruited, and untreated hypertensive patients. Patients were included only if with normal (55%) left ventricular ejection fraction (LVEF). Left ventricular systolic function was assessed by echocardiography measuring midwall fractional shortening (MFS), circumferential end-systolic stress (cESS), MFS/cESS, peak systolic wall stress, left ventricular fractional shortening (LVFS), and LVEF.Results:At multivariate analysis, awake and 24-h-weighted SBP variabilities (directly, P=0.038 and P=0.002, respectively) as well as relative wall thickness (RWT) (inversely, P=0.001) were significantly related to cESS. Awake and 24-h SBP average values (inversely, P=0.011 and P=0.002, respectively), awake and 24-h-weighted SBP variabilities (inversely, P=0.017 and P=0.024, respectively), and RWT (directly, P=0.001) were all significantly related to MFS/cESS. Finally, awake and 24-h average SBP (directly, P=0.01 for both), awake and 24-h-weighted SBP variability (directly, P=0.001 and P=0.032, respectively), and RWT (inversely, P=0.001) were all significantly and independently related to peak systolic wall stress.Conclusion:In newly diagnosed never-treated hypertensive patients, in the absence of LVEF changes and independent of left ventricular mass index, higher awake, or 24-h-weighted short-term SBP variabilities are associated with early depressed left ventricular systolic function.