RISK STRATIFICATION OF LEFT-VENTRICULAR HYPERTROPHY IN SYSTEMIC HYPERTENSION USING NONINVASIVE AMBULATORY BLOOD-PRESSURE MONITORING

Twenty-four-hour noninvasive ambulatory blood pressure (BP) monitoring and echocardiography were performed in 165 consecutive untreated hypertensive patients and in 92 healthy subjects. In the hypertensive group, left ventricular (LV) mass index showed closer correlations (all p < 0.01 in the comparisons between the r coefficients) with average 24-hour ambulatory systolic (r = 0.47) and diastolic (r = 0.33) BP than with casual systolic (r = 0.35) and diastolic (r = 0.28) BP. Hypertensive patients were classified according to the difference between their observed and predicted levels of ambulatory BP (the latter assessed by regressing the observed ambulatory BP on the casual BP). When compared to those with lower than predicted ambulatory BP (≤10 mm Hg systolic, ≤6 mm Hg diastolic), patients with higher than predicted ambulatory BP (≥ 10 mm Hg systolic and ≥ 6 mm Hg diastolic) had higher values of LV mass index and other indexes of LV hypertrophy (all p < 0.01) but had similar values of casual BP. Prevalence of LV hypertrophy was 6 to 10% in the former and 35 to 39% in the latter (p < 0.001). None of the indexes of LV structure differed between the group with low ambulatory BP and the normotensive group. It is concluded that hypertensive patients whose ambulatory BP readings are notably higher than one would predict from clinical BP readings are at highest risk of LV hypertrophy, an independent prognostic marker. Noninvasive ambulatory BP monitoring identifies a subset of hypertensive patients in whom the routine echocardiographic examination of the left ventricle is recommended. © 1990.