RELATION OF HEMODYNAMIC REACTION DURING STRESS TO LEFT-VENTRICULAR HYPERTROPHY IN ESSENTIAL-HYPERTENSION

To elucidate the impact of increased afterload during physical and mental stress on myocardial hypertrophy, a homogeneous population of 73 patients with untreated mild-to-moderate essential hypertension were enrolled in the current study. Left ventricular mass and cross-sectional area, both determined by 2-D guided M-mode echocardiogra-phy, were related to blood pressure measured at rest as well as during various stress situations. Left ventricular mass and cross-sectional area correlated with systolic pressure at work site (r = 0.28 and r = 0.23 respectively, P <.05) and systolic pressure at complete rest (r = 0.35 and r = 0.33, P <.01). Neither the response in blood pressure to mental arithmetic or a bicycle exercise test performed in the laboratory, nor blood pressure during both stress tests were significantly related to the degree of left ventricular hypertrophy. In addition, patients with a hyperreactive response to mental arithmetic or to the physical stress test did not disclose a greater left ventricular mass than normoreactors. Examining the hemodynamic response pattern during mental arithmetic, we found that patients with vasoconstriction during mental stress had a greater left ventricular mass than individuals with vasodilation during mental stress (244 ± 73 v 204 ± 53 g, P <.05), but this was due to the impact of obesity on left ventricular mass (analysis of covariance: F = 2.1, P = NS). Thus, blood pressure at work site and at rest, but not blood pressure during mental or physical stress, nor the response of blood pressure to both stress tests, was linked to the degree of left ventricular hypertrophy. It therefore appears that chronic hemodynamic load (at work, during sleep) is more determined for left ventricular hypertrophy than intermittent increments of afterload due to physical or mental stress. © 1990 by the American Journal of Hypertension, Ltd.