Blood pressure pattern importance in the development of left ventricular hypertrophy in hypertension.

Heterogeneous results regarding correlations between blood pressure, (measured by various methods and in different conditions), and left ventricular mass in arterial hypertension have been reported. Fifty-three essential hypertensives, I-II WHO stage, have been studied in order to verify the relationship between office and average 24-hour blood pressure, and its day- and night-time pattern with left ventricular hypertrophy. All patients had newly diagnosed essential hypertension, and no subject had received any antihypertensive therapy before entry. The subjects underwent 24-hour blood pressure monitoring, evaluating the average of 24 hours, day- and night-time blood pressures, and M-mode echocardiography. Neither subjects with nor without left ventricular hypertrophy showed correlations between office blood pressure and left ventricular mass. On the contrary, average 24-hour systolic and diastolic blood pressure resulted related to left ventricular mass (r = 0.36 and 0.40, p less than 0.01 respectively). Furthermore, in the subgroup with left ventricular hypertrophy, left ventricular mass was correlated directly with nocturnal systolic blood pressure (r = 0.46) and inversely with the rate of nocturnal decrease in systolic pressure (r = -0.60, p less than 0.01). These results appear to confirm the usefulness of 24-hour blood pressure monitoring in evaluating cardiac afterload in essential hypertension, and the important role that the 24-hour systolic pressure has in the development of left ventricular hypertrophy in these subjects.