Left ventricular mass in hypertension: Correlation with casual, exercise and ambulatory blood pressure

The purpose of this work was to assess the best haemodynamic determinant of left ventricular hypertrophy (LVH) in patients with essential hypertension. We studied the relationships between left ventricular mass (LVM) and casual, exercise and 24h ambulatory blood pressure monitoring (ABPM) in 60 newly discovered patients with mild to moderate essential hypertension. LVM was only weakly related to both casual and exercise blood pressure, while it was significantly related to average ABPM values. Diastolic hypertensive load, calculated as the percentage of diastolic measurements > 90 mmHg, was the best predictor of the development of LVH (r = 0.51, P < 0.001). Six of six patients with a diastolic load > 50% had LVH, whereas only two of 18 patients (11%) with a diastolic load < 10% had LVH (P < 0.001). In conclusion, in patients with mild to moderate essential hypertension, LVM is poorly related to both casual and exercise blood pressure, but is related to ABPM. Blood pressure load is the best determinant of LVH. These findings suggest that blood pressure load should be considered when analysing ABPM.