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Blood pressure determinants of left ventricular wall thickness and mass index in hypertension: comparing office, ambulatory and exercise blood pressures

Journal of Human Hypertension volume 15, pages 627–633 (2001)Cite this article

Abstract

Left ventricular (LV) mass relates positively and continuously to cardiac mortality and thus its regression is a rational therapeutic aim. Whilst the office blood pressure (BP) relates poorly to LV mass, it was unclear whether the 24-h ambulatory BP or the exercise systolic BP (ExSBP) was the stronger correlate of LV structural indices. We studied 49 hypertensive patients with a mean age of 45 (s.d. 12) years with a mean body mass index of 27.1(3.9) kg/m2. The mean (s.d.) of office BP, ambulatory BP and ExSBP measured at the end of the first three stages of Bruce protocol treadmill exercise I, II and III were 161(20)/99(10), 140(13)/89(10), 190(30), 198(30) and 201(33) mm Hg respectively. The LV indices measured echocardiographically were LV septal thickness (IVSd) (1.1(0.2) cm), LV posterior wall thickness (LVPWd) (1.0(0.1) cm) and LV mass indexed to body surface area (LVMI) (123(30) g/m2). Age and gender (male) had the highest correlations with the LV indices. Of the BP measures, the stage II ExSBP’s correlation with the LV indices was consistently higher than all other ExSBP, office systolic BP and 24-h systolic ambulatory BP. In a stepwise multiple regression analysis on IVSd, after adjusting for age and gender, the stage II ExSBP was independently associated with IVSd (β= 0.018 (s.e. 0.008), P = 0.024). When only BP measures were considered as explanatory variables only stage II ExSBP was a significant predictor (P = 0.0001) of IVSd as was the case with LVPWd (P = 0.006) and LVMI (P = 0.0008). Submaximal exercise BP measured at a workload comparable to physical activity encountered in daily life correlated more closely with the left ventricular wall thickness and mass. The exercise BP should perhaps be normalised in hypertension management to optimise regression of LV hypertrophy.

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Acknowledgements

Catherine MacLeod for helping with the treadmill exercise tests and did all the echocardiographic examinations. Professor Allan D Struthers for his helpful critique of the paper. (Funding: Anonymous Trust of Dundee, Scotland.)

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Authors and Affiliations

  1. Department of Clinical Pharmacology and Therapeutics, Hypertension Research Centre, and Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK

    PO Lim, PT Donnan & TM MacDonald

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  1. PO Lim
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  2. PT Donnan
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  3. TM MacDonald
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Correspondence to PO Lim.

Additional information

This paper has been published in an abstract form following an oral presentation in the 18th Scientific Meeting of the International Society of Hypertension, J Hypertens 2000; 18 (Suppl 4): S9[4C.04].

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Lim, P., Donnan, P. & MacDonald, T. Blood pressure determinants of left ventricular wall thickness and mass index in hypertension: comparing office, ambulatory and exercise blood pressures. J Hum Hypertens 15, 627–633 (2001). https://doi.org/10.1038/sj.jhh.1001229

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