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European Heart Journal 2002 23(8):658-665; doi:10.1053/euhj.2001.2941
Copyright © 2002 by the European Society of Cardiology.
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Prevalent influence of systolic over pulse pressure on left ventricular mass in essential hypertension

P. Verdecchiaa,f1, G. Schillacib, C. Borgionic, R. Gattobigiod, G. Ambrosioa and C. Porcellatic

a Cardiologia e Fisiopatologia Cardiovascolare, Perugia, Italy
b Medicina Interna, Angiologia e Malattie da Arteriosclerosi, Università di Perugia, Perugia, Italy
c Ospedale R. Silvestrini, Dipartimento di Malattie Cardiovascolari, Perugia, Italy
d Ospedale Beato G. Villa, Cittá della Pieve

revised July 24, 2001; accepted July 25, 2001

Abstract

Background Elevated pulse pressure, an index of increased large artery stiffness, has been associated with increased left ventricular mass. It is unknown whether this relation is independent or mediated by other blood pressure components.

Methods and Results We examined data in 2545 untreated hypertensive subjects (45% women) who underwent echocardiography and 24-h ambulatory blood pressure monitoring. Left ventricular mass increased with all blood pressure components and all associations were closer with ambulatory than with office blood pressure. In a multiple regression analysis, after adjustment for the significant association with age, gender, body weight and duration of hypertension, the proportion of variability of left ventricular mass explained by systolic blood pressure was greater than that explained by other blood pressure components. When different blood pressure components were forced into the same model, the same degree of left ventricular mass variability was accounted for by models including 24-h systolic blood pressure alone, or 24-h mean blood pressure plus 24-h pulse pressure, or 24-h diastolic blood pressure plus 24-h pulse pressure. When 24-h systolic blood pressure and 24-h pulse pressure were forced into the same model, 24-h pulse pressure lost statistical significance.

Conclusions The association between pulse pressure and left ventricular mass is explained by systolic blood pressure, which is the main pressure determinant of left ventricular mass in essential hypertension.

Key Words: Hypertension, arterial, hypertrophy, echocardiography, ambulatory blood pressure

f1 Correspondence: Dr Paolo Verdecchia, Cardiologia e Fisiopatologia Cardiovascolare, Università di Perugia, Policlinico Monteluce, Via Brunamonti, 51, 06122 Perugia PG, Italy.

References

  1. Nichols WW, O'Rourke MF. Atherosclerosis. McDonald's blood flow in arteries: theoretical, experimental and clinical principles. London: Arnold; 1998. p. 396–401
  2. Franklin SS. New interpretations of blood pressure: the importance of pulse pressure. Oparil S, Weber MA. Hypertension. A Companion to Brenner and Rector's The Kidney. St. Louis: Saunders Company; 2000. p. 227–234
  3. Mitchell GF. Pulse pressure, arterial compliance and cardiovascular morbidity and mortality. Curr Opin Nephrol Hypertens. 1999;8:335–342[CrossRef][ISI][Medline]
  4. Franklin SS, Sutton-Tyrrel K, Belle S, Weber M, Kuller LH. The importance of pulsatile components of hypertension in predicting carotid stenosis in older adults. J Hypertens. 1997;15:1143–1150[CrossRef][ISI][Medline]
  5. Zanchetti A, Bond MG, Hennig M. Risk factors associated with alterations in carotid intima-media thickness in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis. J Hypertens. 1998;16:949–961[CrossRef][ISI][Medline]
  6. Pannier B, Brunel P, El Aroussy W, Lacolley P, Safar ME. Pulse pressure and echocardiographic findings in essential hypertension. J Hypertens. 1989;7:127–132[ISI][Medline]
  7. Baguet JP, Mallion JM, Moreau-Gaudry A, Noirclerc M, Peoc'h M, Siche JP. Relationships between cardiovascular remodeling and the pulse pressure in never treated hypertension. J Hum Hypertens. 2000;14:23–30[CrossRef][ISI][Medline]
  8. Mourad JJ, Hanon O, Girerd X, Boutouyrie P, Safar ME. Effect of hypertension on cardiac mass and radial artery wall thickness. Am J Cardiol. 2000;86:564–567[CrossRef][ISI][Medline]
  9. Brahimi M, Dahan M, Dabire H, Levy BI. Impact of pulse pressure on degree of cardiac hypertrophy in patients with chronic uraemia. J Hypertens. 2000;18:1645–1650[CrossRef][ISI][Medline]
  10. Flack JM, Gardin JM, Yunis C, Liu K. Static and pulsatile blood pressure correlates of left ventricular structure and function in black and white young adults: the CARDIA study. Am Heart J. 1999;138:856–864[CrossRef][ISI][Medline]
  11. Pascual JM, Baldo E, Bertolin V. Ambulatory arterial pressure and left ventricular hypertrophy in untreated hypertensive patients (in Spanish). Med Clin (Barc). 1999;112:166–170[Medline]
  12. Khattar RS, Acharya DU, Kinsey C, Senior R, Lahiri A. Longitudinal association of ambulatory pulse pressure with left ventricular mass and vascular hypertrophy in essential hypertension. J Hypertens. 1997;15:737–743[CrossRef][ISI][Medline]
  13. Devereux RB, Roman MJ. Hypertensive cardiac hypertrophy: pathophysiologic and clinical characteristics. Laragh JH, Brenner BM. Hypertension: Pathophysiology, Diagnosis and Management. New York: Raven Press, Ltd; 1995. p. 409–424
  14. Safar ME, London GM. Therapeutic studies and arterial stiffness in hypertension: recommendations of the European Society of Hypertension. The Clinical Committee of Arterial Structure and Function. Working Group on Vascular Structure and Function of the European Society of Hypertension. J Hypertens. 2000;18:1527–1535[CrossRef][ISI][Medline]
  15. Verdecchia P, Schillaci G, Guerrieri M. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation. 1990;81:528–536[Abstract/Free Full Text]
  16. Verdecchia P, Porcellati C, Schillaci G. Ambulatory blood pressure: an independent predictor of prognosis in essential hypertension. Hypertension. 1994;24:793–801[Abstract/Free Full Text]
  17. Verdecchia P, Schillaci G, Borgioni C. Prognostic significance of serial changes in left ventricular mass in essential hypertension. Circulation. 1998;97:48–54[Abstract/Free Full Text]
  18. Verdecchia P, Schillaci G, Boldrini F, Guerrieri M, Zampi I, Porcellati C. Quantitative assessment of day-to-day spontaneous variability in non-invasive ambulatory blood pressure measurements in essential hypertension. J Hypertens. 1991;9:S322–S323[CrossRef]
  19. Sahn DJ, DeMaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-Mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978;58:1072– 83[Abstract/Free Full Text]
  20. Devereux RB, Alonso DR, Lutas EM. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–458[CrossRef][ISI][Medline]
  21. de Simone G, Daniels SR, Devereux RB. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and the impact of overweight. J Am Coll Cardiol. 1992;20:1251–1260[Abstract]
  22. Mancia G, Zanchetti A, Agabiti Rosei E. Ambulatory blood pressure is superior to clinic blood pressure in predicting treatment-induced regression of left ventricular hypertrophy. Circulation. 1997;95:1464–1470[Abstract/Free Full Text]
  23. Tarazi RC. The role of the heart in hypertension. Clin Sci. 1982;63:347s–365s
  24. Iketani T, Iketani Y, Takazawa K, Yamashina A. The influence of the peripheral reflection wave on left ventricular hypertrophy in patients with essential hypertension. Hypertens Res. 2000;23:451–458[ISI][Medline]
  25. Saba PS, Roman MJ, Ganau A. Relationship of effective arterial elastance to demographic and arterial characteristics in normotensive and hypertensive adults. J Hypertens. 1995;13:971–997[ISI][Medline]
  26. Saba PS, Ganau A, Devereux RB, Pini R, Pickering TG, Roman MJ. Impact of arterial elastance as a measure of vascular load on left ventricular geometry in hypertension. J Hypertens. 1999;17:1007–1015[CrossRef][ISI][Medline]
  27. Verdecchia P. Prognostic value of ambulatory blood pressure. Current evidence and clinical implications. Hypertension. 2000;35:844–851[Abstract/Free Full Text]
  28. Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Pede S, Porcellati C. Ambulatory pulse pressure: a potent predictor of total cardiovascular risk in hypertension. Hypertension. 1998;32:983–988[Abstract/Free Full Text]

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This Article
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