title: Twenty-four-hour heart rate and blood pressure are additive markers of left ventricular mass in hypertensive subjects.
abstract: BACKGROUND
  We investigated whether mean heart rate (HR(24)) and blood pressure (BP) parameters during 24-h ambulatory BP monitoring (ABP) are independent or additive markers of left ventricular (LV) mass in subjects with newly diagnosed, untreated hypertension.
  
  
  METHODS
  A total of 250 patients (40% women, 60% men; mean age 59.6 +/- 11 years) with essential hypertension who were attending the outpatient Hypertension Unit were studied. All patients underwent 24-h ABP and HR monitoring as well as echocardiography for assessment of left ventricular (LV) dimensions and function.
  
  
  RESULTS
  A decreasing HR24 or increasing ABP parameters (ie, systolic, diastolic, mean BP, and pulse pressure) were associated with increasing LV mass (P < .001) and wall thickness (P < .01). In multivariate analysis, after adjusting for age, gender, body surface area, body mass index, hematocrit, glucose, cholesterol, smoking, and each of the measured ABP parameters separately, decreasing HR24 was independently related to increasing LV mass in addition to ABP and body size parameters (P < .001). The addition of HR24 in different multivariate models for prediction of LV mass significantly increased the adjusted model r2 (range of r2 change: 0.039 to 0.064, P for change <.05). Decreasing HR24 or HR during daytime (6 am to 10 pm) was associated with a higher likelihood of LV hypertrophy in addition to ABP parameters (adjusted odds ratio 0.92 (CI 0.87 to 0.98), per 1 beat/min greater HR24 P = .002 and 0.93 (CI: 0.87 to 0.98), per 1 beat/min greater HR in the daytime P = .017).
  
  
  CONCLUSIONS
  The 24-h HR and BP during ABP are independent and additive markers of increased LV mass in untreated hypertensive individuals.
authors.affiliation: Department of Clinical Therapeutics, National and Kapodestrial University, Alexandra Hospital, Athens, Greece. nkazop@med.uoa.gr
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Zakopoulos
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Vemmos
authors.forename: Efstathios
authors.initials: E
authors.lastname: Manios
authors.forename: Ioanna
authors.initials: I
authors.lastname: Spiliopoulou
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spengos
authors.forename: Dora
authors.initials: D
authors.lastname: Psaltopoulou
authors.forename: Myron
authors.initials: M
authors.lastname: Mavrikakis
authors.forename: Spyridon D
authors.initials: SD
authors.lastname: Moulopoulos
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D002940:Circadian Rhythm / Q000502:physiology*; D018450:Disease Progression; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index