title: Impact of the time rate of blood pressure variation on left ventricular mass.
abstract: OBJECTIVE
  Blood pressure (BP) changes are steeper in hypertensive than in normotensive individuals, whereas an increased rate of BP fluctuations is associated with medial hypertrophy of the carotid arteries. We evaluated the association between the rate of BP variation derived from ambulatory blood pressure monitoring (ABPM) data analysis and left ventricular mass (LVM).
  
  
  METHODS
  ABPM and echocardiographic measurements of LVM were performed in 365 normotensive, 185 white-coat hypertensive (WCH) and 448 uncomplicated hypertensive individuals.
  
  
  RESULTS
  The daytime and night-time rate of systolic blood pressure (SBP) and diastolic BP variation were significantly higher in hypertensive than in normotensive (P < 0.001) and WCH (P < 0.05) individuals. In the entire study population multiple linear regression models revealed independent determinants of LVM in the following rank order: body mass index (beta + 0.266, P < 0.001), daytime SBP (beta + 0.264, P < 0.001), male sex (beta +0.220, P < 0.001), age (beta + 0.203, P < 0.001), daytime heart rate (HR; beta - 0.191, P < 0.001), daytime rate of SBP variation (beta + 0.167, P < 0.001), and SBP dipping (beta - 0.132, P < 0.001). A 0.1 mmHg/min increase in the daytime rate of SBP variation correlated with an increment of 7.087 g (95% confidence interval 4.775-9.399) in the LVM. The addition of the daytime rate of SBP variation in the multiple regression model for the prediction of LVM significantly increased the adjusted model R [R change 0.024 (2.4%); P for change < 0.001].
  
  
  CONCLUSIONS
  Steeper BP variations may produce a greater stress on the left ventricular wall and may have an additive role to body habitus, BP and HR levels in the detection of cardiac hypertrophy. Target-organ damage in hypertensive patients, in addition to BP levels, dipping status and BP variability, may also be related to a steeper rate of BP oscillations.
authors.affiliation: Department of Clinical Therapeutics, Alexandra Hospital, Greece. nzakop@med.uoa.gr
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Zakopoulos
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.forename: Gerassimos
authors.initials: G
authors.lastname: Barlas
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spengos
authors.forename: Efstathios
authors.initials: E
authors.lastname: Manios
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.forename: Savas
authors.initials: S
authors.lastname: Toumanidis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dolianitis
authors.forename: Kostas
authors.initials: K
authors.lastname: Vemmos
authors.forename: Demetris
authors.initials: D
authors.lastname: Vassilopoulos
authors.forename: Spyridon D
authors.initials: SD
authors.lastname: Moulopoulos
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D013997:Time Factors