Left ventricular diastolic function evaluated by the E/e' ratio is impaired in patients with masked uncontrolled hypertension.
BACKGROUND
Masked uncontrolled hypertension (MUH), defined as controlled office blood pressure (BP) but uncontrolled out-of-office BP in treated hypertensives, is a risk factor for cardiovascular disease. We tested the hypothesis that MUH is associated with a greater degree of diastolic dysfunction than controlled hypertension (CH) or uncontrolled hypertension (UH).


RESULTS
We studied 299 treated patients who had at least one cardiovascular risk factor (age, 63 ± 10 years; male sex, 43%), consisting of 94 (31.4%) patients with UH, 46 (15.4%) with MUH, 56 (18.7%) with treated white-coat hypertension (WCH), and 103 (34.4%) with CH. We performed office and home BP monitoring, electrocardiography, echocardiography and blood tests. Diastolic dysfunction was defined as an E-wave to e'-wave (E/e') ratio ≥8 measured by Doppler echocardiography. The value of E/e' was higher in the MUH (8.3 ± 2.7) and UH (8.3 ± 2.7) groups than in the CH group (7.3 ± 2.3; p = 0.08, p = 0.02, respectively). In multivariable analysis, MUH was associated with a significantly higher likelihood of diastolic dysfunction than CH (odds ratio 2.90 versus CH, p < 0.01) after adjusting for significant covariates.


CONCLUSIONS
MUH and UH were associated with a greater degree of diastolic dysfunction than CH. Even in treated patients, out-of-office BP is important to stratify the risk of cardiovascular disease.
Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine , Shimotsuke, Tochigi , Japan.
Takahiro
T
Komori
Kazuo
K
Eguchi
Tomoyuki
T
Kabutoya
Joji
J
Ishikawa
Satoshi
S
Hoshide
Kazuomi
K
Kario
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000209:etiology; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D059468:Masked Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D008875:Middle Aged; D012307:Risk Factors; D017211:Treatment Failure; D016277:Ventricular Function, Left; D059466:White Coat Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology
D000959:Antihypertensive Agents
Blood pressure; diastolic function; echocardiography; hypertension