Association between ambulatory blood pressure monitoring parameters and left ventricular hypertrophy in an Ecuadorian population

Background: Systemic arterial hypertension (SAH) is the leading modifiable cardiovascular risk factor worldwide and a major cause of hypertension-mediated organ damage (HMOD), including left ventricular hypertrophy (LVH). Ambulatory blood pressure monitoring (ABPM) provides a more accurate assessment of hemodynamic load and circadian blood pressure variability than office measurements. However, its diagnostic performance for LVH detection has not been well studied in Latin American populations. Objective: To evaluate the cross-sectional diagnostic discrimination of ABPM-derived blood pressure parameters for detecting echocardiographic LVH in an Ecuadorian hypertensive cohort. Methods: women). Receiver operating characteristic (ROC) curves were generated for ABPM parameters, and optimal cut-off values were determined using Youden's index. All cut-offs are presented as exploratory and sample-dependent, requiring external validation. Results: = 0.047) with an optimal cut-off of ≥134 mmHg (sensitivity 45.0%, specificity 77.8%, Youden's J = 0.228). Nighttime diastolic load >30% showed high sensitivity (89.5%) but low specificity (29.2%; Youden's J = 0.19), suggesting potential utility for triage rather than confirmation. Diastolic parameters showed poor discrimination (AUCs 0.515-0.607). Conclusion: In this Ecuadorian cohort, ABPM-derived parameters showed modest cross-sectional discrimination for LVH detection, with daytime SBP demonstrating the best diagnostic balance. These findings are hypothesis-generating and do not support the use of individual ABPM parameters as stand-alone screening tools for LVH. Instead, ABPM should be regarded as a complementary tool for cardiovascular risk stratification and for prioritizing echocardiographic evaluation in resource-limited settings. The proposed thresholds are exploratory and require validation in larger, prospective, multicenter Latin American studies.