Left ventricular hypertrophy in controlled hypertension: Is blood pressure variability blamed?

Background: Blood pressure (BP) has been shown to exhibit important variations not only in the short term but also over more prolonged periods of time. Aim: To evaluate the impact of different ambulatory BP variability indices on left ventricular hypertrophy (LVH) in controlled hypertensive patients (Pts). Patients and methods: Ninety controlled hypertensive Pts (office and ambulatory BP control criteria) with mean age 55.9 ± 8.5 years were enrolled. Pts were classified into two groups: Non-LVH group including 75 Pts with normal LV mass index and LVH group including 15 patients with LV mass index >134 g/m2 in men and >110 g/m2 in women. Mean BP and BP load values were obtained for the full 24 h and day-time and night-time periods. Similarly Standard Deviation (SD) and Average Reading Variability (ARV) were calculated in all pts. Results: Regarding office BP, Dipping status and average ambulatory BP, there was no statistically significant difference between both groups. Meanwhile, SD of BP readings and ARV showed a significant difference. After step-wise regression, ARV of systolic BP 24 h was the most powerful variability index that was associated with LVH (R2 = 0.944). The ROC curve analysis showed that the discriminative power was best at more than 14.23 mmHg with sensitivity and specificity 100% and 96% respectively for prediction of LVH. Conclusion: The adverse cardiovascular consequences of hypertension not only depend on mean BP values but may also depend on BPV, which independently adds to CV risk over elevated mean BP levels.