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/m(2) in men and > 110 g/m(2) 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. (C) 2015 Production and hosting by Elsevier B. V. on behalf of Egyptian Society of Cardiology. This is an open access article under the CC BY-NC-ND license.