Relation of arterial pressure level and variability to left ventricular geometry in normotensive and hypertensive adults.

OBJECTIVES: To assess the impact of blood pressure level and variability on left ventricular geometry. METHODS: Twenty-four-hour ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) were related to echocardiographic left ventricular geometry in 76 normotensive and 245 hypertensive adults. RESULTS: The differences in SBP and DBP between hypertensive patients with concentric hypertrophy - the most prognostically adverse left ventricular pattern - and those with other ventricular geometric patterns were greater for ambulatory awake and home blood pressure (+8 to +15/+3 to +7 and +11 to +16/+4 to +7 mmHg) than they were for physician-measured clinic bloiod pressure (+7 to +15/0 to +5 mmHg). The white-coat effect (clinic minus ambulatory awake SBP) was greatest in hypertensive patients with eccentric left ventricular hypertrophy (17 +/- 19 mmHg) and was least in those with concentric hypertrophy (9 +/- 14 mmHg); no patient with concentric hypertrophy had a normal ambulatory blood pressure. The within-patient SD of awake ambulatory blood pressure was increased in patients with concentric hypertrophny, independent of covariates, as was the dip between ambulatory awake and asleep SBP. In analyses that also considered sex, age, measures of body habitus and clinic blood pressure, left ventricle mass was related most closely to ambulatory awake SBP and relative left ventricular wall thickness was related most closely to ambulatory awake DBP (both P < 0.0005). CONCLUSIONS: Left ventricular geometric adaptations associated with an adverse prognosis were related more strongly to the level and variability of ambulatory blood pressure than theyh were to clinic blood pressure measurements, but were not associated with loss of the nocturnal dip in blood pressure.