IMPACT OF AMBULATORY BLOOD-PRESSURE ON LEFT-VENTRICULAR DIASTOLIC DYSFUNCTION IN UNCOMPLICATED ARTERIAL SYSTEMIC HYPERTENSION

To determine the relations of 24-hour blood pressure (BP) and its diff erent phases with left ventricular (LV) diastolic filling, 125 subject s (mean age 46 years) not taking cardiac drugs were studied by Doppler echocardiography and ambulatory BP recording. Subjects (excluding tho se with coronary artery or valvular heart disease, heart failure, or d iabetes) were classified into 2 groups according to the level of Doppl er-derived ratio of peak early to atrial velocity (E/A ratio): 59 had E/A > 1 (normal diastole), 62 had E/A < 1 (impaired diastale), and 4 h ad E/A = 1. Patients with E/A < 1 were older and had higher LV mass in dexed for height, average 24-hour BP, average nighttime BP, and lower day-night BP decrease, whereas average daytime BP did not differ signi ficantly between the 2 groups. Negative correlations of E/A were found with age, heart rate, office, average 24-hour and average nighttime s ystolic and diastolic BP, and LV mass index. In a multivariate model t hat included potentially confounding factors, only age (standardized b eta coefficient = -0.52, p <0.00001), nighttime BP (beta = -0.28, p < 0.0001), and heart rate (beta = -0.22, p < 0.001) were independent pre dictors of E/A in the pooled population, In conclusion, LV diastolic f unction is more closely related to ambulatory, rather than to clinic, BP measurements, and high average nocturnal diastolic BP is a powerful marker of LV filling impairment.