STRUCTURAL CARDIOVASCULAR ALTERATIONS AND BLOOD-PRESSURE VARIABILITY IN HUMAN HYPERTENSION

Aim: To evaluate the cardiovascular risk of hypertensive patients in r elation to left ventricular hypertrophy, arteriolar hypertrophy and bl ood pressure variability, and the effects of antihypertensive treatmen t. Left ventricular hypertrophy: In hypertensive subjects with marked left ventricular hypertrophy, cardiovascular problems are about three times more frequent than in hypertensives who do not have left ventric ular hypertrophy. The evidence suggests, however, that a moderate degr ee of left ventricular hypertrophy may be compensatory and that regres sion of mild hypertrophy should not necessarily be pursued. Arteriolar hypertrophy: An increased wall to lumen ratio leads to an increase in vascular resistance and thus promotes hypertension. Regression of thi s alteration with antihypertensive treatment appears to be both benefi cial and achievable, although it is not clear whether all antihyperten sive agents have the same effect. Moreover, there are methodological p roblems in determining whether a regression has actually been achieved . Blood pressure variability: There is evidence to suggest that end-or gan damage is more frequent and more marked in hypertensives with grea ter 24 h blood pressure variability. It appears that antihypertensive treatment does not easily reduce this variability, although the interm ittent measurements taken by automatic monitoring devices do not fully reflect patterns of blood pressure variation. It may be that hyperten sives with a greater degree of blood pressure variability can obtain a reduction in the magnitude of this variability with antihypertensive treatment.