LEFT-VENTRICULAR DIASTOLIC FUNCTION IN HYPERTENSION - CORRELATION WITH AMBULATORY BLOOD-PRESSURE AND LEFT-VENTRICULAR MASS

Using digitized M-mode Doppler echocardiography and 24-hour noninvasiv e ambulatory blood pressure monitoring, we evaluated the relationship between average level of blood pressure, left ventricular (LV) mass an d diastolic function in 26 untreated hypertensives with normal LV dias tolic diameter and systolic function. LV mass was increased in 13 pati ents; peak lengthening rate of LV diameter (+dD/dt), index of LV relax ation, was reduced in 15 patients, 6 of whom with normal LV mass; Dopp ler E/A ratio was < 1 in 9 patients, 4 of whom with normal LV mass. Fr om 24-hour blood pressure monitoring we evaluated: average 24-hour (24 -h), daytime (d) and nighttime (n) systolic (SAP), diastolic (DAP) and mean arterial pressure (MAP). We found a significant inverse correlat ion between LV mass and peak lengthening rate of LV diameter (r = -0.5 8; p < 0.005). LV mass weakly correlated only with SAP 24-h, SAP d and DAP d; E/A ratio correlated with SAP 24-h, SAP d, SAP n, MAP 24-h and MAP n; +dD/dt correlated with all blood pressure parameters. The weak correlation between LV mass and blood pressure confirms that blood pr essure is only one of the factors responsible for development of myoca rdial hypertrophy. Diastolic function is significantly load dependent, being influenced not only by LV mass, but also and to a greater exten t by the average level of arterial pressure. Peak lengthening rate is more consistently abnormal and more closely related to average values of blood pressure than Doppler E/A ratio, thus indicating that the two parameters reflect different aspects of LV diastolic function.