CLINICAL CORRELATED OF LEFT-VENTRICULAR MASS IN ELDERLY HYPERTENSIVES

We set out to examine the prevalence of echocardiographically-determin ed left ventricular hypertrophy (LVH) in a hospital-based population o f untreated elderly hypertensives and to study the relationship betwee n left ventricular mass index and clinic and 24h ambulatory BP, urinar y electrolyte and microalbumin excretion and ECG changes. We studied 5 2 untreated elderly hypertensives, mean age 76 years, with no evidence of stroke or heart disease. Subjects underwent 24h ambulatory BP reco rding together with 24h urine collection for electrolytes and microalb umin estimation. A standard ECG was examined for LVH by commonly used criteria. Subjects were examined by 2-dimensional guided M-mode echoca rdiography; left ventricular mass was calculated from the formula of D evereux and Riechek and corrected for body surface area (left ventricu lar mass index, LVMI). Mean LVMI was 168 +/- 39 g/m2 for men and 153 /- 36 g/m2 for women; 43 (83%) subjects had LVH. LVMI was significantl y related to clinic SBP (r = 0.27, P = 0.05), ambulatory daytime SBP ( r = 0.27, P = 0.05), nighttime SBP (r = 0.41, P = 0.003) and nighttime DBP (r = 0.29, P = 0.04). LVMI was also related to the difference in mean SBP between day and night (r = -0.32, P = 0.02) and subjects with a day-night SBP difference of greater-than-or-equal-to 10 mmHg (n = 2 7) had significantly lower LVMI than those with a day-night SBP differ ence < 10 mmHg (141 +/- 32 g.m2 VS. 176 +/- 35 g/m2, respectively; P = 0.0005). Fifteen subjects had LVH by ECG criteria giving a sensitivit y of 28% and specificity of 66%. LVMI was not related to urinary sodiu m, potassium or albumin excretion. This study shows that in elderly hy pertensives it is measures of nighttime BP which are most closely rela ted to LVMI and subjects with a greater nocturnal fall in BP have lowe r LVMI, presumably reflecting differences in 24h BP load.