Ambulatory blood pressure and metabolic abnormalities in hypertensive subjects with inappropriately high left ventricular mass

Appropriateness of left ventricular (LV) mass to cardiac workload can be ev aluated by the ratio of observed LV mass to the value predicted for an indi vidual's gender, height(2.7), and stroke work at rest (%PLVM). It is unclea r which pathophysiological factors are associated with inappropriately high LV mass in hypertensive subjects. Adequate LV mass was defined by the 90% confidence interval (73% to 128%) of the distribution of %PLVM in 393 norma l-weight normotensive subjects. In 185 hypertensive subjects (aged 56+/-11 years; 60% male, 29% black), according to %PLVM, 164 (88%) had adequate LV mass, 16 (9%) had inappropriately high LV mass (%PLVM >128%), and 5 (3%) ha d %PLVM <73% (low LV mass). Age, gender, smoking habit, proportion of never -treated subjects, total cholesterol, triglycerides, and creatinine levels did not differ significantly between subjects with adequate and inappropria tely high LV mass. Body mass index, fasting glucose, and proportion of blac k subjects were higher (all P<0.05), while HDL cholesterol was lower (P<0.0 5) in subjects with inappropriately high LV mass. Blood pressure at the ech ocardiogram was comparable between subjects with adequate and inappropriate ly high LV mass, but the latter group had higher ambulatory blood pressure (P<0.01). Subjects with inappropriately high LV mass also had higher aortic root dimension and LV relative wall thickness and relatively lower LV syst olic performance than those with adequate LV mass (all P<0.001). Larger aor tic root diameter and lower systolic function were also found in hypertensi ve subjects with inappropriate LV hypertrophy compared with those with adeq uate LV hypertrophy. In an exploratory case-control study that compared sub jects with low %PLVM with age-matched counterparts with adequate LV mass, l ow %PLVM was associated with lower body mass index, more favorable metaboli c profile, and higher LV myocardial contractility. Higher body mass index, larger aortic root, and black race were independent correlates of increased %PLVM. Thus, in arterial hypertension, levels of LV mass inappropriately h igh for gender, cardiac workload, and height(2.7) are associated with highe r body mass index, higher ambulatory blood pressure, larger aortic root dia meters, and relatively low myocardial contractility.