Left ventricular diastolic function evaluated by the E/e' ratio is impaired in patients with masked uncontrolled hypertension.

BACKGROUND

Masked uncontrolled hypertension (MUH), defined as controlled office blood pressure (BP) but uncontrolled out-of-office BP in treated hypertensives, is a risk factor for cardiovascular disease. We tested the hypothesis that MUH is associated with a greater degree of diastolic dysfunction than controlled hypertension (CH) or uncontrolled hypertension (UH).

METHODS AND RESULTS

We studied 299 treated patients who had at least one cardiovascular risk factor (age, 63 ± 10 years; male sex, 43%), consisting of 94 (31.4%) patients with UH, 46 (15.4%) with MUH, 56 (18.7%) with treated white-coat hypertension (WCH), and 103 (34.4%) with CH. We performed office and home BP monitoring, electrocardiography, echocardiography and blood tests. Diastolic dysfunction was defined as an E-wave to e'-wave (E/e') ratio ≥8 measured by Doppler echocardiography. The value of E/e' was higher in the MUH (8.3 ± 2.7) and UH (8.3 ± 2.7) groups than in the CH group (7.3 ± 2.3; p = 0.08, p = 0.02, respectively). In multivariable analysis, MUH was associated with a significantly higher likelihood of diastolic dysfunction than CH (odds ratio 2.90 versus CH, p < 0.01) after adjusting for significant covariates.

CONCLUSIONS

MUH and UH were associated with a greater degree of diastolic dysfunction than CH. Even in treated patients, out-of-office BP is important to stratify the risk of cardiovascular disease.