Disparate relationships between blood pressure and left ventricular mass in patients with and without left ventricular hypertrophy.

The relationship between casual blood pressure and left ventricular (LV) mass has been reported to be fairly weak in hypertensive patients. In this study we analyzed this relationship using noninvasive devices to monitor blood pressure for 24 hours in ambulatory patients and M-mode echocardiography to determine LV mass. Among the 33 patients with hypertension, 21 had echocardiographic LV hypertrophy (LV mass greater than 250 g). Patients with LV hypertrophy did not differ significantly from patients without hypertrophy with respect to age or casual systolic or diastolic blood pressure. The averages of whole-day systolic and diastolic blood pressures were 146 +/- 17 (SD) over 90 +/- 12 and 136 +/- 16 over 89 +/- 12 mm Hg, respectively. The relationship between whole-day average systolic blood pressure and LV mass was significantly positive (r = 0.66, p less than 0.05) in patients without hypertrophy but was not significant in patients with LV hypertrophy (r = -0.24). Similarly, the relationship between whole-day average diastolic blood pressure and LV mass was significantly positive in the former group (r = 0.64, p less than 0.05) but significantly negative in hypertensive patients with LV hypertrophy (r = -0.67, p less than 0.01). Thus, blood pressure correlates positively with LV mass only in patients without cardiac hypertrophy. In hypertensive patients with LV hypertrophy, factors additional to the high blood pressure itself must participate in the regulation of LV mass.