Twenty-four-hour heart rate and blood pressure are additive markers of left ventricular mass in hypertensive subjects

Background: We investigated whether mean heart rate (HR24) and blood pressure (BP) parameters during 24-h ambulatory BP monitoring (ABP) are independent or additive markers of left ventricular (LV) mass in subjects with newly diagnosed, untreated hypertension. Methods: A total of 250 patients (40% women, 60% men; mean age 59.6 +/- 11 years) with essential hypertension who were attending the outpatient Hypertension Unit were studied. All patients underwent 24-h ABP and HR monitoring as well as echocardiography for assessment of left ventricular (LV) dimensions and function. Results: A decreasing HR24 or increasing ABP parameters (ie, systolic, diastolic, mean BP, and pulse pressure) were associated with increasing LV mass (P <.001) and wall thickness (P <.01). In multivariate analysis, after adjusting for age, gender, body surface area, body mass index, hematocrit, glucose, cholesterol, smoking, and each of the measured ABP parameters separately, decreasing HR24 was independently related to increasing LV mass in addition to ABP and body size parameters (P <.001). The addition of HR24 in different multivariate models for prediction of LV mass significantly increased the adjusted model r(2) (range of r(2) change: 0.039 to 0.064, P for change <.05). Decreasing HR24 or HR during daytime (6 AM to 10 Pm) was associated with a higher likelihood of LV hypertrophy in addition to ABP parameters (adjusted odds ratio 0.92 (CI 0.87 to 0.98), per 1 beat/min greater HR24 P =.002 and 0.93 (CI: 0.87 to 0.98), per 1 beat/min greater HR in the daytime P =.017). Conclusion: The 24-h HR and BP during ABP are independent and additive markers of increased LV mass in untreated hypertensive individuals.