Central Blood Pressure a Good Indicator of LVH Development

A new study claims that central blood pressure (CPB) is a more important indicator of the development of left ventricular hypertrophy (LVH) than is brachial (pulse) blood pressure.

Researchers at Weill Cornell Medical College (New York, NY, USA) conducted an analysis involving 2,585 American Indian participants of the fourth Strong Heart study, with a mean age of 40 ± 17 years (60% women, 21% with diabetes, and 33% hypertensive). Echocardiography and radial applanation tonometry were performed in all participants, and left ventricular mass was calculated using an anatomically validated formula (adjusted for height). Brachial blood pressure was measured according to a standardized protocol, and central pressures were derived using a generalized transfer function.

The results showed that all blood pressure variables were significantly related to left ventricular absolute and relative wall thickness and left ventricular mass index, with considerable variation in correlation coefficients. Central systolic pressures were uniformly more strongly related to left ventricular wall thickness, diastolic vessel diameter, and mass index, than their respective pulse pressures. Left ventricular relative wall thickness and mass index were also more strongly related to central than to brachial pulse pressures. The study was published in the February 2010 issue of the Journal of Hypertension.

"Central pressures are more strongly related than brachial pressures to concentric left ventricular geometry,” concluded lead author Mary Roman, M.D., and colleagues of the division of cardiology. "These data suggest that absolute (systolic) pressure is more important in stimulating left ventricular hypertrophy and remodeling, whereas pulsatile stress (pulse pressure) is more important in causing vascular hypertrophy and atherosclerosis.”

LVH is the thickening of the myocardium of the left ventricle of the heart; while LVH itself is not a disease, it is usually a marker for disease involving the heart. Processes that can cause LVH include any disease that increases the afterload that the heart has to contract against, such as hypertension, aortic insufficiency, and aortic stenosis, as well as primary hypertrophic cardiomyopathy, a significant cause of sudden unexpected cardiac death in any age group.

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