Left Ventricular Changes Seen in Isolated Office Hypertension

Isolated office (IO) hypertension is not a benign condition because patients display qualitative left ventricular morphofunctional changes usually seen in patients with never-treated sustained hypertension.

“Our main finding is that IO hypertensives have left ventricular morphofunctional changes qualitatively similar to sustained hypertensives, but of less extent,” Italian researchers report.

“In fact, compared with normotensives, IO hypertensives had significantly thicker left ventricular walls, increased left ventricular mass, a higher prevalence of left ventricular hypertrophy, decreased diastolic function and a higher prevalence of pre-clinical diastolic dysfunction.

“Sustained hypertensives, compared with IO hypertensives, had significantly thicker left ventricular walls, higher left ventricular mass and lower diastolic function, whereas the prevalence of left ventricular hypertrophy and pre-clinical diastolic dysfunction was greater than in IO hypertensives ” but the difference did not reach statistical significance.”

They explain that left ventricular end-diastolic diameter was normal in all participants and almost identical in the three groups.

“Therefore, the difference in left ventricular mass index was due to progressively increased thickness of the interventricular septum and the posterior wall from normotensives to IO hypertensives to sustained hypertensives, indicating a predominant concentric pattern of hypertrophy.”

These differences are not accounted for by differences in age, sex, body mass index (BMI), clinic blood pressure (BP) or ambulatory BP, investigators add.

“Results of this study support the hypothesis that IO hypertension should not be simply considered a benign condition.

“Further studies are needed to determine whether longitudinal monitoring and non-pharmacological interventions are enough or whether IO hypertensives with demonstrated cardiovascular remodelling also need drug treatment,” they suggest.

Researchers from the University of Insubria in Varese enrolled three sets of 42 patients with different levels of hypertension: IO hypertensives, normotensives and never-treated sustained hypertensives.

They matched all participants by age, sex and BMI as well as by clinic and daytime BPs.

Clinic BP for the IO hypertensives was greater than 140 and/or 90 mm Hg and daytime BP was equal to or less than 130/80 mm Hg. Clinic BP for normotensives was less than 135 and/or 85 mm Hg with daytime BP equal to or less than 130/80 mm Hg. For sustained hypertensives clinic BP was greater than 140 and/or 90 mm Hg, with daytime BP equal to or greater than 140 and/or 90 mm Hg.

Investigators concluded: “Comparing matched BP groups, IO hypertensives have left ventricular morphofunctional characteristics considerably different from normotensives and qualitatively similar to sustained hypertensives.”

Archives of Internal Medicine, 2001; 161: 2677-2681.