Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Special Issue: Current evidence and perspectives for hypertension management in Asia
  • Published:

Ambulatory blood pressure is associated with left ventricular geometry after 10 years in hypertensive patients with continuous antihypertensive treatment

Hypertension Research volume 48, pages 212–222 (2025)Cite this article

A Comment to this article was published on 07 November 2024

Abstract

Both aging and high blood pressure (BP) are associated with a risk of left ventricular concentricity and hypertrophy. We hypothesized that optimal BP management improves left ventricular remodeling beyond aging. Among 558 hypertensive patients on continuous antihypertensive treatment and without concurrent heart disease who were referred to a cardiology clinic with echocardiography and ambulatory BP monitoring data, 142 patients’ echocardiographic data was available after 10 years. Baseline BP and changes in left ventricular geometry were evaluated. Mean age at baseline was 71.0 years old. Baseline daytime BP was 129.9/72.4 ± 17.1/10.2 mmHg and nighttime BP was 122.5/67.1 ± 16.9/9.1 mmHg. After 10 years, left ventricular mass index (LVMI) and relative wall thickness (RWT) significantly decreased from 104.5 ± 26.3 to 97.9 ± 26.4 g/m2, p = 0.003 and 0.51 ± 0.09 to 0.47 ± 0.09, p < 0.001, consecutively. Among patients with hypertrophic geometry at baseline, 17.2% reverted to normal geometry at follow-up. Daytime systolic BP (136.9 ± 18.5 mmHg vs 126.2 ± 16.5 mmHg, p = 0.03), nighttime systolic BP (126.2 ± 17.7 mmHg vs 116.3 ± 16.0 mmHg, p = 0.038) and daytime pulse pressure (63.5 ± 17.3 mmHg vs 53.1 ± 14.9 mmHg, p = 0.022) at baseline were higher in patients who remained hypertrophic than those without hypertrophy at follow-up. On logistic regression analysis, daytime, nighttime systolic BP, and daytime pulse pressure were significantly related to the regression of hypertrophy adjusted for age, sex, eGFR, BMI, LVMI, and RWT at baseline. For conclusion, antihypertensive treatment for 10 years improved LV geometry despite aging. Ambulatory BP and pulse pressure at baseline predicted the change of LV geometry after 10 years.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Savage DD, Levy D, Dannenberg AL, Garrison RJ, Castelli WP. Association of echocardiographic left ventricular mass with body size, blood pressure and physical activity (the Framingham Study). Am J Cardiol. 1990;65:371–6.

    Article  CAS  PubMed  Google Scholar 

  2. Gidding SS, Liu K, Colangelo LA, Cook NL, Goff DC, Glasser SP, et al. Longitudinal determinants of left ventricular mass and geometry: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Circ Cardiovasc Imaging. 2013;6:769–75.

    Article  PubMed  Google Scholar 

  3. Lieb W, Gona P, Larson MG, Aragam J, Zile MR, Cheng S, et al. The natural history of left ventricular geometry in the community: clinical correlates and prognostic significance of change in LV geometric pattern. JACC Cardiovasc Imaging. 2014;7:870–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Desai RV, Ahmed MI, Mujib M, Aban IB, Zile MR, Ahmed A. Natural history of concentric left ventricular geometry in community-dwelling older adults without heart failure during seven years of follow-up. Am J Cardiol. 2011;107:321–4.

    Article  PubMed  Google Scholar 

  5. Ascher SB, de Lemos JA, Lee M, Wu E, Soliman EZ, Neeland IJ, et al. Intensive blood pressure lowering in patients with malignant left ventricular hypertrophy. J Am Coll Cardiol. 2022;80:1516–25.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wachtell K, Dahlöf B, Rokkedal J, Papademetriou V, Nieminen MS, Smith G, et al. Change of left ventricular geometric pattern after 1 year of antihypertensive treatment: the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Am Heart J. 2002;144:1057–64.

    Article  CAS  PubMed  Google Scholar 

  7. Pierdomenico SD, Cuccurullo F. Risk reduction after regression of echocardiographic left ventricular hypertrophy in hypertension: a meta-analysis. Am J Hypertens. 2010;23:876–81.

    Article  PubMed  Google Scholar 

  8. Toba A, Kariya T, Aoyama R, Ishiyama T, Tsuboko Y, Takeda K, et al. Impact of age on left ventricular geometry and diastolic function in elderly patients with treated hypertension. Blood Press. 2017;26:264–71.

    Article  PubMed  Google Scholar 

  9. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28:1–39.e14.

    Article  PubMed  Google Scholar 

  10. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57:450–8.

    Article  CAS  PubMed  Google Scholar 

  11. Foppa M, Duncan BB, Rohde LE. Echocardiography-based left ventricular mass estimation. How should we define hypertrophy? Cardiovasc Ultrasound. 2005;3:17.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.

    Article  CAS  PubMed  Google Scholar 

  13. Ganau A, Saba PS, Roman MJ, de Simone G, Realdi G, Devereux RB. Ageing induces left ventricular concentric remodelling in normotensive subjects. J Hypertens. 1995;13:1818–22.

    Article  CAS  PubMed  Google Scholar 

  14. Yoneyama K, Donekal S, Venkatesh BA, Wu CO, Liu CY, Souto Nacif M, et al. Natural history of myocardial function in an adult human population: serial longitudinal observations from MESA. JACC Cardiovasc Imaging. 2016;9:1164–73.

    Article  PubMed  Google Scholar 

  15. Hu J, Zhou Y. Effect of intensive blood pressure lowering on left ventricular hypertrophy in patients with hypertension: a meta-analysis of randomized trials. Blood Press. 2023;32:2242501.

    Article  PubMed  Google Scholar 

  16. Deng Y, Liu W, Yang X, Guo Z, Zhang J, Huang R, et al. Intensive blood pressure lowering improves left ventricular hypertrophy in older patients with hypertension: the STEP trial. Hypertension. 2023;80:1834–42.

    Article  CAS  PubMed  Google Scholar 

  17. Izzo R, Losi MA, Stabile E, Lönnebakken MT, Canciello G, Esposito G, et al. Development of left ventricular hypertrophy in treated hypertensive outpatients: the Campania Salute Network. Hypertension. 2017;69:136–42.

    Article  CAS  PubMed  Google Scholar 

  18. Jung JY, Park SK, Oh CM, Kang JG, Choi JM, Ryoo JH, et al. The influence of prehypertension, controlled and uncontrolled hypertension on left ventricular diastolic function and structure in the general Korean population. Hypertension Res. 2017;40:606–12.

    Article  Google Scholar 

  19. Lønnebakken MT, Izzo R, Mancusi C, Gerdts E, Losi MA, Canciello G, et al. Left ventricular hypertrophy regression during antihypertensive treatment in an outpatient clinic (the Campania Salute Network). J Am Heart Assoc. 2017;6:e004152.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Protogerou AD, Safar ME, Iaria P, Safar H, Le Dudal K, Filipovsky J, et al. Diastolic blood pressure and mortality in the elderly with cardiovascular disease. Hypertension. 2007;50:172–80.

    Article  CAS  PubMed  Google Scholar 

  21. Palmieri V, Bella JN, Arnett DK, Liu JE, Oberman A, Schuck MY, et al. Effect of type 2 diabetes mellitus on left ventricular geometry and systolic function in hypertensive subjects: Hypertension Genetic Epidemiology Network (HyperGEN) study. Circulation. 2001;103:102–7.

    Article  CAS  PubMed  Google Scholar 

  22. De Jong KA, Czeczor JK, Sithara S, McEwen K, Lopaschuk GD, Appelbe A, et al. Obesity and type 2 diabetes have additive effects on left ventricular remodelling in normotensive patients-a cross sectional study. Cardiovasc Diabetol. 2017;16:21.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Cheng S, Fernandes VR, Bluemke DA, McClelland RL, Kronmal RA, Lima JA. Age-related left ventricular remodeling and associated risk for cardiovascular outcomes: the Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging. 2009;2:191–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Battistelli M, Bartoccini C, et al. Adverse prognostic significance of concentric remodeling of the left ventricle in hypertensive patients with normal left ventricular mass. J Am Coll Cardiol. 1995;25:871–8.

    Article  CAS  PubMed  Google Scholar 

  25. O’Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al. European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31:1731–68.

    Article  PubMed  Google Scholar 

  26. Cuspidi C, Facchetti R, Bombelli M, Sala C, Negri F, Grassi G, et al. Nighttime blood pressure and new-onset left ventricular hypertrophy: findings from the Pamela population. Hypertension. 2013;62:78–84.

    Article  CAS  PubMed  Google Scholar 

  27. Mancia G, Carugo S, Grassi G, Lanzarotti A, Schiavina R, Cesana G, et al. Prevalence of left ventricular hypertrophy in hypertensive patients without and with blood pressure control: data from the PAMELA population. Pressioni Arteriose Monitorate E Loro Associazioni. Hypertension. 2002;39:744–9.

    Article  CAS  PubMed  Google Scholar 

  28. Sega R, Trocino G, Lanzarotti A, Carugo S, Cesana G, Schiavina R, et al. Alterations of cardiac structure in patients with isolated office, ambulatory, or home hypertension: data from the general population (Pressione Arteriose Monitorate E Loro Associazioni [PAMELA] Study). Circulation. 2001;104:1385–92.

    Article  CAS  PubMed  Google Scholar 

  29. Franklin SS, Sutton-Tyrrell K, Belle SH, Weber MA, Kuller LH. The importance of pulsatile components of hypertension in predicting carotid stenosis in older adults. J Hypertens. 1997;15:1143–50.

    Article  CAS  PubMed  Google Scholar 

  30. Benetos A, Safar M, Rudnichi A, Smulyan H, Richard JL, Ducimetieère P, et al. Pulse pressure: a predictor of long-term cardiovascular mortality in a French male population. Hypertension. 1997;30:1410–5.

    Article  CAS  PubMed  Google Scholar 

  31. Odden MC, Peralta CA, Haan MN, Covinsky KE. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med. 2012;172:1162–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Pääkkö TJW, Perkiömäki JS, Kesäniemi YA, Ylitalo AS, Lumme JA, Huikuri HV, et al. Increasing ambulatory pulse pressure predicts the development of left ventricular hypertrophy during long-term follow-up. J Hum Hypertens. 2018;32:180–9.

    Article  PubMed  Google Scholar 

  33. Gardin JM, Arnold A, Gottdiener JS, Wong ND, Fried LP, Klopfenstein HS, et al. Left ventricular mass in the elderly. The Cardiovascular Health Study. Hypertension. 1997;29:1095–103.

    Article  CAS  PubMed  Google Scholar 

  34. Roman MJ, Ganau A, Saba PS, Pini R, Pickering TG, Devereux RB. Impact of arterial stiffening on left ventricular structure. Hypertension. 2000;36:489–94.

    Article  CAS  PubMed  Google Scholar 

  35. Lee L, Cotella JI, Miyoshi T, Addetia K, Schreckenberg M, Hitschrich N, et al. Normal values of left ventricular mass by two-dimensional and three-dimensional echocardiography: results from the World Alliance Societies of Echocardiography Normal Values study. J Am Soc Echocardiogr. 2023;36:533–42.e531.

    Article  PubMed  Google Scholar 

  36. Ravindrarajah R, Hazra NC, Hamada S, Charlton J, Jackson SHD, Dregan A, et al. Systolic blood pressure trajectory, frailty, and all-cause mortality >80 years of age: cohort study using electronic health records. Circulation 2017;135:2357–68.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kollias A, Andreadis E, Agaliotis G, Kolyvas GN, Achimastos A, Stergiou GS. The optimal night-time home blood pressure monitoring schedule: agreement with ambulatory blood pressure and association with organ damage. J Hypertens. 2018;36:243–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Japan

    Ayumi Toba, Joji Ishikawa & Kazumasa Harada

Authors
  1. Ayumi Toba
    View author publications

    Search author on:PubMed Google Scholar

  2. Joji Ishikawa
    View author publications

    Search author on:PubMed Google Scholar

  3. Kazumasa Harada
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Ayumi Toba.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Toba, A., Ishikawa, J. & Harada, K. Ambulatory blood pressure is associated with left ventricular geometry after 10 years in hypertensive patients with continuous antihypertensive treatment. Hypertens Res 48, 212–222 (2025). https://doi.org/10.1038/s41440-024-01905-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41440-024-01905-2

Keywords

This article is cited by

Search

Advanced search

Quick links