Several studies have shown that subjects with masked hypertension (MHT) are at a higher risk of cardiovascular events than those with sustained normotension (NT).
In this backdrop, Dr. Oe Yukiko and coworkers performed the present study that evaluated whether masked hypertension was associated with reduced left ventricular (LV) diastolic function, compared with normotension and sustained hypertension (SHT).
Study population consisted of 798 subjects 59.2% females), without a history of CVD or treated hypertension, were enrolled in the ongoing Masked Hypertension Study (a worksite-based study of the prevalence, predictors, and prognosis of MHT) from February 2005 to December 2010.
As a part of study, all the enrollees underwent the following; 9 clinic BP measurements that were obtained over 3 office visits (3 readings per visit), 24-hour ambulatory BP measurement and two-dimensional echocardiograms including PW and Tissue Doppler. Mean SBP > 140 mmHg or mean DBP > 90 mmHg defined clinic hypertension. Mean SBP > 135 mmHg or mean DBP >85 mmHg defined ambulatory hypertension. Combinations of clinic and ambulatory BP defined MHT, SHT, and NT. 8 enrollees detected with white coat hypertensives (defined as having clinic hypertension and ambulatory normotension) were excluded from this analysis. 116 enrollees (14.5%) had MHT (clinic normotension and ambulatory hypertension), 37 (4.6%) had SHT (clinic and ambulatory hypertension), and 637 (80%) had NT (clinic and ambulatory normotension).
Findings from this analysis showed differences among echocardiographic measures that included diastolic function between MHT and NT; and between SHT and NT in models adjusted for age, sex, race and body mass index (table)
Table: Differences among echocardiographic measures
|
|
Mean(95% CI) |
P-values |
| MHT |
SHT |
NT |
MHT vs. NT |
SHT vs. NT |
| E’-velocity(m/s) |
0.121 (0.114-0.127) |
0.116(0.105-0.127) |
0.131(0.128-0.134) |
<0.01 |
<0.05 |
| E/E’ ratio |
6.2(5.88-6.51) |
6.57(6.01-7.14) |
5.71(5.58-5.84) |
<0.05 |
0.01 |
| Fractional shortening (%) |
33.4(32.1-34.8) |
37(34.6-39.4) |
32.8(32.2-33.4) |
0.63 |
<0.005 |
| Left ventricular mass(g) |
122(116-127) |
134(125-143) |
116(114-119) |
0.18 |
<0.005 |
| Left ventricular mass index |
64.0(61.5-66.6) |
696(65.1-74.1) |
61.8(60.7-62.8) |
0.24 |
0.003 |
| Relative wall thickness |
36.2(34.6-37.9) |
43(40-46) |
35.3(34.6-36) |
0.55 |
<0.005 |
In conclusion this study indicated that reduced diastolic function was reported in subjects with masked hypertension when compared to normotensives in the absence of left ventricular structural and systolic function changes, which was suggestive of an early alteration of diastolic dysfunction in subjects with masked hypertension. | 
