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A Blood Pressure–Matched Comparison With Normotension and Sustained Hypertension

Anna M. Grandi, MD; Roberta Broggi, MD; Sara Colombo, MD; Rosa Santillo, MD; Daniela Imperiale, MD; Andrea Bertolini, MD; Luigina Guasti, MD; Achille Venco, MD

Arch Intern Med. 2001;161:2677-2681.

Background  Isolated office (IO) hypertension is a benign condition according to some researchers, whereas others believe it is associated with cardiovascular abnormalities and increased cardiovascular risk. The aim of this study is to compare morphofunctional characteristics of the left ventricle (LV) in IO hypertensive subjects, normotensive subjects (hereafter, hypertensives and normotensives), and never-treated sustained hypertensives. The 3 groups were matched not only by age, sex, and body mass index but also by clinic blood pressure (BP) (IO hypertensives and sustained hypertensives) and daytime BP (IO hypertensives and normotensives).

Methods  We enrolled 42 IO hypertensives (clinic BP >140 and/or 90 mm Hg and daytime BP 130/80 mm Hg), 42 sustained hypertensives (clinic BP >140 and/or 90 mm Hg and daytime BP 140 and/or 90 mm Hg) and 42 normotensives (clinic BP <135 and/or 85 mm Hg and daytime BP 130/80 mm Hg). Left ventricular morphologic features and function were assessed using digitized M-mode echocardiography.

Results  Compared with normotensives, IO hypertensives had significantly thicker LV walls, increased LV mass, reduced diastolic function, increased prevalence of LV hypertrophy, and preclinical diastolic dysfunction. Sustained hypertensives, compared with IO hypertensives, had significantly thicker LV wall, higher LV mass, and lower diastolic function, whereas the prevalence of LV hypertrophy and preclinical diastolic dysfunction was greater than in IO hypertensives, but the difference did not reach statistical significance (P = .29).

Conclusions  Comparing matched BP groups, IO hypertensives have LV morphofunctional characteristics considerably different from normotensives and qualitatively similar to sustained hypertensives. Therefore, our results support the hypothesis that IO hypertension should not be considered as simply a benign condition.

From the Department of Clinical and Biological Sciences, Faculty of Medicine, University of Insubria, Varese, Italy.

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