A018: Pulse pressure but not heart rate is adversely related to left ventricular remodeling in arterial hypertension

Wide pulse pressure (PP) and tachycardia have been proposed as ominous markers in arterial hypertension, while left ventricular hypertrophy (LVH) has been widely used as a surrogate end-point. To assess the relationship of resting PP and heart rate (HR) to LVH development, we studied 8165 consecutive untreated patients with uncomplicated essential hypertension, according to age groups, PP and HR. Left ventricular mass index (LVMI) was calculated by echocardiographic validated formula (g/m2): (See <cross-ref type="tbl" refid="tb1">Table</cross-ref>) <tbl id="tb1" loc="float"><tblbdy top-stubs="1"><r><c cspan="2" rspan="1">HR (bpm)</c><c ca="c" cspan="2" rspan="1"><50 mmHg</c><c ca="c" cspan="2" rspan="1">50-65 mmHg</c><c ca="c" cspan="2" rspan="1">>65 mmHg</c></r><r><c cspan="1" rspan="1"><50 yrs</c><c ca="c" cspan="1" rspan="1"><65</c><c ca="c" cspan="1" rspan="1">94</c><c ca="c" cspan="1" rspan="1">135 ± 18</c><c ca="c" cspan="1" rspan="1">85</c><c ca="c" cspan="1" rspan="1">141 ± 15</c><c ca="c" cspan="1" rspan="1">52</c><c ca="c" cspan="1" rspan="1">150 ± 25</c></r><r><c cspan="1" rspan="1"></c><c ca="c" cspan="1" rspan="1">65-75</c><c ca="c" cspan="1" rspan="1">359</c><c ca="c" cspan="1" rspan="1">130 ± 15</c><c ca="c" cspan="1" rspan="1">236</c><c ca="c" cspan="1" rspan="1">137 ± 16</c><c ca="c" cspan="1" rspan="1">98</c><c ca="c" cspan="1" rspan="1">145 ± 20</c></r><r><c cspan="1" rspan="1"></c><c ca="c" cspan="1" rspan="1">75-85</c><c ca="c" cspan="1" rspan="1">469</c><c ca="c" cspan="1" rspan="1">130 ± 14</c><c ca="c" cspan="1" rspan="1">349</c><c ca="c" cspan="1" rspan="1">137 ± 16</c><c ca="c" cspan="1" rspan="1">126</c><c ca="c" cspan="1" rspan="1">146 ± 18</c></r><r><c cspan="1" rspan="1"></c><c ca="c" cspan="1" rspan="1">>85</c><c ca="c" cspan="1" rspan="1">399</c><c ca="c" cspan="1" rspan="1">129 ± 13</c><c ca="c" cspan="1" rspan="1">264</c><c ca="c" cspan="1" rspan="1">136 ± 14</c><c ca="c" cspan="1" rspan="1">115</c><c ca="c" cspan="1" rspan="1">140 ± 17</c></r><r><c cspan="1" rspan="1">50-65 yrs</c><c ca="c" cspan="1" rspan="1"><65</c><c ca="c" cspan="1" rspan="1">107</c><c ca="c" cspan="1" rspan="1">143 ± 22</c><c ca="c" cspan="1" rspan="1">230</c><c ca="c" cspan="1" rspan="1">146 ± 19</c><c ca="c" cspan="1" rspan="1">343</c><c ca="c" cspan="1" rspan="1">154 ± 24</c></r><r><c cspan="1" rspan="1"></c><c ca="c" cspan="1" rspan="1">65-75</c><c ca="c" cspan="1" rspan="1">228</c><c ca="c" cspan="1" rspan="1">135 ± 17</c><c ca="c" cspan="1" rspan="1">470</c><c ca="c" cspan="1" rspan="1">142 ± 19</c><c ca="c" cspan="1" rspan="1">564</c><c ca="c" cspan="1" rspan="1">148 ± 20</c></r><r><c cspan="1" rspan="1"></c><c ca="c" cspan="1" rspan="1">75-85</c><c ca="c" cspan="1" rspan="1">198</c><c ca="c" cspan="1" rspan="1">136 ± 18</c><c ca="c" cspan="1" rspan="1">500</c><c ca="c" cspan="1" rspan="1">139 ± 17</c><c ca="c" cspan="1" rspan="1">589</c><c ca="c" cspan="1" rspan="1">147 ± 23</c></r><r><c cspan="1" rspan="1"></c><c ca="c" cspan="1" rspan="1">>85</c><c ca="c" cspan="1" rspan="1">84</c><c ca="c" cspan="1" rspan="1">135 ± 17</c><c ca="c" cspan="1" rspan="1">219</c><c ca="c" cspan="1" rspan="1">140 ± 15</c><c ca="c" cspan="1" rspan="1">269</c><c ca="c" cspan="1" rspan="1">146 ± 18</c></r><r><c cspan="1" rspan="1">>65 yrs</c><c ca="c" cspan="1" rspan="1"><65</c><c ca="c" cspan="1" rspan="1">9</c><c ca="c" cspan="1" rspan="1">143 ± 18</c><c ca="c" cspan="1" rspan="1">36</c><c ca="c" cspan="1" rspan="1">153 ± 18</c><c ca="c" cspan="1" rspan="1">372</c><c ca="c" cspan="1" rspan="1">163 ± 22</c></r><r><c cspan="1" rspan="1"></c><c ca="c" cspan="1" rspan="1">65-75</c><c ca="c" cspan="1" rspan="1">14</c><c ca="c" cspan="1" rspan="1">147 ± 19</c><c ca="c" cspan="1" rspan="1">89</c><c ca="c" cspan="1" rspan="1">146 ± 22</c><c ca="c" cspan="1" rspan="1">530</c><c ca="c" cspan="1" rspan="1">155 ± 20</c></r><r><c cspan="1" rspan="1"></c><c ca="c" cspan="1" rspan="1">75-85</c><c ca="c" cspan="1" rspan="1">11</c><c ca="c" cspan="1" rspan="1">141 ± 25</c><c ca="c" cspan="1" rspan="1">63</c><c ca="c" cspan="1" rspan="1">146 ± 27</c><c ca="c" cspan="1" rspan="1">403</c><c ca="c" cspan="1" rspan="1">156 ± 21</c></r><r><c cspan="1" rspan="1"></c><c ca="c" cspan="1" rspan="1">>85</c><c ca="c" cspan="1" rspan="1">7</c><c ca="c" cspan="1" rspan="1">133 ± 16</c><c ca="c" cspan="1" rspan="1">28</c><c ca="c" cspan="1" rspan="1">146 ± 21</c><c ca="c" cspan="1" rspan="1">145</c><c ca="c" cspan="1" rspan="1">155 ± 21</c></r></tblbdy></tbl> Increased PP was related to elevated LVMI values, for all age and HR subgroups (p < .0001). Tachycardia was not a factor in LVH development, as HR failed to differentiate among groups. On the contrary, bradycardia was accompanied with increased LVMI values in every age and PP subgroup.