Relationship Between Masked Hypertension Measured by Ambulatory Blood Pressure Monitoring and Left Ventricular Global Longitudinal Strain: A Retrospective Study

Abstract

Ming Fu,1,* Xiangming Hu,2,* Shuo Sun,1 Shixin Yi,1 Ying Zhang,1 Yingqing Feng,1 Yingling Zhou,1 Qingshan Geng,1 Haojian Dong1 1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People’s Republic of China; 2The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.; Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Haojian DongDepartment of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People’s Republic of ChinaEmail [email protected]: Masked hypertension (MHT), as an independent clinical entity, the cardiac dysfunction caused by it can be early detected through left ventricular global longitudinal strain (GLS), yet the quantitative relation between MHT and GLS is still unclear. Therefore, we tried to conduct a community-based retrospective study to define this relationship.Patients and Methods: A total of 308 enrolled participants from Dongguan, China, were divided into non-hypertension (NHT) and MHT groups. Baseline characteristics were recorded, and echocardiography and 24-hour ambulatory blood pressure monitoring were performed. Linear regression analysis and receiver-operating characteristic (ROC) curve analysis were used to assess the associations between MHT and GLS in univariate and multivariate models, and the dose–response curve was plotted to demonstrate their relationship.Results: The mean age of the NHT and MHT groups was 57 and 60 years, respectively. Signs of left ventricular diastolic function, E/A was reduced and E/e’ was increased in the MHT group while those of the NHT group were nearly normal. The MHT group also showed a significantly lower (“worse”) GLS than NHT (− 15.2% vs − 19.9%, P < 0.001) while left ventricular ejection fraction (LVEF) did not differ between the groups. Worse GLS was independently and significantly associated with MHT both in univariate (odds ratio [OR]: 1.97, P < 0.001) and stepwise multivariate regression analysis (OR: 1.99, P < 0.001). Comparison of ROC curve results showed that area under curve of GLS was larger than that of E/e’ both in unadjusted (0.8673 vs 0.6831) and adjusted model (0.9178 vs 0.8284). Further analysis showed adjusted nonlinear correlation between MHT and GLS.Conclusion: Based on the relationship between MHT and GLS, in clinical practice, GLS measurement could facilitate diagnosis for suspected MHT patients and could define the extent of left ventricular dysfunction for diagnosed MHT patients.Keywords: masked hypertension, left ventricular dysfunction, global longitudinal strain, nonlinear relation

Keywords

• masked hypertension
• left ventricular dysfunction
• global longitudinal strain
• nonlinear relation