Background: Systolic blood pressure (BP) is the main pressure determinant of left ventricular (LV) mass in hypertension. It is uncertain whether arterial stiffness and central hemodynamics are related to LV mass and geometry independently of brachial, central or 24-hour BP level.

Methods: 744 consecutive never-treated subjects with uncomplicated essential hypertension (men 59%, age 49±11 years, BP 149/93±16/10 mmHg) underwent M-mode echocardiography and 24-hour BP monitoring. Carotid-femoral pulse wave velocity (cfPWV), aortic augmentation and aortic BP were evaluated by applanation tonometry.

Results: Women with LV hypertrophy (LV mass >51 g/m^2.7) had a higher cfPWV (10.5±3 vs 9.3±2 m/s, p<0.001), augmentation (21±7 vs 16±7 mmHg, p<0.001) and heart rate-corrected augmentation index (.37±.08 vs .34±.12, p=0.04). Similar data were found in men. LV relative wall thickness (RWT) but not LV mass index was significantly associated with cfPWV independent of age and brachial, central or 24h systolic BP (see Table). The association of aortic augmentation with LV mass and RWT was no longer significant after adjustment for age and systolic BP. In a multiple regression model, 24h systolic BP, LV mass and cfPWV (all p<0.05) independently predicted LV-RWT when a consistent number of risk factors was simultaneously controlled for.

Conclusion: The impact of aortic PWV on LV concentric geometry is independent and additional to that of peripheral, central or 24h BP.