It has been previously shown that regression of electrocardiographic left ventricular hypertrophy (ECG-LVH) in treated hypertensives is associated with a more favourable cardiovascular outcome. Our aim was to further elucidate, whether 1) change in home ([delta]home) or 2) change in office ([delta]office) blood pressure (BP) is more strongly associated with change in ECG-LVH ([delta]ECG-LVH).Design and method:
The study sample consisted of 1097 participants, randomly chosen at baseline to be representative of the Finnish general adult population aged 45–74 years. ECG, home BP (28 self-measurements over 7 days with an oscillometric monitor) and office BP (a duplicate measurement by a nurse with a mercury sphygmomanometer) were measured in the baseline and 11-year follow-up examinations. ECG-LVH was determined using following measures: A) Sokolow-Lyon index, B) Cornell voltage and C) maximum R amplitude from aVL (RaVL). Pearson's correlation was used to examine the associations between [delta]BP and [delta]ECG-LVH. We also assessed whether [delta]ECG-LVH is more strongly associated with [delta]home BP than [delta]office BP with the Steiger's test.Results:
The correlation coefficients between [delta]ECG-LVH and 1) [delta]home and 2) [delta]office BP are shown in the Table. All correlations were statistically significant (P < 0.001). However, [delta]home BP was more strongly associated with with changes in Cornell voltage and RaVL (for systolic) than [delta]office BP. No significant difference was observed in correlations between change in Sokolow-Lyon and 1) [delta]home and 2) [delta]office BP. In a subpopulation of 793 participants who had performed all 28 home BP measurements at baseline and follow-up, the correlations between [delta]home BP and [delta]Cornell voltage increased slightly with the number of home measurements (r for systolic/diastolic BP, day 1: 0.24/0.24, day 3: 0.26/0.26 and day 7: 0.27/0.25), but no material improvement in coefficients occurred after day 3 (12 measurements).Conclusions:
In conclusion, home BP measuring should be used as a first-line method for both the diagnosis and follow-up of hypertension as it seems to be more strongly associated with changes in left ventricular hypertrophy than office BP measuring is.