ORIGINAL ARTICLE 24-h Ambulatory blood pressure in patients with ECG-determined left ventricular hypertrophy: left ventricular geometry and urinary albumin excretion—a LIFE substudy N Wiinberg 1 , LE Bang 2 , K Wachtell 3 , J Larsen 2 , MH Olsen 3 , C Tuxen 1 , PR Hildebrandt 1 , J Rokkedal 3 , H Ibsen 3 and RB Devereux 4 1 Frederiksberg University Hospital, Frederiksberg, Denmark; 2 Næstved Hospital, Næstved, Denmark; 3 Glostrup University Hospital, Glostrup Denmark; 4 Weill Medical College of Cornell University, New York, NY, USA This study was undertaken to evaluate the relationships among left ventricular (LV) geometric patterns and urinary albumin excretion in patients with hypertension and electrocardiographic (ECG) LV hypertrophy. In 143 patients with stage II–III hypertension, 24-h ambulatory blood pressure (BP) monitoring, single urine albumin determination, and echocardiography were performed after 14 days of placebo treatment. Mean age was 6877 years, 35% were women, body mass index was 2875 kg/ m 2 , LV mass index (LVMI) was 125726 g/m 2 , and 24% had microalbuminuria. The mean office BP was 176715/ 9978 mmHg and the mean daytime ambulatory BP was 161718/92712 mmHg. Ambulatory BP, but not office BP, was higher among albuminuric compared to nor- moalbuminuric patients. In patients with established hypertension, daytime pulse pressure and office BP were different in the four patterns of LV geometry, with the highest pressure in those with abnormal geometry. Furthermore, microalbuminuria was more frequent in hypertensive patients with LV hypertrophy than in those with either normal geometry or concentric remodelling. White coat hypertensives (10%) showed lower LVMI and no microalbuminuria compared to patients with estab- lished hypertension. There were no differences in the prevalence of nondippers (26%) among the four LV geometric patterns or in microalbuminuria. In conclu- sion, increased daytime pulse pressure and office BP were associated with increased prevalence of abnormal LV geometry. Microalbuminuria was more frequent in groups with concentric and eccentric LV hypertrophy. Ambulatory BP, but not office BP, was higher in albuminuric than normoalbuminuric patients. With re- gard to the relationship among BP, LV geometric patterns, and urine albumin excretion in this population, 24-h ambulatory BP did not provide additional informa- tion beyond the office BP. Journal of Human Hypertension (2004) 18, 391–396. doi:10.1038/sj.jhh.1001717 Published online 1 April 2004 Keywords: left ventricular hypertrophy; ambulatory blood pressure; microalbuminuria; white coat hypertension; LIFE substudy Introduction Left ventricular (LV) hypertrophy 1 and increased urinary albumin excretion 2 have been shown to be strong predictors of morbidity and mortality in patients with essential hypertension. The office blood pressure (BP), especially the systolic BP, has been shown to relate to LV hypertrophy 3 and microalbuminuria, 4 but closer relations have been observed using ambulatory BP. 5 LV hypertrophy is a result of increased BP load on the heart, resulting in development of various patterns of LV geometry shown by echocardiography. 6 Furthermore, studies have shown additional risk associated with abnor- mal LV geometry beyond the simple LV mass increase. 7,8 Whether the BP load determined by 24-h ambu- latory BP is related to specific LV geometric patterns determined by echocardiography and urinary albu- min excretion remains unclear. 9 Correspondence: N Wiinberg, Department of Clinical Physiology and Nuclear Medicine, Frederiksberg University Hospital, DK-2000 Frederiksberg, Denmark. E-mail: nielsw@dadlnet.dk The study was funded in parts by grants from Merck & Co., Inc., West Point, PA, USA, and Editor, Mr and Mrs Anders Kaarsens Foundation, Copenhagen, Denmark Published online 1 April 2004 Journal of Human Hypertension (2004) 18, 391–396 & 2004 Nature Publishing Group All rights reserved 0950-9240/04 $30.00 www.nature.com/jhh