Left Ventricular Hypertrophy in Men with Normal Blood Pressure: Relation to Exaggerated Blood Pressure Response to Exercise

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Abstract
Objective: To determine whether normal, nonhypertensive subjects who have unusually large increases of systolic blood pressure with exercise have left ventricular hypertrophy (LVH). Design: Case-comparison using echocardiography as a criterion standard for measurement of left ventricular mass and the diagnosis of LVH. Setting: Population-based health fitness screening program and referral Veterans Affairs Hospital. Subjects: Thirty-nine men (average age, 44.6 ± 8.5 years; range, 34 to 71 years) were studied, including 25 participants in a health fitness screening program and an additional 14 normal men with atypical chest pain. Twenty-two subjects with a systolic blood pressure during peak exercise of 210 mm Hg or greater were compared with 17 others with systolic pressure less than 210 mm Hg during exercise. Measurements and Main Results: Left ventricular hypertrophy (left ventricular mass index > 134 g/m2) was found in 14 of 22 men with a systolic blood pressure of 210 mm Hg or greater (present in 6.3% of normotensive healthy male volunteers in a health screening program) but in only 1 person with a lower exercise blood pressure. Left ventricular mass index was linearly correlated (r = 0.65, n = 39, P < 0.001) with maximum exercise blood pressure. Whereas LVH was mild in about 50%, substantial LVH was present in the others. The presence of LVH was not related to superior physical conditioning and was accompanied by increased left atrial size suggesting impaired left ventricular filling. Conclusions: Even in the absence of hypertension, exaggerated blood pressure responses during exercise testing suggest a probability of 0.64 (95% CI, 0.41 to 0.83) of LVH, a finding associated with the cardiac "end-organ" manifestations of hypertension.