# Association between ambulatory blood pressure monitoring parameters and left ventricular hypertrophy in an Ecuadorian population

## TL;DR

The study finds that ambulatory blood pressure monitoring has limited ability to detect heart damage in Ecuadorians with high blood pressure.

## Contribution

The study evaluates ABPM parameters for LVH detection in an Ecuadorian population for the first time.

## Key findings

- Daytime systolic blood pressure showed the best diagnostic balance for LVH detection.
- Nighttime diastolic load had high sensitivity but low specificity for LVH.
- ABPM parameters showed modest discrimination overall, suggesting limited standalone utility for LVH screening.

## Abstract

Systemic arterial hypertension (SAH) is the leading modifiable cardiovascular risk factor worldwide and a major cause of hypertension-mediated organ damage (HMOD), including left ventricular hypertrophy (LVH). Ambulatory blood pressure monitoring (ABPM) provides a more accurate assessment of hemodynamic load and circadian blood pressure variability than office measurements. However, its diagnostic performance for LVH detection has not been well studied in Latin American populations.

To evaluate the cross-sectional diagnostic discrimination of ABPM-derived blood pressure parameters for detecting echocardiographic LVH in an Ecuadorian hypertensive cohort.

We conducted a cross-sectional study including 110 adults who underwent 24-h ABPM and three-dimensional echocardiography from October 2021 to June 2022 at the Instituto Ecuatoriano del Corazón (IECOREC), Guayaquil, Ecuador. LVH was defined using sex-specific left ventricular mass index thresholds (>115 g/m2 men; >95 g/m2 women). Receiver operating characteristic (ROC) curves were generated for ABPM parameters, and optimal cut-off values were determined using Youden’s index. All cut-offs are presented as exploratory and sample-dependent, requiring external validation.

LVH was present in 34.5% (n = 38) of participants. Median systolic blood pressure (SBP) values were higher in the LVH group across all periods: 24-h SBP (128 vs. 125 mmHg; p = 0.038), daytime SBP (133 vs. 130 mmHg; p = 0.043), and nighttime SBP (119 vs. 115 mmHg; p = 0.011). ROC analysis showed modest discriminative performance for all ABPM parameters (all AUCs <0.65). Daytime SBP demonstrated the best diagnostic balance (AUC = 0.620; 95% CI: 0.523–0.717; p = 0.047) with an optimal cut-off of ≥134 mmHg (sensitivity 45.0%, specificity 77.8%, Youden’s J = 0.228). Nighttime diastolic load >30% showed high sensitivity (89.5%) but low specificity (29.2%; Youden’s J = 0.19), suggesting potential utility for triage rather than confirmation. Diastolic parameters showed poor discrimination (AUCs 0.515–0.607).

In this Ecuadorian cohort, ABPM-derived parameters showed modest cross-sectional discrimination for LVH detection, with daytime SBP demonstrating the best diagnostic balance. These findings are hypothesis-generating and do not support the use of individual ABPM parameters as stand-alone screening tools for LVH. Instead, ABPM should be regarded as a complementary tool for cardiovascular risk stratification and for prioritizing echocardiographic evaluation in resource-limited settings. The proposed thresholds are exploratory and require validation in larger, prospective, multicenter Latin American studies.