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

Background 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. Objective To evaluate the cross-sectional diagnostic discrimination of ABPM-derived blood pressure parameters for detecting echocardiographic LVH in an Ecuadorian hypertensive cohort. Methods 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/m 2 men; >95 g/m 2 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. Results 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 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). Conclusion 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.