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Pulse pressure and nocturnal fall in blood pressure are predictors of vascular, cardiac and renal target organ damage in hypertensive patients (LOD-RISK study)

2009; Lippincott Williams & Wilkins; Volume: 14; Issue: 4 Linguagem: Inglês

10.1097/mbp.0b013e32832e062f

1473-5725

Luis García‐Ortiz, Manuel A. Gómez‐Marcos, Javier Martín‐Moreiras, Luis J. González-Elena, José I. Recio-Rodríguez, Yolanda Castaño-Sánchez, Gonzalo Grandes, Carlos Martínez‐Salgado,

Heart Rate Variability and Autonomic Control

Objectives To analyse the relationship between various parameters derived from ambulatory blood pressure monitoring (ABPM) and vascular, cardiac and renal target organ damage. Methods A cross-sectional, descriptive study. It included 353 patients with short-term or recently diagnosed hypertension. Primary measurements: ABPM, carotid intima–media thickness (IMT), Cornell voltage–duration product (Cornell VDP), glomerular filtration rate and albumin/creatinine ratio to assess vascular, cardiac and renal damage. Results Two hundred and twenty-three patients (63.2%) were males, aged 56.12±11.21 years. The nocturnal fall in blood pressure was 11.33±8.41, with a dipper pattern in 49.0% (173), nondipper in 30.3% (107), extreme dipper in 12.7% (45) and riser in 7.9% (28). The IMT was lower in the extreme dipper (0.716±0.096 mm) and better in the riser pattern (0.794±0.122 mm) (P<0.05). The Cornell VDP and albumin/creatinine ratio were higher in the riser pattern (1818.94±1798.63 mm/ms and 140.78±366.38 mg/g, respectively) than in the other patterns. In the multivariate analysis after adjusting for age, sex and antihypertensive treatment, with IMT as dependent variable the 24-h pulse pressure (β = 0.003), with Cornell VDP the rest pulse pressure (β = 12.04), and with the albumin/creatinine ratio the percentage of nocturnal fall in systolic blood pressure (β = −3.59), the rest heart rate (β = 1.83) and the standard deviation of 24-h systolic blood pressure (β = 5.30) remain within the equation. Conclusion The estimated pulse pressure with ABPM is a predictor of vascular and cardiac organ damage. The nocturnal fall and the standard deviation in 24-h systolic blood pressure measured with the ABPM is a predictor of renal damage.