高龄老年高血压患者夜间血压与靶器官损害相关性研究

目的 探讨高龄老年高血压患者夜间血压控制水平与靶器官损害之间的关系及其干预策略。方法2005年1月至2007年12月仁济医院老年病科就诊208例高龄老年高血压患者（年龄≥80岁）,根据动念血压检测结果分为单纯夜间血压控制不良组（n=102）和全天血压控制均在正常范围组（n=106）,对患者的临床资料、生化指标、心脏彩超和颈动脉B超榆查结果及降压治疗方案进行分析。结果两组年龄、性别、血肌酐、血尿素氮、尿酸水平的差异均无统计学意义。两组总胆同醇、甘油三酯、空腹血糖、左室相关参数、颈动脉结构血流参数及斑块情况的差异有统计学意义（P〈0．05）;CCB＋ACEI／ARB组合比利尿剂＋ACEI／ARB组合,在高龄老年高血压患者夜间血压水平控制方面更为有效（JP〈0．001）结论高龄老年高血压患者夜间血压水平与左心室肥厚、颈动脉斑块（P〈0．05）正相关;CCB＋ACEI／ARB药物组合在高龄老年高血压患者夜间血压水平控制效果较好。     

Isolated ambulatory hypertension and changes in target organ damage in treated hypertensive patients

Isolated ambulatory hypertension is a condition characterized by elevated ambulatory but normal clinic blood pressure (BP), and has been reported to be associated with increased cardiovascular risk in untreated subjects. However, little is known about the relationship between this condition and intermediate end points such as target organ damage (TOD) in treated hypertensives. We investigated the impact of isolated ambulatory hypertension on left ventricular hypertrophy (LVH) and microalbuminuria (MA) in a selected sample of treated nondiabetic hypertensives with effective and prolonged clinic BP control (BP<140/90 mmHg). Clinic BP measurements, routine diagnostic procedures, echocardiography and 24-h urine collection for MA, were undertaken in 80 patients (mean age 53+/-8 years) with essential hypertension attending our hospital outpatient centre at baseline and after an average follow-up of 30 months. At follow-up evaluation BP status was assessed by self-measurement of BP and ambulatory BP monitoring (ABPM). At the follow-up visit, 51 out of 80 patients (63.7%) reached a BP control according to ABP (average daytime BP<132/85 mmHg) criteria (group I) whereas the remaining 29 did not (group II); home BP was controlled (BP<135/85 mmHg) in all members of group I and in 86% of group II. In the overall study population, mean Sokolow voltage, LV mass index (LVMI) and urinary albumin excretion (UAE) decreased compared to baseline from 24.1+/-5.0 to 18.9+/-5.1 mm (P<0.05), 115.6+/-24.1 to 97.7+/-21.6 g/m(2) (P<0.01), 11.8+/-23.7 to 5.8+/-14.9 mg/24 h (P<0.05), respectively. The prevalence of ECG LVH, altered LV patterns and MA fell from 7.5 to 2.5% (P=NS), from 45 to 25 (P<0.01) and from 13.7 to 5.1% (P<0.05), respectively. However, when data were analysed separately for the two groups a significant decrease of echo LVH and MA was found only in patients with controlled ABP. LVMI and MA decreased from 117.1+/-23.1 to 95.9+/-22.1 g/m(2) (P<0.01) and 12.8+/-24.7 to 4.1+/-5.7 mg/24 h (P<0.05) in group I, and from 114.1+/-24.8 to 102.3+/-20.3 (P=NS) and 11.9+/-22.1 to 6.3+/-18.1 mg/24 h (P=NS) in group II. In conclusion, in the present study isolated ambulatory hypertension in treated patients is associated with a lack of regression in cardiac and extracardiac TOD, suggesting that a tight BP control throughout the 24 h plays a key role in lowering hypertension-induced structural and functional alterations at cardiac and renal level.     

Age-specific impact of self-monitored pulse pressure on hypertensive target organ damage in treated hypertensive patients

The authors examined the relationship of clinic and self-measured pulse pressure with target organ damage in 597 treated hypertensive patients without clinical evidence of renal dysfunction or a history of heart failure. The cross-sectional relationships of plasma brain natriuretic peptide (BNP) and urinary albumin/creatinine ratio with clinic and self-monitored pulse pressures were estimated in age tertile groups: younger than 67 years (n=193), 67 to 75 years (n=216), and older than 75 years (n=188), controlling for various confounding factors. In multivariable analyses, both clinic and self-monitored higher pulse pressures were associated with increased urinary albumin/creatinine ratio in all 3 age groups. Self-monitored higher pulse pressure, but not clinic pulse pressure, was consistently associated with increased BNP in the younger and middle-aged patients. In the very old (older than 75 years), however, there were no consistent associations between pulse pressure measures and BNP. More studies are needed in the evaluation of cardiac risk with hemodynamic measures in the very old.     

Masked hypertension and target organ damage in treated hypertensive patients

BACKGROUND: Recent studies have shown that an elevated ambulatory or home blood pressure (BP) in the absence of office BP-a phenomenon called masked hypertension-is associated with poor cardiovascular prognosis. However, it remains to be elucidated how masked hypertension modifies target organ damage in treated hypertensive patients. METHODS: A total of 332 outpatients with chronically treated essential hypertension were enrolled in the present study. Patients were classified into four groups according to office (<140/90 or >or=140/90 mm Hg) and daytime ambulatory (<135/85 or >or=135/85 mm Hg) BP levels; ie, controlled hypertension (low office and ambulatory BP), white-coat hypertension (high office but low ambulatory BP), masked hypertension (low office but high ambulatory BP), and sustained hypertension (high office and ambulatory BP). Left ventricular mass index, carotid maximal intima-media thickness, and urinary albumin levels were determined in all subjects. RESULTS: Of the patients, 51 (15%), 65 (20%), 74 (22%), and 142 (43%) were identified as having controlled hypertension, white-coat hypertension, masked hypertension, and sustained hypertension, respectively. Left ventricular mass index, maximal intima-media thickness, and urinary albumin level in masked hypertension were significantly higher than in controlled hypertension and white-coat hypertension, and were similar to those in sustained hypertension. Multivariate regression analyses revealed that the presence of masked hypertension was one of the independent determinants of left ventricular hypertrophy, carotid atherosclerosis, and albuminuria. CONCLUSIONS: Our findings indicate that masked hypertension is associated with advanced target organ damage in treated hypertensive patients, comparable to that in cases of sustained hypertension.     

动态血压及血压昼夜节律与高血压靶器官损害的关系

目的　探讨高血压病患者的动态血压及血压昼夜节律与靶器官损害 ( TOD)的关系。方法　采用 2 4h动态血压监测仪 ,对 13 5例高血压病患者进行监测。分为 TOD组 82例和非 TOD组 5 3例 ,以 2 4h、日间、夜间血压均值 ( SBP、DBP)及血压昼夜节律值为参数指标。结果　两组的血压均值及血压昼夜节律值比较均有统计学意义 ( P<0 .0 5 )。结论　血压及其昼夜节律性与 TOD密切相关     

Prevalence of target organ damage in treated hypertensive patients: different impact of clinic and ambulatory blood pressure control

OBJECTIVES: First, to evaluate the prevalence of left ventricular (LV) hypertrophy, LV concentric remodelling and microalbuminuria in a selected sample of treated hypertensive patients with effective and prolonged clinic blood pressure (BP) control (BP < 140/90 mmHg). Second, to compare the prevalence of these markers of organ damage in patients with and without ambulatory BP (ABP) control, defined as average daytime BP < 132/85 mmHg). DESIGN AND METHODS: Fifty-eight consecutive hypertensive patients who attended our hypertension outpatient clinic over a period of 3 months and were regularly followed up by the same medical team were included in the study. Obesity, diabetes mellitus, history or signs of cardiovascular or renal complications and major noncardiovascular diseases were the exclusion criteria from the study. Each patient underwent 24 h ABP monitoring, echocardiography and 24 h urine collection for albumin measurement. RESULTS: The prevalence of LV hypertrophy (LV mass index > 125 g/m2 in both sexes), LV concentric remodelling (relative wall thickness > 0.45) and microalbuminuria (urinary albumin excretion < 300 mg/ 24 h) in this selected group of patients (32 men, 26 women; mean age 53 +/- 9 years; mean clinic BP 122 +/- 9/ 78 +/- 6 mmHg) was markedly low (6.9, 8.6 and 5.1%, respectively). The 26 patients with effective ABP control (group I) were similar to the 32 patients without effective ABP control (group II) in age, gender, body surface area, clinic BP, smoking habit, glucose, cholesterol and creatinine plasma levels. Prevalence of LV hypertrophy, LV concentric remodelling and microalbuminuria was lower in group I than in group II (0 versus 12.9% P< 0.01, 7.7 versus 9.4% NS, 3.8 versus 6.2% NS, respectively). CONCLUSIONS: This study demonstrates that nonobese, nondiabetic hypertensive patients with an effective clinic BP control have a very low prevalence of target organ damage and that LVH is present only in individuals with insufficient ABP control.     

Tele-monitoring of home blood pressure in treated hypertensive patients

AIM: To compare the accuracy of clinic blood pressure (CBP) and telemedical home blood pressure (HBP) measurement in the assessment of antihypertensive effect. METHODS: 362 patients on antihypertensive medication performed HBP measurement (5 days, duplicate measurements, four times daily) and ambulatory blood pressure (ABP) monitoring in random order. Main outcome measure was the agreement of CBP and HBP with daytime ABP. RESULTS: CBP was much higher than ABP and average HBP (p < 0.001). There was a progressive decline in HBP over the course of the study, achieving the level of daytime ABP on the last 2 monitoring days. The correlation between CBP and ABP was weak (systolic: r = 0.343, diastolic r = 0.430), whereas strong correlations existed between HBP and ABP (systolic r = 0.804, diastolic r = 0.776). A progressive improvement in the strength of the correlation between average HBP of single days and ABP was obtained over the 5 monitoring days. The HBP readings taken in the afternoon showed a stronger correlation with ABP than the values measured in the morning, at noon and in the evening. Averaging more HBP readings taken on succeeding days resulted in a progressive improvement in the agreement with ABP with a further benefit when readings of day 1 were included. CONCLUSIONS: The accuracy of telemedical HBP measurement is substantially better than that of CBP. The results suggest, that HBP should be measured for 5 days, and afternoon measurements should be preferred in assessing control of hypertension.     

Ambulatory blood pressure, target organ damage and aortic root size in never-treated essential hypertensive patients

The relationship between ambulatory blood pressure (ABP), target organ damage (TOD) and aortic root (AR) size in human hypertension has not been fully explored to date. We investigated the relationship between ABP, different markers of TOD and AR size in never-treated essential hypertensive patients. A total of 519 grade 1 and 2 hypertensive patients (mean age 46+/-12 years) referred for the first time to our outpatient clinic underwent the following procedures: (1) routine examination, (2) 24 h urine collection for microalbuminuria (MA), (3) ambulatory blood pressure monitoring over two 24 h periods within 4 weeks, (4) echocardiography and (5) carotid ultrasonography. AR dilatation was defined by sex-specific criteria (> or =40 mm in men and > or =37 mm in women). AR diameter was increased in 3.7% of patients. Demographic variables (body mass index, age and male gender), average night-time diastolic blood pressure (BP) (but not clinic or average 48 h BP), left ventricular mass index and carotid intima-media (IM) thickness showed an independent association with AR size in both univariate and multivariate analyses. When TOD data were analysed in a categorical way, a stepwise increase in the prevalence of left ventricular hypertrophy (LVH) (I=17.5%, II=27.6%, III=35.8%) and carotid IM thickening (I=20.9%, II=28.8%, III=34.4%), but not in MA (I=6.8%, II=9.1%, III=8.7%) was found with the progression of AR size tertiles. Our results show that (1) AR enlargement in uncomplicated never-treated hypertensive patients has a markedly lower prevalence than traditional markers of cardiac and extracardiac TOD; (2) night-time BP, LVH and carotid IM thickening are independent predictors of AR dimension.     

Aggressive blood pressure-lowering therapy guided by home blood pressure monitoring improves target organ damage in hypertensive patients with type 2 diabetes/prediabetes

J Clin Hypertens (Greenwich). 2012; 14:422–428. ©2012 Wiley Periodicals, Inc. The authors tested the hypothesis that an aggressive antihypertensive treatment is beneficial in protecting against target organ damage (TOD) in patients with type 2 diabetes/prediabetes. The authors enrolled 60 patients with uncontrolled hypertension and diabetes/prediabetes and performed clinic, home, and ambulatory blood pressure (BP) monitoring. Irbesartan, amlodipine, and indapamide were used according to a titration schedule from step 1 to 5 for target home BP level ≤125/75 mm Hg. The flow‐mediated vasodilation (FMD), radial augmentation index (AI), pulse wave velocity (PWV), and urinary albumin excretion ratio (UACR), as a surrogate marker of TOD, were measured at baseline and 6 months. Compared with baseline, clinic, home, and ambulatory BP measures were significantly lower in the sixth month. FMD was increased significantly and AI, PWV, and UACR were reduced by the treatment. The extent of the changes in PWV and UACR were associated with the changes in all BP measures, but only the change in home morning BP was associated with the change in FMD. The change in AI was not associated with the change in BP levels, but was associated with the change in PWV. A very aggressive antihypertensive therapy guided by home morning BP was effective for surrogate end points in patients with diabetes/prediabetes.     

Masked nocturnal hypertension and target organ damage in hypertensives with well-controlled self-measured home blood pressure.

It has been reported that masked hypertension, a state in which patients show normal clinic blood pressure (BP) but elevated out-of-clinic BP by self-measured home BP, is a predictor of cardiovascular morbidity much like sustained hypertension. In addition, nocturnal BP is closely associated with cardiovascular disease. This might mean that ambulatory and self-measured home BP monitoring each provide independent information. We performed ambulatory BP monitoring, self-measured home BP monitoring, echocardiography and carotid ultrasonography in 165 community-dwelling subjects. We subclassified the patients according to the ambulatory and self-measured home BP levels as follows: in the masked nocturnal hypertension group, the self-measured home BP level was <135/85 mmHg and the ambulatory nocturnal BP level was >or=120/75 mmHg; in the normotensive group, the self-measured home BP level was <135/85 mmHg and the ambulatory nocturnal BP level was <120/75 mmHg. The intima-media thickness (IMT) and relative wall thickness (RWT) were greater in the masked nocturnal hypertension group than in the normotensive group (IMT: 0.76+/-0.20 vs. 0.64+/-0.14 mm, p<0.05; RWT: 0.50+/-0.14 vs. 0.41+/-0.10, p<0.05). Even in hypertensives with well-controlled self-measured home BP, elevated ambulatory nocturnal BP might promote target organ damage. We must rule out masked hypertension using self-measured home BP monitoring, and we might also need to rule out nocturnal masked hypertension using ambulatory BP monitoring.     

老年高血压患者血压节律变化与靶器官损害的关系

目的 探讨老年高血压患者血压节律变化与靶器官损害的关系. 方法 70例老年高血压患者均行24h动态血压检测、颈动脉超声和超声心动图检查,根据24 h动态血压检测结果分为2组:勺形组40例及非勺形组30例,并对2组颈动脉粥样硬化(CAS)、左室肥厚(LVH)及动态血压各参数进行比较. 结果 CAS及LVH检出率非勺形组均高于勺形组(P＜0.01);2组间24 h平均收缩压(24hSBP)及舒张压(24hDBP)、24 h收缩压和舒张压负荷值(24hSBPL、24hDBPL),差异无统计学意义(P＞0.05).勺形组白天平均收缩压(dSBP)及舒张压(dDBP)、白天收缩压和舒张压负荷值(dSBPL、dDBPL)高于非勺形组(P＜0.05).勺形组夜间平均收缩压(nSBP)及舒张压(nDBP)、夜间收缩压和舒张压负荷值(nSBPL、nDBPL)明显低于非勺形组(P＜0.01). 结论 老年高血压患者血压节律变化的消失与靶器官损害关系密切,高血压患者降压治疗的同时还需纠正紊乱的血压昼夜节律.     

The frequency of combined target organ damage and the beneficial effect of ambulatory blood pressure monitoring in never treated mild-to-moderate hypertensive patients

The aim of this study was to determine the frequency of target organ damage (TOD) and the beneficial properties of ambulatory blood pressure monitoring (ABPM) for detecting patients who are at high risk for TOD and cardiovascular disease in never treated mild-to-moderate hypertension. Sixty-seven patients (28 males and 39 females, mean age, 49.6 +/- 9.5 years) were divided into two groups, dippers (group I, n = 43) and nondippers (group II, n = 24), according to nocturnal blood pressure (BP) reduction of less than 10%. The groups were compared with respect to demographic and laboratory data and the signs of TOD (microalbuminuria, left ventricular hypertrophy, and retinopathy). We also tested the relationship between ABPM and clinic BP findings with TOD. Group I had significantly lower values than group II for serum fibrinogen (0.28 +/- 0.06 versus 0.32 +/- 0.06 g/L, P = 0.02), uric acid (0.18 +/- 0.05 versus 0.25 +/- 0.11 mmo/L, P = 0.01), urinary sodium excretion (133.7 +/- 45.2 versus 161.8 +/- 52.2 mmol/L, P = 0.02), urinary albumin excretion (17.5 +/- 14.2 versus 31.3 +/- 19.7 mg/24-h, P = 0.001), left ventricular mass index (111.8 +/- 31.0 versus 128.7 +/- 36.6 g/m(2), P = 0.05), and the prevalence of hypertensive retinopathy (51% versus 83%, P = 0.01). The frequency of the combination of all three signs of TOD (microalbuminuria, left ventricular hypertrophy, and hypertensive retinopathy) was higher in nondippers than in dippers (71.4% versus 30%, P = 0.04). We suggest ABPM may provide clinical information to detect patients prone to develop cardiovascular risks and TOD in newly diagnosed mild-to-moderate hypertension.     

Ambulatory blood pressure monitoring versus self-measurement of blood pressure at home: correlation with target organ damage

OBJECTIVE: Ambulatory blood pressure (BP) monitoring and home blood pressure measurements predicted the presence of target organ damage and the risk of cardiovascular events better than did office blood pressure. METHODS: To compare these two methods in their correlation with organ damage, we consecutively included 325 treated (70%) or untreated hypertensives (125 women, mean age = 64.5 +/- 11.3) with office (three measurements at two consultations), home (three measurements morning and evening over 3 days) and 24-h ambulatory monitoring. Target organs were evaluated by ECG, echocardiography, carotid echography and detection of microalbuminuria. Data from 302 patients were analyzed. RESULTS: Mean BP levels were 142/82 mmHg for office, 135.5/77 mmHg for home and 128/76 mmHg for 24-h monitoring (day = 130/78 mmHg; night = 118.5/67 mmHg). With a 135 mmHg cut-off, home and daytime blood pressure diverged in 20% of patients. Ambulatory and Home blood pressure were correlated with organ damage more closely than was office BP with a trend to better correlations with home BP. Using regression analysis, a 140 mmHg home systolic blood pressure corresponded to a 135 mmHg daytime systolic blood pressure; a 133 mmHg daytime ambulatory blood pressure and a 140 mmHg home blood pressure corresponded to the same organ damage cut-offs (Left ventricular mass index = 50 g/m, Cornell.QRS = 2440 mm/ms, carotid intima media thickness = 0.9 mm). Home-ambulatory differences were significantly associated with age and antihypertensive treatment. CONCLUSION: We showed that home blood pressure was at least as well correlated with target organ damage, as was the ambulatory blood pressure. Home-ambulatory correlation and their correlation with organ damage argue in favor of different cut-offs, that are approximately 5 mmHg higher for systolic home blood pressure.     

动态血压参数与原发性高血压患者靶器官损害的关系

目的探讨24h动态血压参数与原发性高血压患者靶器官损害的关系。方法对140例原发性高血压患者进行24h动态血压监测,根据血压昼夜节律变化消失与否将其分为两组,对两组患者靶器官损害的情况进行对比分析,并对心、脑、肾各靶器官损害的危险因素进行Logistic回顾分析。结果两组脑卒中、左室肥厚、心力衰竭和肾功能损害的发生率差异有统计学意义(P<0.05),24h动态血压参数与各种靶器官损害的相关性不同。结论24h动态血压各参数对高血压患者靶器官损害的影响不同,血压负荷、昼夜血压曲线消失和血压波动幅度与靶器官损害显著相关。     

老年高血压病患者血压节律与靶器官损害的相关性

目的探讨老年高血压病患者血压节律变化与心、脑、肾等靶器官损害的相关性。方法观察高血压病血压节律正常（杓型组）和异常（非杓型组）２组老年患者各３８例的临床资料。结果组间在体重指数、偶测血压、白昼平均收缩压等无显著差异（Ｐ＞０．０５）；非杓型组２４ｈ平均收缩压和舒张压、白昼平均舒张压、夜间平均收缩压和舒张压、收缩压和舒张压负荷值较杓型组升高（Ｐ＜０．０５～０．０１）；左室重量和左室重量指数显著增加（Ｐ＜０．０５，０．０１）；无症状腔隙性脑梗塞的个数及发病率均高于后者（Ｐ均＜０．０５）；无痛性心肌缺血次数增多，总持续时间延长（Ｐ＜０．０１，０．０５）；尿蛋白检出率亦高于后者（Ｐ＜０．０１）。结论血压昼夜节律消失较节律正常的高血压病患者有更显著的靶器官损害。     

老年代谢综合征患者血压负荷值、昼夜节律与靶器官损害的关系

目的：探讨老年代谢综合征（MS）患者动态血压负荷值及血压昼夜节律与靶器官损害的关系。方法：选择204例老年MS患者进行24h动态血压监测,其中55例无靶器官损害为对照组,心脏损害组43例、脑损害组35例、肾损害组38例及多器官损害组33例,分析其24h、白昼、夜间血压负荷值,血压昼夜节律。结果：与对照组比较,心脏损害组、脑损害组、肾损害组、多器官损害组的24h、白昼、夜间血压负荷值均明显升高（P〈0．01）,夜间血压下降率明显降低（P〈0．01～〈0．001）;与心脏损害组、脑损害组、肾损害组比较,多器官损害组的24h、白昼、夜间血压负荷值明显升高（P〈0．05）,夜间血压下降率明显降低（P〈0．05～〈0．01）。结论：老年代谢综合征伴靶器官损害者的血压负荷值明显升高,血压昼夜节律明显减弱。     

Ambulatory blood pressure, target organ damage and left atrial size in never-treated essential hypertensive individuals

OBJECTIVE: To investigate the relationship between ambulatory blood pressure and different markers of target organ damage with left atrial size in never-treated essential hypertensive individuals. METHODS: A total of 519 grade 1 and 2 hypertensive patients (mean age 46 +/- 12 years), referred for the first time to our outpatient clinic, underwent routine examinations: 24-h urine collection for microalbuminuria, ambulatory blood pressure monitoring over two 24-h periods in 4 weeks, echocardiography and carotid ultrasonography. RESULTS: Left atrial diameter was increased in 17.3% of patients. No significant differences were found between subjects with and without increased left atrial size with regard to sex, duration of hypertension, clinic and mean 48-h ambulatory blood pressure, and daytime and night-time values. Compared with 429 patients with normal left atrial size, the 90 patients with enlarged left atria were older, had higher body mass index, were more frequently smokers, and included more individuals with the metabolic syndrome. The prevalence of left ventricular hypertrophy, of intima-media thickening, but not of microalbuminuria was significantly higher in subjects with increased left atrial size. CONCLUSION: Left atrial enlargement is not an early echocardiographic finding in relatively young never-treated hypertensive individuals, as its prevalence is lower than that of well-validated markers of target organ damage, and it is unrelated to ambulatory blood pressure. Overweight, left ventricular hypertrophy, carotid intima-media thickening and metabolic syndrome are independent predictors of left atrial dimension, suggesting that changes in left atrial size represent an adaptive response when high blood pressure is associated with other cardiovascular or metabolic abnormalities.     

Exercise blood pressure and target organ damage in essential hypertension

To study whether exercise blood pressure is more closely related to the complications of hypertension than resting blood pressure, 169 patients with essential hypertension, aged 16-66 years, (WHO stages I and II), underwent a graded uninterrupted exercise test on the bicycle ergometer up to exhaustion. BP was measured in intra-arterially. Target organ damage was assessed by eye-fundus grade and by electrocardiographic voltage criteria and T-wave patterns. After adjustment for relevant covariates (age, gender, body height and weight), the manifestations of target organ damage were significantly related to systolic (r ranging from 0.19 to 0.39) and diastolic (r ranging from 0.11 to 0.30) intra-arterial pressure at supine rest. The complications of hypertension were not more closely related to BP during upright submaximal and peak exercise than to resting BP, and exercise BP did not contribute independently from BP at rest to their variance. In conclusion, exercise BP is not better related to target organ damage than BP at rest in patients with essential hypertension.     

Relationships between 24 h blood pressure load and target organ damage in patients with mild-to-moderate essential hypertension

OBJECTIVE: To analyse the relationships between 24 h blood pressure load (the percentage of systolic/diastolic blood pressures exceeding 140/90 mmHg while awake and 120/80 mmHg during sleep) and some indices of hypertensive target organ involvement, independently of the mean level of 24 h blood pressure. METHODS: One hundred and thirty patients with mild-to-moderate hypertension underwent 24 h ambulatory blood pressure monitoring, ocular fundus examination, microalbuminuria assay and two-dimensional guided M-mode echocardiography. The study population was divided into subsets according to the systolic and diastolic 24 h blood pressure load values predicted from the regression equation relating 24 h blood pressure load to 24 h mean blood pressure. The subjects with an observed load above this predicted value were included in the higher blood pressure load groups, the remaining ones being included in the lower groups. RESULTS: Relative myocardial wall thickness and total peripheral resistance were greater, and mid-wall fractional shortening, end-systolic stress-corrected mid-wall fractional shortening and cardiac index lower, in the subjects with a higher systolic blood pressure load. Moreover, the stroke index:pulse pressure ratio was reduced, and a greater prevalence of hypertensive retinopathy was observed in the higher systolic load group. On the contrary, no statistically significant difference was found for any of the cardiac, renal and funduscopic parameters examined when the two groups with a higher and lower 24 h diastolic blood pressure load were compared. CONCLUSIONS: Our results seem to suggest that, in mild-to-moderate arterial hypertension, a high 24 h systolic blood pressure load may be associated, independently of the average level of 24 h systolic ambulatory blood pressure, with an adverse cardiovascular risk profile.