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

摘要

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.