Comparison of Blood Pressure Variability between 24 h Ambulatory Monitoring and Office Blood Pressure in Diabetics and Nondiabetic Patients: A Cross-Sectional Study.

Background: Evidence regarding blood pressure (BP) variability (BPV) and its independent association with adverse outcomes has grown. Diabetic patients might have increased BPV, but there is still an evidence gap regarding relation between BPV and type 2 diabetes beyond mean values of BP. Objective: To examine the relationship between 24 h ambulatory BP monitoring (ABPM, short-term variability) and visit-to-visit in-office BPV (OBP, long-term variability), in diabetics (D) and nondiabetics (ND), and to explore BPV relation with estimated glomerular filtration rate (eGFR), and pulse wave velocity (PWV) as indicators of target organ lesion. Materials and Methods: We conducted a single-center cross-sectional study in an outpatient BP unit, including adult patients consecutively admitted from 1999 to 2019. Multivariate was performed to compare BPV between D and ND adjusted for clinical variables. Pearson's correlation was performed to evaluate relation of BPV with eGFR and PWV. Results: A total of 1123 patients with ABPM and OBP measurements were included. Values of eGFR and PWV were worse in D than in ND. Measurements of OBPV did not differ between groups. Of ABPM BPV, the coefficient of variation and standard deviation for daytime systolic BP were higher in D compared to ND, but only in ND did BPV correlated with both eGFR and PWV. Conclusion: We found that diabetes is associated with higher variability of daytime BP than nondiabetics along with worse damage of vascular and renal function. However, in contrast to nondiabetics, in diabetics eGFR and PWV may not be dependent on BP variability, suggesting that other mechanisms might explain more rigorously the greater damage of target organ lesion markers.

Long-term cardiovascular risk of white-coat hypertension with normal night-time blood pressure values.

BACKGROUND: The prognostic impact of white-coat hypertension (WCHT) is still a matter of debate and controversy. Night-time blood pressure (NBP) is related strongly to cardiovascular (CV) prognosis, but this has not been considered currently in the definition of WCHT. PATIENTS AND METHODS: We investigated the long-term CV prognosis of 2659 patients submitted at admission to 24 h-ambulatory blood pressure (BP) monitoring divided into three groups: normotension (NT) (n=812; 59% female; ageing 49±13 years), sustained hypertension (SHT) (n=1230; 56% female; ageing 51±13 years) and WCHT (n=617; 55% female; ageing 50±3 years) defined as office BP of at least 140/90 mmHg, daytime BP less than 135/85 mmHg and NBP less than 120/70 mmHg. RESULTS: The median follow-up was 7.6 years (range: 0.4-24.4), during which a total of 257 CV events (36 fatal) occurred (46% strokes, 32% coronary and 22% others), 38 in NT, 31 in WCHT and 188 in SHT. The event rate per 100 patient-years was 0.60 in the WCHT group, 0.66 in the NT group and 2.09 in the SHT group. Cox's regression analysis adjusted for covariables showed a higher risk of CV events in patients with SHT than WCHT [hazard ratio (HR)=2.230, 95% confidence interval: 1.339-3.716, P=0.002], whereas there was no difference between WCHT and NT groups. Event-free survival was significantly different from SH versus WCHT and NT groups. Within the group of WCHT, 29% of patients received sustained antihypertensive medication during the follow-up, but the HR of CV events between WCHT either treated or not treated did not differ: HR=0.76 (95% confidence interval: 0.37-1.51, P=0.42). CONCLUSION: In patients with WCHT defined by normal daytime and NBP values, the risk of CV events was significantly lower than that of SHT and similar to that of NT patients, suggesting that NBP should be included in the WCHT definition and in its prognostic stratification.

Unattended versus two attended, ambulatory and central blood pressure measurements in hypertensive patients with and without diabetes.

OBJECTIVE: To compare unattended blood pressure (BP) with two attended BP, with 24-h ambulatory (ABPM) and central BP measurements in hypertensive patients with (DMs) and without diabetes (HTs). METHODS: In the same hypertension clinic we evaluate 129 consecutive HTs (56% female, 59 + 16 yrs) and 91 DMs (62% female, 64 + 9 yrs) who were referred for 24-h ABPM. During 48 hours they underwent a first attended BP (5 minutes resting, 3 recordings 2 minutes apart), (AT1), an unattended BP (UnAT), 3 measurements 2 minutes apart with a pre-programmed oscillometric Omron M10- IT, a second attended BP (AT2) similar to AT1, a 24-h ABPM and an evaluation of central BP (C) from the aortic wave form (SpygmoCor). RESULTS: BP (mm Hg) and differences (Δ) from UnAT = 135/82 ± 17/10 were 1AT = +13.8/3.9 ± 10.3/5.6, AT2 = +7.3/2.9 ± 7.4/4.9, 24-h = -1.3/-1.7 ± 7.5/7.5 and C = -2.4/1.2 ± 10.3/9.1, all p < .01 vs UnAT. Limits of agreement (2 SDs in Bland-Altman plots) were between AT1 and UnAT systolic BP, +34.2 to -6.8 mm Hg and between AT2 and UnAT BP were +21.7 to -7.0 mm Hg. Unattended systolic BP values were similar to that of 24-h in HTs and to that of daytime in DMs. Intraclass correlation coefficients of systolic BP and diastolic BP between UnAT and AT1 and between UnAT and AT2 were within the range 0.78 to 0.83, all p < .01. CONCLUSIONS: In HTs with and without DM the unattended BP significantly underestimates attended BP being more close to ambulatory BP values. These differences should be taken into account since targets based on these BP measurements are not equivalent.

Ambulatory blood pressure monitoring profiles in a cross-sectional analysis of a large database of normotensive and true or suspected hypertensive patients.

OBJECTIVE: To assess ambulatory blood pressure monitoring (ABPM) circadian patterns and their determinants in a large sample of normotensive and hypertensive patients. METHODS: A total of 26170 individual ABPM recordings from 1995 to 2015 were analyzed. Mean office blood pressure (OBP), 24-hour blood pressure (BP), daytime BP and nocturnal BP were measured. Circadian patterns were classified by nocturnal systolic BP fall as extreme dipper (ED, ≥20%), dipper (D, 10%-19.9%), non-dipper (ND, 0%-9.9%), and reverse dipper (RD, <0%). RESULTS: The population were 52% female, aged 58±15 years, mean body mass index (BMI) 27±5 kg/m2. Using ABPM criteria of normalcy, 22.8% were normotensives (NT), 19.1% were untreated hypertensives, 29.7% were controlled hypertensives and 28.4% were treated but uncontrolled hypertensives. Among NT, 60.7% were white-coat hypertensive. In controlled hypertensives 62.4% had OBP ≥140/90 mmHg. In treated but uncontrolled hypertensives 8.2% had masked uncontrolled hypertension. ABPM values were lower than OBP in all cases. In all subgroups the most common pattern was D (42-50%), followed by ND (35-41%), ED (7-11%) and RD (4-11%). Age and BMI were determinants of attenuation of nocturnal BP fall and ND+RD. The proportion of ND+RD was higher in patients with BMI >30 kg/m2 vs. others (46.5 vs. 42.9%, p<0.01) and in those aged ≥65 vs. <65 years (54.9. vs. 33.1%, p<0.00). Nocturnal BP fall was greater in NT than in hypertensives (11.3±6.7 vs. 9.9±7.9%, p<0.000). CONCLUSIONS: There was a marked discrepancy between office and ABPM values. The rates of control on ABPM were more than double those on OBP. Non-dipping occurred in >43%, including in NT. Age and BMI predicted non-dipping.

Association between ambulatory blood pressure values and central aortic pressure in a large population of normotensive and hypertensive patients.

OBJECTIVE: Our aim was to examine the association of ambulatory blood pressure monitoring (ABPM) and central blood pressure (CBP) data in a large set of normotensive and hypertensive patients and its relation with pulse wave velocity (PWV). PATIENTS AND METHODS: This cross-sectional study was carried out in a single centre and included 2864 individuals who carried out an ABPM, measurement of CBP from the aortic waveform (SphygmoCor) and carotid-femoral PWV (Complior). RESULTS: In our study, 26.6% of the normotensive individuals and 32.5% of controlled hypertensive patients had abnormal values of at least one or of both ABPM and CBP values, compared with 96.6% of uncontrolled hypertensive patients. In the overall population, normal ABPM and CBP occurred in 25.3% (group 1), abnormal ABPM and CBP occurred in 44.4% (group 4), abnormal ABPM and normal CBP occurred in 10.5% (group 3) and normal ABPM and abnormal CBP occurred in 19.8% (group 2). PWV was significantly superior in group 4 versus group 3; group 4 versus group 1 and group 3 versus group 2 and group 2 versus group 1 (Mann-Whitney U-test; P<0.001). CONCLUSION: At least 26-32% of patients classified as normotensive or controlled hypertensive patients have abnormal ABPM or CBP associated with target organ damages. When abnormal values of ABPM and CBP coexist, target organ damage (aortic stiffness) is greater than that occurring when only one abnormal ABPM or CBP is present in the absence of the other. Isolated central hypertension entails greater organ damage than both normal ABPM and CBP. These patients may be at higher risk of further target organ damage because of unawareness of their central hypertension.

[Assessment of central hemodynamic properties of the arterial wall in women with previous preeclampsia]. / Avaliação das propriedades dinâmicas da pressão arterial em mulheres com antecedentes de pré-eclâmpsia.

BACKGROUND: We investigated viscoelastic properties of the arterial wall in women with previous preeclampsia (PE) compared to those with normal pregnancy (NP). METHODS: In a cross-sectional study 45 women with previous PE and 55 with NP were included, matched for age (PE 38±6 vs. NP 38±5 years, NS) and body mass index: (PE 25±4 vs. NP 26±4 kg/m(2), NS) studied, respectively, 76±34 and 86±48 months after delivery. We assessed arterial distensibility - pulse wave velocity (PWV, Complior) and reflected waves (augmentation pressure [AP], mmHg) and augmentation index (AIx) - in the central pressure wave and blood pressure (BP) on 24-h ambulatory BP monitoring (ABPM). RESULTS: PE showed higher (p<0.01) peripheral systolic blood pressure (SBP): PE 131±18 vs. NP 121±19, and central SBP: PE 122±18 vs. NP 110±19 mmHg, with less amplification of central-peripheral pressure: PE 10±4 vs. NP 12±5, p=0.041, and higher (p<0.05) AP: PE 10±3 vs. NP 8±2, and AIx: PE 26±5 vs. NP 20±5 mmHg, but PE and NP did not differ in pulse wave velocity. On ABPM, PE (n=39) vs. NP (n=33) had higher nighttime SBP: PE 121±10 vs. NP 108±10 mmHg and lower percentage nocturnal SBP fall: PE 11±6 vs. NP 18±11%, both p<0.02. During follow-up, the need for antihypertensive medication was seven times higher in PE than in NP. CONCLUSION: Women with previous PE have a greater risk of hypertension, higher nighttime BP values, blunted nocturnal BP fall and changes in central pressure suggestive of increased reflected waves and peripheral vascular resistance. These factors may contribute to their higher cardiovascular risk after pregnancy.

Association of 24-h urinary salt excretion with central haemodynamics and assessment of food categories contributing to salt consumption in Portuguese patients with hypertension.

OBJECTIVE: High salt intake has been associated with the development of arterial hypertension, but it still remains controversial as to how salt consumption relates with central haemodynamics and central pressures. For interventional purposes, it is crucial to identify the main food categories that contribute toward high salt consumption. METHODS: In 638 Caucasian hypertensive patients (age 50±15 years, 329 women) enrolled for 7 years, we evaluate the independent relationship between urinary sodium (UNa, mean 207±78 mEq/24 h) or potassium (UK, mean 79±26 mEq/24 h) excretion measured in validated 24-h samples and office blood pressure (BP), 24 h BP, central pulse pressure, and parameters of central pulse wave analysis. A subgroup (n=154) of this population (UNa, mean 205±75 mEq/24 h) was also subjected to structured validated food frequency questionnaires on dietary habits. RESULTS: Multiple regression analysis showed that UNa was associated independently with increases in 24-h systolic BP, central pulse pressure, and augmented aortic augmentation index (AIx) and associated inversely with pulse pressure amplification. In the subgroup, patients of the upper tercile of distribution of UNa (288±21 mEq/24 h) ate significantly higher amounts (g/day) of vegetables, sauces, bread, cheese, fries and sausages/cold meat, yielding an estimation that bread could account for 20-27% of all daily salt intake. CONCLUSION: Reduction of salt intake on the basis of the main food sources that we have identified could also influence cardiovascular risk throughout effects on 24-h and central pressures.

Different patterns of peripheral versus central blood pressure in hypertensive patients treated with ß-blockers either with or without vasodilator properties or with angiotensin receptor blockers.

BACKGROUND: It is unclear whether the assumed inferiority of atenolol to reduce central (aortic) blood pressure (BP) extends to other ß-blockers with vasodilating properties and, within that scope, how these drugs differ from the angiotensin receptor blockers (ARBs). METHODS: In a retrospective study, we compared three groups of hypertensive patients (aged 35-65 years) chronically treated with either ARBs (n=83, group 1), carvedilol/nebivolol (n=75, 25+25 mg/day/5 mg/day, group 2) or atenolol (n=84, 50-100 mg/day, group 3), matched for age (mean 52 years), sex (61% female), brachial BP and concomitant use of diuretics (75-81%)and dihydropyridine calcium antagonists (27-33%). We measured aortic stiffness by pulse wave velocity (Complior), and central BP, central-peripheral pulse pressure amplification, wave reflection [augmentation index (AIx) corrected for heart rate] and augmentation pressure (Sphygmocor). RESULTS: For similar age, sex distribution, brachial BP levels (145/85±11/10 mmHg) and pulse wave velocity (10±2 m/s), the atenolol group showed significantly (P<0.03 analysis of variance) higher central systolic BP (139±9 mmHg) versus group 2 (135±10 mmHg) and group 1 (132±11 mmHg), higher AIx (34±12%) versus group 2 (27±7%) and group 1 (23.0±9%), lower pulse pressure amplification (1.16±0.09) versus group 2 (1.22±0.10) and group 1 (1.31±0.11) and lower heart rate beats/min (61±9) versus group 2 (69±11) and group 1 (82±11). The differences on these values, between group 2 and group 1, were also significant (P<0.04). After adjustment for the heart rate, AIx became similar in groups 2 and 1, but still lower (P<0.04) than the atenolol group. CONCLUSION: These findings suggest that, for similar brachial BP and aortic stiffness, treatment with either vasodilating ß-blockers or angiotensin receptor blockers associates with lower central systolic BP and wave reflections than treatment with atenolol. These findings may suggest that the vasodilating ß-blockers may exert more favourable central haemodynamic effects, compared with atenolol, which are more alike, although not completely equal, to those of the ARBs.

Improvement of aortic reflection wave responses 6 months after stopping smoking: a prospective study.

BACKGROUND: Cigarette smoking is one important preventable cause of cardiovascular illness that has been associated with increased stiffness of large arteries and wave reflection, which are independent predictors of cardiovascular disease. METHODS: We investigated the effect of a 6-month quitting smoking programme on aortic stiffness, central pressure and wave reflections in chronic heavy smokers. Seventy-one (83% normotensives) long-term heavy smokers [>20 cigarettes/day and exhaled carboxy haemoglobin (COHb) (> or =4% and CO ppm > or =21)] completed a 6-month psychological-based stop-smoking program. Patients were divided into two groups. Thirty-one patients aged 45+/-2 years, 71% male, fully quit smoking for 6 months (COHb <2% and CO ppm <10 at 1, 3 and 6 months)--group I, whereas 40 patients aged 45+/-1 years, 73% male, did not change their smoking habits--group II. We measured between baseline and changes after 6 months in aortic stiffness assessed as pulse wave velocity (Complior), central-peripheral pulse pressure (PP) amplification ratio (PPAr), wave reflection (augmentation index corrected for heart rate), augmentation pressure and transit time (Sphygmocor). Ambulatory 24 h blood pressure (ABP) data were obtained at baseline and after 6 months in 36 patients (n = 19) of group I and 17 of group II. RESULTS: In group I, but not in group II, there were significant reductions of peripheral systolic BP (baseline: 131+/-4 to after 6 months: 127+/-4 mmHg, P<0.04) and of systolic BP (baseline: 121+/-4 to after 6 months: 114+/-4 mmHg, P<0.03). In group I from baseline to after 6 months, PPAr increased by 13.1+/-4.1% and transit time (ms) by 8.7+/-2.9%; augmentation index was reduced by 9.2+/-1.6%, augmentation pressure by 5.7+/-1.9 mmHg (all P<0.03 vs. baseline and vs. group II); and pulse wave velocity by 2.3+/-2.8% (P = 0.062). In group I, only daytime ABP was reduced from baseline to after 6 months (129/82+/-2/2 to 123/78+/-2/2 mmHg, P<0.03), whereas no change in 24h-ABP was found in group II. CONCLUSION: Six months of smoking cessation is associated with clear improvement of reflected waves, central pressure and aortic stiffness, and with a reduction of daytime BP. This may contribute to the improvement of cardiovascular prognosis attributed to smoking cessation.

Estimation of salt intake by urinary sodium excretion in a Portuguese adult population and its relationship to arterial stiffness.

BACKGROUND: Portugal has one of the highest mortality rates from stroke, a high prevalence of hypertension and probably a high salt intake level. AIM: To evaluate Portuguese salt intake levels and their relationship to blood pressure and arterial stiffness in a sample of four different adult populations living in northern Portugal. METHODS: A cross-sectional study evaluating 24-hour urinary excretion of sodium (24 h UNa+), potassium and creatinine, blood pressure (BP), and pulse wave velocity (PWV) as an index of aortic stiffness in adult populations of sustained hypertensives (HT), relatives of patients with previous stroke (Fam), university students (US) and factory workers (FW), in the context of their usual dietary habits. RESULTS: We evaluated a total of 426 subjects, mean age 50 +/- 22 years, 56% female, BMI 27.9+/-5.1, BP 159/92 mmHg, PWV 10.4+/-2.2 m/s, who showed mean 24h UNa+ of 202 +/- 64 mmol/d, corresponding to a daily salt intake of 12.3 g (ranging from 5.2 to 24.8). The four groups were: HT: n = 245, 49 +/- 18 years, 92% of those selected, 69% treated, BP 163/94 mmHg, PWV 11.9 m/s, 24 h UNa+ 212 mmol/d, i.e. 12.4 g/d of salt); Fam: n = 38, 64 +/- 20 years, 57 % of those selected, BP 144/88 mmHg, PWV 10.5 m/s, 24 h UNa+ 194 mmol/d, i.e. 11.1 g/d of salt; US: n = 82, 22 +/- 3 years, 57% of those selected, BP 124/77 mmHg, PWV 8.7 m/s, 24h UNa+ 199 mmol/d, i.e. 11.3 g/d of salt; FW: n = 61, 39 9 years, 47% of those selected, BP 129/79 mmHg, PWV 9.5 m/s, 24 h UNa+ 221 mmol/d, i.e. 12.9 g/d of salt. The ratio of urinary sodium/potassium excretion (1.9 (0.4) was significantly higher in HT than the other three groups. In the 426 subjects, 24h UNa+ correlated significantly (p < 0.01) with systolic BP (r = 0.209) and with PWV (r=0.256) after adjustment for age and BP. Multivariate analysis showed that BP, age and 24h UNa+ correlated independently with PWV taken as a dependent variable. CONCLUSIONS: Four different Portuguese populations showed similarly high mean daily salt intake levels, almost double those recommended by the WHO. Overall, high urinary sodium excretion correlated consistently with high BP levels and appeared to be an independent determining factor of arterial stiffness. These findings suggest that Portugal in general has a high salt intake diet, and urgent measures are required to restrict salt consumption in order to prevent and treat hypertensive disease and to reduce overall cardiovascular risk and events.

Blood pressure on arising, morning blood pressure surge and blood pressure variability in white coat hypertensives and in matched normotensives and sustained hypertensives.

INTRODUCTION: It is still controversial whether subjects with white-coat hypertension (WCHT) exhibit higher cardiovascular risk compared to normotensive subjects (NT). In subjects with WCHT it is not known whether the abnormal blood pressure (BP) reaction in the office also occurs at other times of day, particularly on arising and immediately after waking, i.e. the times at which the majority of cardiovascular events are reported to occur. OBJECTIVE AND METHODS: To evaluate with 24h ambulatory BP measurement the values of morning BP surge, BP on arising and BP variability in subjects with WCHT in comparison with age-, gender- and weight-matched normotensives (BP) and untreated sustained hypertensives (BP). RESULTS: Groups of BP, WCHT and BP were matched for age, gender and body weight: BP: n=69, age 49 +/- 7 years, 54 % female, BMI 26 +/- 1, casual BP 126/79 +/- 5/4 mmHg, daytime BP 124/80 +/- 6/6 mmHg; WCHT: n=74, age 52 +/- 8 years, 57% female, BMI 26 +/- 2, casual BP 152/95 +/- 7/7 mmHg, daytime BP 126/80 +/- 5/6 mmHg; HT: n=79, age 53 +/- 7 years, 56% female, BMI 27 +/- 2, casual BP 154/97 +/- 9/8 mmHg, daytime BP 143/89 +/- 12/10 mmHg. Of the three groups, subjects with WCHT exhibited BP on arising (121/81 +/- 13/8 mmHg) similar to that of NTs (120/80 +/- 13/9 mmHg, NS), both significantly lower than that of HTs (137/92 +/- 17/10 mmHg, p < 0.01), suggesting the absence of an alerting BP reaction in WCHT at that time. By contrast, subjects with WCHT showed higher values of systolic morning BP surge vs. NTs (25 +/- 10 vs. 22 +/- 11 mmHg, p < 0.05), both lower than that observed in hypertensives (33 +/- 11 mmHg, p < 0.01 vs. NT and WCHT) and greater daytime variability (systolic BP standard variation), i.e. 12 2 vs. 10 +/- 2 mmHg, p < 0.05, both lower than that observed in hypertensives (14 +/- 3 mmHg, p < 0.01 vs. NT and WCHT). CONCLUSIONS: Although subjects with WCHT did not show any alerting blood pressure reaction on arising, morning BP surge and BP variability were greater in these subjects than in control normotensives, although lower than sustained hypertensives. Although this is still speculative, we cannot exclude the possibility that even a slight increase in morning BP surge might in the long term constitute an additional load on the circulation that could increase cardiovascular risk in subjects with WCHT compared to matched normotensives.

Morning rise, morning surge and daytime variability of blood pressure and cardiovascular target organ damage. A cross-sectional study in 743 subjects.

OBJECTIVE: To evaluate in a large population the relationship between cardiovascular target organ damage and values of the night-to-morning rise of systolic blood pressure (MR-BP), the morning surge of BP at the moment of rising (BP surge) and daytime BP variability (standard deviation [SD] of daytime BP). METHODS: This was a cross-sectional study, evaluating 743 subjects, aged 30-75 years, 416 female, with normal renal function and no previous cardiovascular events. The population included: I-174 patients with type 2 diabetes, II-317 hypertensive patients with ongoing treatment over at least the previous 6 months, III-127 hypertensive patients untreated in the last 6 months, IV-125 healthy normotensive subjects. All underwent 24-hour ambulatory BP monitoring to calculate MR-BP, BP surge and SD of daytime BP. Target organ evaluation included: pulse wave velocity (PWV) (an indicator of aortic stiffness) in 711 subjects, left ventricular mass index (LVMI) in 185 subjects and 24-hour albuminuria in 239 subjects. RESULTS: In the population as a whole, BP surge, MR-BP and SD of daytime BP correlated significantly with PWV (r = 0.434, p < 0.0001; r = 0.126, p < 0.001; 0.337, p < 0.001, respectively), with LVMI (r = 0.447, p < 0.0001; r = 0.307, p < 0.001; 0.162, p < 0.05, respectively) and to a lesser degree with albuminuria (r = 0.126, p < 0.05; r = 0.083, NS; 0.082, NS, respectively). In the upper quintile of distribution of BP surge, the percentage of cases with abnormal PWV (>12 m/s) (21%), cardiac hypertrophy (53 %) and microalbuminuria (47 %) was significantly greater (p < 0.03) than that observed in the lower quintile (1%, 14% and 27%, respectively). BP surge correlated more strongly with indices of target organ damage than did MR-BP or SD of daytime BP, independently of night-time BP and nocturnal BP fall. CONCLUSIONS: In this large population, MR-BP, BP surge and daytime BP variability are strongly correlated with target organ damage severity, and are probably related to organ deterioration. Of the three, morning surge of BP at the moment of rising is more strongly related to organ damage than MR-BP, perhaps because unlike MR-BP, BP surge is independent of night-time BP values.

Relationship between aortic stiffness and cardiovascular risk factors in a population of normotensives, white-coat normotensives, white-coat hypertensives, sustained hypertensives and diabetic patients.

OBJECTIVE: To evaluate the relationship between carotid-femoral pulse wave velocity (PWV) and office and ambulatory blood pressure (ABP) and other cardiovascular risk factors and to determine the discriminatory value of PWV in a large population including normotensive subjects (NT), white-coat normotensives (masked hypertension) (WCNT), and white-coat hypertensives (WCHT) compared to a group of treated and untreated hypertensive patients. METHODS: The study population included a total of 688 subjects aged from 18 to 80 years, with no previous cardiovascular events, who underwent 24 h ABP monitoring, biochemical evaluation and determination of PWV and left ventricular mass index (LVMI). Subjects were classified as true normotensives (NT, n=132; normal office and ABP values), WCNT (n=39; office BP < 140/90 and daytime BP > or =135 or > or =85 mmHg), WCHT (n=87; office BP > or =140 or > or =90 and daytime BP < 135/85 mmHg). Untreated (UT-HT, n=154) and treated (T-HT, n=171) hypertensive patients and type 2 diabetic patients (DM, n=102) were also studied. RESULTS: Values of PWV (m/s) in all groups were, in ascending order: NT (8.9 +/- 0.2) < WCHT (9.9 +/- 0.2) < T-HT (11.4 +/- 0.2) = WCNT (11.5 +/- 0.4) < UT-HT (11.9 +/- 0.3) < DM (12.6 +/- 0.4) (ANOVA, p = 0.043), and of LVMI (g/m2): NT (59 +/- 2) = WCHT (63 +/- 2) < WCNT (73 +/- 3) = T-HT (75 +/- 3) = UT-HT (77 +/- 3) < DM (84 +/- 4) (ANOVA, p < 0.05). The percentage of subjects with PWV values below the median (10.7 m/s) was higher (p < 0.02) in NT (81.8%) and WCHT (72.6%) than in UT-HT (49.2%), T-HT (43.6%), WCNT (47.6%) and DM (27.7%). In multiple regression analysis, taking PWV as the dependent variable, age (all groups), 24h systolic BP (UT-HT, T-HT, WCNT and DM) and 24h diastolic BP (NT and WCHT) were the variables that independently influenced the PWV value. CONCLUSIONS: Higher values of PWV occur in clinical situations associated with higher cardiovascular risk. This is in agreement with risk stratification based on ABP values but not on office BP values. Lower PWV and LVMI values occur in NT and WCHT subjects, supporting a low cardiovascular risk in these groups. By contrast, higher PWV values were associated with higher ABP values in DM, hypertensive patients and white-coat normotensives, i.e. clinical situations that are associated with higher cardiovascular risk, who in the present study also exhibited higher LVMI than subjects with normal ABP values.

Different influences on central and peripheral pulse pressure, aortic wave reflections and pulse wave velocity of three different types of antihypertensive drugs.

OBJECTIVE: To evaluate in hypertensive patients (pts) with similar peripheral blood pressure (BP) whether different antihypertensive treatments have different influences on aortic stiffness, aortic central pressures and aortic wave reflections. METHODS: In a cross-over study 41 nondiabetic hypertensives (21 women, age 35-60 yrs) were evaluated after stabilized (> 4 months) antihypertensive treatment and with casual BP between 130/80 and 160/95 mmHg. Patients were divided into 3 groups: Group I--12 pts all medicated with beta-blockers; Group II--14 pts all medicated with calcium channel blockers; Group III--15 pts all medicated with either angiotensin-converting enzyme inhibitors (ACEIs) (n = 8) or angiotensin II receptor blockers (ARBs) (n = 7). We evaluated casual BP and carotid-femoral pulse wave velocity (PWV). Systolic blood pressure (SBP) and pulse pressure (PP), left ventricular ejection duration (LVED), augmentation pressure (delta P) and augmentation index (AI%) in the aorta (a measure of aortic wave reflection), derived using radial and carotid applantation tonometry, were measured. Data are means + SEM. RESULTS: For similar casual peripheral BP values, group III vs. group I showed lower (p < 0.05) values of: aortic stiffness--PWV (10.3 +/- 0.2 vs. 11.2 +/- 0.3 m/s), central PP (48 +/- 2 vs. 55 +/- 2 mmHg), delta TP (11 +/- 3 vs. 21 +/- 3 mmHg), LVED (297 +/- 5 vs. 319 +/- 8 ms), AI% (22 +/- 4 vs. 39 +/- 3%), suggesting reduced vascular tone in the arteries and greater brachial-aortic PP amplification. Data in group II did not differ significantly from the other two groups. CONCLUSIONS: Independently of casual BP values, the three classes of antihypertensive drugs appear to have different influences on aortic stiffness, central pressures and aortic wave reflections, ACEIs or ARBs appearing to exhibit a more favorable profile.