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[Target organ effects in untreated hypertension]
D Babici1, I M'Pio, A Hadj-Aïssa
1Département de néphrologie et d'hypertension artérielle, hôpital Edouard Herriot, Université C. Bernard Lyon 1, EA 645, 69437 Lyon.
Insights
Untreated hypertension can cause early kidney and heart damage, especially in permanent hypertensives. Ambulatory blood pressure monitoring is crucial for identifying these risks, as white coat hypertensives show no significant organ effects.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Context:
- Systemic hypertension often leads to renal and cardiac complications, yet parallel investigations in untreated individuals are rare.
- Differentiating between white coat hypertension and sustained hypertension is critical for understanding target organ effects.
Purpose:
- To assess renal function (glomerular filtration rate, renal plasmatic debit, microalbuminuria) and cardiac function (left ventricular mass index) in never-treated hypertensive patients.
- To compare renal and cardiac parameters between white coat hypertensives, permanent hypertensives, and normotensive subjects based on 24-hour blood pressure.
Summary:
- Permanent hypertensives exhibited reduced renal plasmatic debit, increased microalbuminuria, and higher left ventricular mass index compared to normotensives and white coat hypertensives.
- White coat hypertensives showed normal renal function, while permanent hypertensives had significantly impaired glomerular filtration rate and renal plasmatic debit.
- Ambulatory systolic blood pressure correlated with microalbuminuria and left ventricular mass index in all hypertensive subjects, indicating a continuum of organ effects.
Impact:
- Ambulatory blood pressure monitoring is essential for detecting early renal and cardiac damage in permanent hypertensives.
- This study highlights that white coat hypertension does not appear to cause significant early target organ damage.
- Findings underscore the importance of continuous blood pressure monitoring for personalized hypertension management and risk stratification.
Abstract:
The parallel investigation of the renal and cardiac complications of recent and never treated systemic hypertension has only rarely been undertaken. The aim of this study was to define the renal function of never treated hypertensive subjects, separated into white coat hypertensives (HTbb: n = 19, BP at consultation 153/97 mmHg) or permanent hypertensives (HT: n = 49, BP at consultation 169/104 mmHg) as a function of their 24 hour BP. Their renal functions were then compared with those of normotensive subjects (NT: n = 10). The 68 hypertensive subjects seen consecutively underwent renal function investigation (DFG: glomerular filtration rate, DPR: renal plasmatic debit, and muAlb: microalbuminuria over 24 hours), and myocardial echography (measurement of the left ventricular mass index, IMVG). The white coat hypertensives had a normal renal function, while the permanent hypertensives had a significant decrease in DPR and a significantly higher muAlb compared to the normotensives. Compared to the white coat hypertensives, the permanent hypertensives had a significantly lower DFG and DPR, as well as a higher muAlb and IMVG. In all the hypertensives (white coat and permanent) the 24 hour systolic BP was significantly correlated with muAlb (r = 0.51, p < 0.001), filtration fraction (r = 0.30, p < 0.05), and IMVG (r = 0.52, p < 0.001). The renal and myocardial parameters were not significantly correlated. In conclusion, there seems to be a continuum between the level of ambulatory BP and the effect on target organs without a parallel progression of the renal and myocardial effects. From a practical point of view, only ambulatory BP measurement allows differentiation of permanent hypertensives who have a very early renal and/or myocardial effect, while white coat hypertensives are spared.