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Relationship between initial cardiovascular structural changes and daytime and nighttime blood pressure monitoring
D Rizzoni1, M L Muiesan, G Montani
1Department of Medical Sciences, University of Brescia, Italy.
Insights
Ambulatory blood pressure monitoring (ABPM) better predicts target organ damage in hypertension than clinic readings. Elevated ABPM and blood pressure variability are linked to cardiac and vascular structural changes.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Background:
- Clinic blood pressure measurements may not fully capture the cardiovascular risk associated with hypertension.
- Ambulatory blood pressure monitoring (ABPM) offers a more comprehensive assessment of blood pressure patterns.
- Target organ damage in hypertensive patients often correlates with average blood pressure over 24 hours.
Purpose of the Study:
- To investigate the correlation between ambulatory blood pressure monitoring (ABPM) values and cardiac/vascular structural changes.
- To compare the predictive value of ABPM versus clinic blood pressure for organ damage.
- To explore the relationship between blood pressure variability and arterial structural alterations.
Main Methods:
- Echocardiography was used to assess cardiac anatomy (left ventricular mass) in 91 subjects (23 normotensive, 68 hypertensive).
- Forearm minimal vascular resistance was calculated as an index of arterial structural changes.
- Blood pressure was measured using both clinic readings and noninvasive ABPM, with correlations analyzed against cardiac and vascular parameters.
Main Results:
- Left ventricular mass showed a stronger correlation with average 24-hour, daytime, or nighttime ABPM than with clinic blood pressure.
- Minimal vascular resistance correlated significantly with ABPM values and blood pressure variability.
- Patients with non-dipping blood pressure patterns exhibited higher minimal vascular resistance and left ventricular mass.
Conclusions:
- Elevated average ABPM values are associated with increased left ventricular mass.
- Increased blood pressure variability may be linked to vascular structural changes.
- Further research is needed to determine if cardiac hypertrophy and vascular changes are causes or consequences of hypertension and variability.
Abstract:
It has been shown that in hypertensive patients the degree of target organ damage correlates more closely with average blood pressure as recorded by ambulatory monitoring (ABPM) throughout 24 h than with clinic blood pressure. We examined a group of 91 clinically healthy subjects, 23 normotensives and 68 hypertensives according to clinic blood pressure. Cardiac anatomy was investigated by echocardiography. As an index of arterial structural changes forearm minimal vascular resistance was calculated from mean arterial pressure and maximal postischemic blood flow, as assessed by venous occlusion plethysmography. The results were correlated to clinic blood pressure or ABPM values (measured by noninvasive ABPM ICR 5200, Spacelabs, Bellevue, CA). Left ventricular mass was correlated more closely with the average blood pressure recorded during 24 h, or during daytime or nighttime periods, than with clinic blood pressure. Minimal vascular resistance was also significantly correlated to ABPM values, but the correlation was similar to that observed with clinic blood pressure. Minimal vascular resistance was significantly correlated to blood pressure variability, as evaluated by the standard deviation of the mean. Minimal vascular resistance and left ventricular mass were higher in a subgroup of patients in whom blood pressure was not significantly reduced during the night. The results of this study confirm that elevated average ABPM values are associated to higher left ventricular mass; in addition, they suggest that increased blood pressure variability may be associated with vascular structural changes, as evaluated by minimal vascular resistance. It remains to be clarified whether cardiac hypertrophy and/or vascular structural changes are a cause or consequence of increased blood pressure values and variability.