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Blood pressure and organ damage
1Istituto di Clinica Medica Generale e Terapia Medica, Università di Milano, Italy.
Insights
Casual blood pressure readings offer limited insight into cardiovascular risk. Continuous 24-hour monitoring, including blood pressure variability, better predicts target organ damage in hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Measurement
Background:
- Casual blood pressure measurements have limited predictive value for cardiovascular complications, especially in mild hypertension.
- Blood pressure is dynamic and influenced by measurement conditions, making casual readings a biased assessment of risk.
- Advances in ambulatory blood pressure monitoring (ABPM) provide better insights into daily blood pressure fluctuations.
Purpose of the Study:
- To correlate target organ damage in hypertensive patients with blood pressure values obtained via cuff sphygmomanometry and 24-hour intraarterial monitoring.
- To investigate the relationship between blood pressure variability and organ damage in hypertensive individuals.
Main Methods:
- Utilized portable equipment for continuous intraarterial blood pressure recording in 108 hypertensive patients.
- Correlated target organ damage with both cuff blood pressure measurements and various indices from 24-hour intraarterial blood pressure monitoring.
Main Results:
- Twenty-four-hour blood pressure means showed a closer relationship with the incidence and severity of target organ damage compared to cuff values.
- Blood pressure variability, derived from 24-hour monitoring, was also found to be significantly related to target organ damage.
Conclusions:
- Twenty-four-hour intraarterial blood pressure monitoring provides a more accurate assessment of cardiovascular risk than casual measurements.
- Blood pressure variability is an independent predictor of target organ damage in hypertensive patients, highlighting its clinical significance.
Abstract:
Casual blood pressure measurements can predict the development of cardiovascular morbidity and mortality, but especially in mild hypertension the correlation indices between casual measurements of blood pressure and the subsequent occurrence of complications are low. Casual and office blood pressure measurements, however, provide a very limited and biased assessment of blood pressure as a risk factor since blood pressure is known to change from moment to moment and to be influenced by its very measurement. Considerable advances in our understanding of the factors influencing blood pressure during daily life and in assessing blood pressure variability have been made possible by use of portable equipment for continuous intraarterial recording of blood pressure. Equipment for noninvasive ambulatory blood pressure monitoring is also available; this equipment is more practical than intraarterial equipment, but is associated with some degree of error and several limitations. Data are reported from a recent study conducted by our group in which target organ damage in 108 hypertensive patients was correlated with blood pressure values as measured by a cuff sphygmomanometer and with various indices derived from 24-h intraarterial blood pressure monitoring. The findings indicate that the incidence and severity of organ damage are more closely related to 24-h blood pressure means than to cuff values. They also provide the first unequivocal evidence that target organ damage also relates to blood pressure variability.