Relationship between home blood pressure and vascular function in patients receiving antihypertensive drug treatment

Area of Science:

• Cardiovascular Medicine
• Hypertension Research
• Vascular Biology

Background:

• Hypertension is a major risk factor for vascular dysfunction, including arterial stiffness and endothelial impairment.
• Antihypertensive medications aim to control blood pressure but their impact on specific vascular parameters requires further investigation.
• Out-of-office blood pressure monitoring provides a comprehensive assessment of blood pressure variability and its association with vascular health.

Purpose of the Study:

• To examine the relationship between out-of-office blood pressure patterns and vascular function in patients undergoing antihypertensive treatment.
• To determine if specific out-of-office blood pressure profiles (daytime, nocturnal, sustained hypertension) correlate with arterial stiffness and endothelial function.

Main Methods:

• 169 patients on antihypertensive drugs were assessed for out-of-office blood pressure using home monitoring.
• Vascular function was evaluated using brachial-ankle pulse wave velocity (baPWV) for arterial stiffness, and flow-mediated vasodilation (FMD) and nitroglycerine-induced vasodilation (NID) for endothelial and smooth muscle function.
• Patients were categorized into normotension, isolated nocturnal hypertension, isolated daytime hypertension, and sustained hypertension groups.

Main Results:

• Brachial-ankle pulse wave velocity (baPWV) was significantly elevated in patients with sustained hypertension compared to other groups (P < 0.001).
• A baPWV cutoff value of 1858 cm/s predicted sustained hypertension, showing a significant association (OR, 5.01; P < 0.001) after adjusting for confounders.
• No significant association was found between home blood pressure status and flow-mediated vasodilation (FMD) or nitroglycerine-induced vasodilation (NID).

Conclusions:

• In patients receiving antihypertensive drugs, sustained hypertension is significantly associated with increased arterial stiffness (baPWV).
• Flow-mediated vasodilation (FMD) and nitroglycerine-induced vasodilation (NID) were impaired irrespective of home blood pressure status in this cohort.
• Brachial-ankle pulse wave velocity (baPWV) may serve as a valuable indicator of sustained hypertension and associated vascular stiffness in patients on antihypertensive therapy.