Admission blood pressure response as an indicator of hypertensive risk

In this retrospective study we aimed to identify from 50 outpatient (OP) mild hypertensives without clinical evidence of target organ damage (TOD), a group with unsustained hypertension in order to see whether they had less echocardiographic TOD than patients with sustained hypertension. Following OP assessment, patients were admitted to a hospital ward and BP was measured after 30 minutes' rest. In 21 patients (fallers) BP fell after admission and in 29 (non-fallers) BP either rose or remained the same (fallers = 164/102 OP v 152/93 mmHg hospital, non-fallers = 165/102 OP v 168/105 mmHg hospital, P less than 0.001 for SBP/DBP differences between the groups on hospitalisation). During the whole day after admission, ambulatory intra-arterial pressure (IABP) was consistently lower in the fallers (137/88 v 148/93 mmHg, P less than 0.04 for SBP, P = NS for DBP) and systolic variability was slightly but significantly higher (18 v 16 mmHg P = 0.05). Echocardiographically-assessed left ventricular mass index (LVMI) was significantly higher in the non-fallers (117 v 101 g/m2 P = 0.03) and correlated positively with mean systolic IABP in both groups although this only reached significance in the non-fallers (n = 25, r = 0.53 P less than 0.01 nonfallers v n = 18 r = 0.42 P = NS fallers). We believe the less sustained pressure of the fallers was responsible for their lower LVMIs and that an exaggerated defence reaction was operating when they were outpatients which relaxed following 30 minutes' rest in hospital. The study demonstrates the importance of sustained hypertension in the development of hypertensive cardiac TOD.