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Ambulatory Blood Pressure Phenotypes, Arterial Stiffness, and Cardiac Remodeling
Cesare Cuspidi1, Rita Facchetti1, Elisa Gherbesi2
1Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
Insights
Arterial stiffness and left ventricular hypertrophy increase sustained hypertension risk. Combining these markers improves sustained hypertension identification in the general population, aiding clinical management.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Diagnostic Biomarkers
Background:
- Limited evidence exists on arterial stiffness and left ventricular (LV) remodelling/hypertrophy (LVH) in relation to abnormal blood pressure (BP) phenotypes in the community.
- This study investigates the association between vascular and cardiac organ damage and BP phenotypes in the Pressioni Monitorate E Loro Associazioni (PAMELA) study cohort.
Purpose of the Study:
- To assess the relationship between arterial stiffness (measured by Cardio-Ankle Vascular Index - CAVI) and LV remodelling/LVH with different blood pressure phenotypes.
- To determine the incremental value of combined vascular and cardiac organ damage in identifying sustained hypertension (SH).
Main Methods:
- Analysis of 491 participants from the PAMELA study with 10 and 25-year follow-ups.
- Data included medical history, anthropometrics, blood tests, office BP, ambulatory BP monitoring (ABPM), echocardiography, and CAVI measurements.
Main Results:
- Prevalence rates: sustained normotension (31.2%), white coat hypertension (10.0%), masked hypertension (24.2%), sustained hypertension (34.6%), and non-dipping (35.8%).
- Increased CAVI and LV remodelling/LVH were associated with a four-fold higher likelihood of sustained hypertension (OR=4.31).
- Combined markers showed incremental value in discriminating SH compared to isolated markers.
Conclusions:
- Vascular and cardiac target organ damage are valuable in optimizing the identification of sustained hypertension.
- This approach can enhance the clinical management of sustained hypertension in the general population.
Background:
Evidence on the association of arterial stiffness and left ventricular (LV) concentric remodelling/LVH assessed by echocardiography, with abnormal blood pressure (BP) phenotypes, defined by office and ambulatory BP monitoring (ABPM) in the community is scanty. Thus, we investigated this issue in the participants to the Pressioni Monitorate E Loro Associazioni (PAMELA) study.
Methods:
The present study included 491 participants who attended the second and third survey of the PAMELA study performed after 10 and 25 years from the initial evaluation. Data collection included medical history, anthropometric parameters, blood examinations, office, ABPM, echocardiographic and Cardio-Ankle Vascular Index (CAVI) measurements.
Results:
In the whole study sample (age 66+10 years, 50% males), the prevalence rates of sustained normotension (NT), white coat hypertension (WCH), masked hypertension (MH), sustained hypertension (SH) and non-dipping (ND) were 31.2, 10.0, 24.2, 34.6, and 35.8% and respectively. The likelihood of having SH, the BP phenotype carrying the greatest CV risk, was four times higher (OR= 4.31, CI:2.39-7.76, p<0.0001) in participants with increased CAVI and LV remodelling/LVH compared to their counterparts without organ damage. This association showed an incremental value in discriminating SH compared to both isolated markers of organ damage (OR=1.92,p=0.03 for increased CAVI and OR= 2.02, p=0.02 for LV remodelling/LVH). The presence of isolated but also combined organ damage was unrelated to ND.
Conclusions:
Our study provides new evidence of the incremental value of looking for both vascular and cardiac target organ damage to optimize the identification and clinical management of SH in the general population.
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