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[Ambulatory blood pressure, intima media thickness, global cardiovascular risk and therapeutic decisions]
1Service de médecine interne et d'hypertension artérielle, Pavillon Turiaf, CHU Purpan, Toulouse.
Insights
Ambulatory blood pressure monitoring (ABPM) and carotid intima media thickness (IMT) significantly influence hypertension treatment strategies. Global cardiovascular risk alone does not dictate therapy, but impacts vascular remodeling.
Area of Science:
- Cardiology
- Hypertension Management
- Vascular Biology
Context:
- Essential, uncomplicated hypertensive patients require tailored treatment strategies.
- Ambulatory blood pressure monitoring (ABPM) and carotid intima media thickness (IMT) are key indicators of cardiovascular health.
- Global cardiovascular risk assessment aids in understanding long-term patient prognosis.
Purpose:
- To investigate the impact of ABPM, IMT, and global cardiovascular risk on hypertension treatment decisions.
- To differentiate therapeutic strategies based on objective patient data.
- To identify predictors of treatment intensity in a hypertension unit.
Summary:
- Fifty-four never-treated hypertensive patients were categorized into lifestyle counseling, single-drug, or combination therapy groups.
- Ambulatory blood pressure and carotid intima media thickness were significantly higher in the combination therapy group.
- Global cardiovascular risk did not directly correlate with therapeutic decisions, but influenced vascular remodeling.
Impact:
- Treatment strategies are primarily driven by ambulatory blood pressure levels and vascular remodeling (IMT).
- This study highlights the importance of ABPM and IMT in guiding hypertension management.
- Findings suggest a need to integrate ABPM and IMT assessments into routine hypertension care for optimized therapeutic strategies.
Objective:
To determine the influence of ambulatory blood pressure monitoring (ABPM), carotid intima media thickness (IMT) and global cardiovascular risk on the therapeutic strategies issued from our hypertension unit.
Methods:
All essential uncomplicated and never treated hypertensive patients referred to our hypertension unit between 1996 and 1997 for etiologic or target organ damage evaluation were considered eligible. We excluded diabetics and patients with renal disease who need a specific therapeutical approach. 54 patients (44.7 +/- 10.1 years) were included (40 men). All patients underwent an ABPM measurement. The right common carotid IMT measurement had been performed (0.06 +/- 09 mm). The global cardiovascular risks were assessed with the Framingham prediction chart taking into account age, sex, total cholesterol, smoking status and systolic office blood pressure. According to the therapeutic decision three groups were made up: group 1 lifestyle counselling (n = 13), group 2 single drug therapy (n = 31), and group 3 combination therapy (n = 10).
Results:
No significant difference was found in age, sex ratio, prevalence of severe hypertension, office systolic blood pressure, body mass index, global cardiovascular risk between the three groups. In contrast ABP (24 h ABP mmHg: group 1: 128.23 +/- 6.91/79.7 +/- 6.4; group 2: 140.48 +/- 9.7/97.48 +/- 8.17; group 3: 152.4 +/- 15.35/99.4 +/- 12.14 p < .0001) and IMT (group 1: 10.55 +/- .09, group 2: .59 +/- .07, group 3: .66 +/- .11 p = .02), were significantly higher in group 3 than in group 2 and in group 1. The percentage of white coat hypertensives was higher in group 1 than in group 3 (group 1: 61.5%, group 2: 3.2%, group 3: 0%). In the whole population, the higher was the global cardiovascular risk, the higher was the common carotid intima media thickness. In this study the global cardiovascular risks are not related to therapeutic decisions. Therapeutic strategies are influenced by ABP level and by the vascular remodeling which depends partly on the global cardiovascular risk.