Abstract 11407: Usefulness of Home and Ambulatory Blood Pressure Changes in Assessing the Change of Cardiovascular Biomarkers During Anti Hypertensive Treatment
Background: The advantages of out-of-office blood pressure (out-of OBP) measurement, i.e., home (HBP) or ambulatory BP measurement (ABPM), over traditional OBP measurement, in assessing target-organ damages (TODs) as well as predicting progression of TODs or cardiovascular disease have long been recognized. However, during anti-hypertensive treatment, evidence that out-of OBP measurement can predict development or regression of TODs over time better than OBP measurement is lacking.
Methods: 252 hypertensive patients (mean age, 68 years; men: 41%) underwent measurements of OBP (average of 3 consecutive measurements), HBP (average of 3 consecutive measurements in morning and evening HBP for the 1-week), ABPM (30-min intervals), and cardiovascular biomarkers (urinary albumin excretion: UAE and brain natriuretic peptide: BNP) before and after 6 months of treatment with candesartan (+ thiazide).
Results: During the intervention, the OBP, HBP, 24-hour BP, and UAE levels were all significantly reduced (all P<0.01). BNP was reduced only in the patients using diuretics (P=0.003). The treatment-induced reduction in UAE was significantly associated with that of home systolic BP (SBP) and nighttime SBP independently of office SBP change (both P<0.05). In contrast, the treatment-induced reduction in BNP was associated with that of 24-hour SBP, in particular of nighttime SBP values, independently of office SBP change (both P<0.05). Treatment-induced reduction in home SBP was not associated with that of BNP during the intervention. Compared with the patients who did not achieve a reduction in at least 1 of the 4 BP parameters (i.e., OBP, HBP, 24-hour and nighttime BP), those who achieved reductions in all 4 BP parameters showed more significant reductions of UAE and BNP (-32.7% vs. -53.4% for UAE and+13.1% vs. -16.1% for BNP; both P<0.05).
Conclusion: HBP and ABPM measurements, particularly nighttime BP values provide additional information for predicting treatment-induced changes of cardiovascular biomarkers when used in conjunction with OBP during anti-hypertensive treatment. More research is needed to clarify whether or not the patients' prognosis is improved when we use out-of BP measurements for assessing the effects of anti-hypertensive treatment.
- © 2011 by American Heart Association, Inc.