Abstract 14803: Nighttime Blood Pressure as a Determinant of Future Increased Arterial Stiffness in Hypertensive Subjects. A 5-year Prospective Study
Introduction: Increased arterial stiffness exacerbates cardiovascular risk, while ambulatory blood pressure (BP) components have been associated with target organ damage.
Hypothesis: We sought to investigate whether daytime or nighttime BP is a superior determinant of arterial stiffness at end-follow-up period.
Methods: 305 white hypertensive non-diabetic patients (51±10 years, 190 men, 123 smokers, body mass index=28.5±4.7kg/m2) were prospectively studied in a mean period of 3.45±1.33 years. At both baseline and follow-up all patients underwent 24-hour ambulatory BP monitoring, carotid-femoral pulse wave velocity (PWV) measurement with Complior SP and metabolic profile evaluation. The patients were treated with the optimal antihypertensive therapy during the follow-up period. We considered 12m/s for the PWV at the last follow-up visit as the threshold value suggesting significant arterial stiffness.
Results: In the total population 24h systolic and diastolic BP were decreased by 10.6±13.3 and 6.7±8.2mmHg (132±11 vs. 121±11 and 82±9 vs. 76±8mmHg) respectively, 24h heart rate decreased by 3±7bpm, while PWV increased by 0.5±1.8m/s (8.6±1.7 vs. 9.1±1.6m/s), (p<0.001 for all). At the last follow-up visit 6% of the population had PWV values≥ 12m/s. In multivariate logistic regression analysis using hemodynamic, demographic and metabolic variables, significant predictors of PWV≥ 12m/s at the last follow-up visit were found to be the baseline PWV levels (OR=1.599, 95%OR C.I.= 1.204-2.124, p<0.001) and the baseline nighttime systolic BP (OR=1.070, 95%OR C.I.= 1.003-1.141, p<0.05), while daytime BP did not prove to be predictive.
Conclusions: The current study qualifies nighttime BP as a stronger prognosticator of future aortic function deterioration compared to daytime hemodynamics, highlighting the importance of ambulatory blood pressure monitoring implementation in order to reveal the increased nocturnal hemodynamic load on hypertensive patients.
- © 2011 by American Heart Association, Inc.