Hemodynamic profiles of arterial hypertension with ambulatory blood pressure monitoring

Abstract

Blood pressure (BP) measurements obtained during a twenty-four-hour ambulatory blood pressure monitoring (24 h ABPM) have not been reliably applied to extract arterial hemodynamics. We aimed to describe the hemodynamic profiles of different hypertension (HT) subtypes derived from a new method for total arterial compliance (Ct) estimation in a large group of individuals undergoing 24 h ABPM. A cross-sectional study was conducted, which included patients with suspected HT. Cardiac output, Ct, and total peripheral resistance (TPR) were derived through a two-element Windkessel model without having a pressure waveform. Arterial hemodynamics were analyzed according to HT subtypes in 7434 individuals (5523 untreated HT and 1950 normotensive controls [N]). The individuals mean age was 46.2 ± 13.0 years; 54.8% were male, and 22.1% were obese. In isolated diastolic hypertension (IDH), the cardiac index (CI) was greater than that in normotensive (N) controls (CI: IDH vs. N mean difference 0.10 L/m/m2; CI 95% 0.08 to 0.12; p value <0.001), with no significant clinical difference in Ct. Isolated systolic hypertension (ISH) and divergent systolic-diastolic hypertension (D-SDH) had lower Ct values than nondivergent HT subtype (Ct: divergent vs. nondivergent mean difference −0.20 mL/mmHg; CI 95% −0.21 to −0.19 mL/mmHg; p value <0.001). Additionally, D-SDH displayed the highest TPR (TPR: D-SDH vs. N mean difference 169.8 dyn*s/cm−5; CI 95% 149.3 to 190.3 dyn*s/cm−5; p value <0.001). A new method is provided for the simultaneous assessment of arterial hemodynamics with 24 h ABPM as a single diagnostic tool, which allows a comprehensive assessment of arterial function for hypertension subtypes.

Visualization of the interplay between arterial properties and 24-hour ambulatory blood pressure during daytime and nighttime, for different age ranges

“…Therefore, a persistent elevation of resistance, e.g., due to increased SNA, requires higher MAP to preserve the blood supply, which occurs in arterial hypertension. A recently reported phenomenological model enables the determination of resistance and stiffness from 24-h ambulatory BP (24hABP) measurements [ 3 ]. Using this method, relatively higher resistance (Resistance↑) and stiffness (Stiffness↑) were shown to occur for SBP > 135 mmHg and PP > 55 mmHg, respectively [ 4 ].…”

Bosentan Does Not Affect Renal Resistive Index in Scleroderma/Systemic Sclerosis Patients

“…However, whether or not this could have affected our results is not clear. Probably, the use of other noninvasive methods of continuous systemic blood pressure evaluation, such as ambulatory or beat-to-beat blood pressure monitoring, might have better represented the relationship between intrarenal and systemic hemodynamic changes [ 41 , 42 ]. Third, we did not have data about albuminuria after bosentan treatment.…”