Variable association of 24-h peripheral and central hemodynamics and stiffness with hypertension-mediated organ damage: the VASOTENS Registry

Abstract

on behalf of the VASOTENS Registry Study GroupObjective: In this analysis of the telehealth-based Vascular health ASsessment Of The hypertENSive patients Registry, we checked how 24-h central and peripheral hemodynamics compare with hypertension-mediated organ damage (HMOD).Methods: In 646 hypertensive patients (mean age 52 AE 16 years, 54% males, 65% treated) we obtained ambulatory brachial and central SBP and pulse pressure (PP), SBP, and PP variability, pulse wave velocity and augmentation index with a validated cuff-based technology. HMOD was defined by an increased left ventricular mass index (cardiac damage, evaluated in 482 patients), an increased intimamedia thickness (vascular damage, n ¼ 368), or a decreased estimated glomerular filtration rate or increased urine albumin excretion (renal damage, n ¼ 388).Results: Ambulatory SBP and PPs were significantly associated with cardiac damage: the largest odds ratio was observed for 24-h central SBP [1.032 (1.012, 1.051), P ¼ 0.001] and PP [1.042 (1.015, 1.069), P ¼ 0.002], the weakest for brachial estimates. The association was less strong for vascular damage with a trend to the superiority of 24-h central [1.036 (0.997, 1.076), P ¼ 0.070] over brachial PP [1.031 (1.000, 1.062), P ¼ 0.052]. No statistically significant association was observed for renal damage. SBP and PP variabilities, pulse wave velocity and augmentation index were not associated with any form of HMOD. In the multivariate analysis, age was associated with any type of HMOD, whereas central SBP and PP were predictive of an increased risk of cardiac damage. Conclusion:In hypertensive patients a variable association exists between peripheral and central hemodynamics and various types of HMOD, with the most predictive power being observed for central SBP and PP for cardiac damage.

E-Health in Hypertension Management: an Insight into the Current and Future Role of Blood Pressure Telemonitoring

“…In a subgroup of 646 hypertensive patients, we also evaluated the relation between 24-h central and peripheral hemodynamics with hypertension-mediated organ damage. The study documented larger 24-h average brachial and central SBP and PP values in subjects with than in subjects without left ventricular hypertrophy (cardiac damage) but showed no relation of peripheral and central hemodynamics with vascular or renal damage [52]. Thus, according to the published studies, ambulatory BPT solutions may represent a useful tool to favor a more accurate hypertension screening and detection.…”

24‐h ambulatory blood pressure variability and hypertensive nephropathy in Han Chinese hypertensive patients

“…Our findings were supported by previous studies. [22][23][24][25][26] Madden and colleagues revealed that microalbuminuria was associated with a significantly higher 24-h SBP ARV, SD, and wSD in the univariate analysis. However, there was no association between any of these parameters after adjusting for mean BP.…”

“…23 Data from the VASOTENS Registry study also indicated that either a decreased eGFR or increased urine albumin excretion was not associated with a significantly increased 24-h systolic BPV after adjusting for mean BP. 22 Recently, results from ONTARGET and TRANSCEND trials revealed that visit-to-visit systolic BPV was not a predictor of renal outcomes, which, in contrast, was sensitively predicted by mean SBP. 24 In addition, similar results were obtained in CKD patients that short-term BPV did not predict CKD progression 25 ; the association between CKD and BPV was primarily explained by higher mean BP among those with CKD.…”

The Role of E-health in 24-h Monitoring of Central Haemodynamics and Vascular Function

“…PWV was increased in subjects with the metabolic syndrome, in the absence of BP changes, suggesting that this condition is associated with increased arterial stiffness independently of BP. Another publication of the same study, exploring the association of vascular biomarkers with hypertension-mediated organ damage, showed that 24-h brachial and central SBP and PP averages were significantly larger in subjects with than in subjects without left ventricular hypertrophy, whereas no statistically significant difference was observed for these estimates in case of vascular or renal damage [15]. No between-group difference was observed for any type of hypertension-mediated organ damage and PWV, AIx or BP variability.…”