Nocturnal blood pressure pattern and target organ damage

35A

AJH–May 2004 –VOL. 17, NO. 5, PART 2

POSTERS: Blood Pressure Measurement/Monitoring

P-5 ABNORMAL NOCTURNAL BLOOD PRESSURE PATTERNS AND PREVELANCE OF STROKE

Only 25 (31.6%) patients were controlled according to ABPM criteria, 14 in D-group, 8 in ND-group, 3 in ED-group, and none on the RDgroup. RD-group had a higher left ventricular mass index (LVMI) then D group (p-0.002), and higher concentric left ventricular hypertrophy index (cLVHI) then D-group (p⬍0.003), ND-group (p⬍0.01), and ED-group (p⬍0.05). RD-group also had a higher nocturnal systolic BP (p⬍0.005) and nocturnal pulse pressure (PPn) (p⬍0.001 and p⬍0.02 with NDgroup) then the other groups. A large proportion of patients thought to have well controled BP do not. These patients present abnormalities of the nocturnal BP fall, and one sub-group (reverse-dipping) seems to stand out from all the others for target organ damage.

Paula Alcantara, Carlos S Moreira, Cristina Alcantara, Jose´ BrazNogueira. S. Medicina I, Hosp. Santa Maria, Lisbon, Portugal. Abnormal patterns of diurnal blood pressure (BP) variation have been reported to be related to advanced target organ damage and poor cardiovascular prognosis. We studied the prevalence of stroke events in patients with different nocturnal blood pressure dipping. From our outpatient hypertension clinic database, 79 hipertensives were divided according their nocturnal BP fall in dippers (⬎10⬍20%) (group D), non-dippers (⬍10%) (group ND), extreme-dippers (⬎20%) (group E), and reverse-dippers (⬍0%) (group R). The exclusion criteria for patients selection was the presence of smoking habits, diabetes, dislipidemia, and renal disease. All patients were under anti-hypertensive therapy. The selection was based in 24h ABPM done when patients were considered controlled by casual BP measurement. Stroke episodes were collected from their medical history and confirmed by a CT-scan. Means were compared by oneway ANOVA and for frequencies Qui-square test was used. Significance was accepted for p⬍0.01 (two-tailed). Of the 79 well controlled patients, only 25 (31.6%) were controlled according to ABPM criteria, 14 in D-group, 8 in ND-group, 3 in EDgroup, and none on the RD-group. Despite that, patients without prior stroke had a higher fall in nocturnal BP then those with stroke (13⫾8.2 and 8⫾11.2, respectively; p⬍0.004). There was an excess of stroke episodes in the RD group in relation to group D (p⬍0.008), group ND (p⬍0.01) and group ED (p⬍0.01). Patints on group RD had a higher nocturnal systolic BP (SBPn) (p⬍0.0001), and nocturnal pulse pressure (p⬍0.002) then on the other groups. Although stroke is more prevelant in patients with abnormal blood pressure nocturnal fall, reverse dipping seams to discriminate between those abnormalities in middle age patients. Dippers

N-Dipper

E-Dipper

Dippers N (%) Fem/male Age BMI SBPd DBPd PPd SBPn DBPn PPn LVMI cLVHI

N-Dippers

E-Dippers

R-Dippers

p

35 (45.6) 24/12 26 (34.2) 12/15 9 (12.6) 6/4 6 (7.6) 2/4 52.7 13.6⫾ 26.1 3.3⫾ 136.6 15.3⫾ 84.7 11.7⫾ 51.9 8.8⫾ 119.5 15.2⫾ 70.2 11.9⫾ 49.3 9.2⫾ 173 49.3⫾ 0.4 0.06⫾

54.8 12.1⫾ 26.6 2.6⫾ 136.9 16.8⫾ 83.7 14.2⫾ 53.2 8.2⫾ 129 17.1⫾ 74.7 13.5⫾ 53.4 10.5⫾ 206.3 52.4⫾ 0.42 0.06⫾

56.9 12.2⫾ 26.2 12.2⫾ 129.3 19.7⫾ 83.6 12.2⫾ 45.7 17.3⫾ 111.2 8.6⫾ 67.9 9.5⫾ 43.2 12.9⫾ 190.5 46.2⫾ 0.42 0.04⫾

57.5 10.8⫾ 26.6 5.4⫾ 144.7 12.8⫾ 84 12.8⫾ 60.7 10.9⫾ 149.4 15.3⫾ 84.6 12.9⫾ 64.8 16.9⫾ 247.3 50.5⫾ 0.48 0.02⫾

ns ns ⬍0.05 ⬍0.05 ⬍0.05 ⬍0.05 ⬍0.05 ⬍0.05 ⬍0.002 ⬍0.003

LVMI-Left ventricular mass index; cLVHI-concentric left ventricular hypertrophy index

Key Words: ABPM, Non-Dipper, Extreme-Dipper

R-Dipper

N (%) Fem/male 36 (45.6) 24/12 27 (34.2) 12/15 10 (12.6) 6/4 6 (7.6) 2/4 Age 52.7 ⫾ 13.6 54.8 ⫾ 12.1 56.9 ⫾ 12.2 57.5 ⫾ 10.8 BMI 26.1 ⫾ 3.3 26.6 ⫾ 2.6 26.2 ⫾ 12.2 26.6 ⫾ 5.4 SBPd 136.6 ⫾ 15.3 136.9 ⫾ 16.8 129.3 ⫾ 19.7 144.7 ⫾ 12.8 DBPd 84.7 ⫾ 11.7 83.7 ⫾ 14.2 83.6 ⫾ 12.2 84 ⫾ 12.8 SBPn 119.5 ⫾ 15.2 129 ⫾ 17.1 111.2 ⫾ 8.6 149.4 ⫾ 15.3 DBPn 70.2 ⫾ 11.9 74.7 ⫾ 13.5 67.9 ⫾ 9.5 84.6 ⫾ 12.9 Dipping (%) 15 ⫾ 2.9 6.2 ⫾ 2.9 28.3 ⫾ 8.1 ⫺2.8 ⫾ 1.2 Stroke (n) 4 3 1 4

P-7 HIGH PREVALENCE OF MASKED HYPERTENSION IN TREATED HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES MELLITUS

Key Words: ABPM, Dippers, Stroke

The study was undertaken to determine whether self-measured home blood pressure (BP) readings are comparable to physician-recorded clinic BP readings in drug-treated hypertensive type II diabetic patients and may be used to make treatment decisions. Over a period of 2 to 3 weeks, 27 patients recruited from a tertiary referral hypertension clinic had 3 clinic, 20 or more home and one ambulatory BP measurements. The BP readings were analyzed using a mixed linear model with mean daytime ambulatory measure as a covariate. Although there was no significant difference in mean systolic BP between home and clinic readings (0.6 mm Hg, F⫽0.03, p⫽0.86), the mean home BP readings were significantly higher (difference ⫽ 6.8 mm Hg, F⫽13.7. p⫽0.0006). The proportion with masked hypertension, defined as elevated home systolic or diastolic BP or both and normal clinic BP, was 40.7%. Three diastolic and one systolic BP measured at home achieved a reliability coefficient of 0.8. Self-measurement of BP with an OMRON device (model HEM757) was easily taught and gave highly reliable readings when they were compared to blinded readings taken by a trained professional using a mercury sphygmomanometer. It is concluded that self-measured BP at home identifies a high prevalence of masked hypertension in treated hypertensive type 2 diabetic patients and is a valuable adjunct in management to ensure maximum benefit from antihypertensive drug therapy.

P-6 NOCTURNAL BLOOD PRESSURE PATTERN AND TARGET ORGAN DAMAGE Paula Alcantara, Carlos S Moreira, Cristina Alcantara, Jose´ BrazNogueira. S. Medicina I, Hosp. Santa Maria, Lisbon, Portugal. Abnormal patterns of diurnal blood pressure (BP) variation have been reported to be relating to advanced target organ damage and poor cardiovascular prognosis. We studied the prevalence LVH in patients with different nocturnal blood pressure dipping. From a 24h ABPM database, 79 hypertensives were divided according their nocturnal BP fall in dippers (⬎10⬍20%) (Group D), non-dippers (⬍10%) (Group ND), extreme-dippers (⬎20%) (Group ED), and reverse-dippers (⬍0%) (Group RD). All the patients were well controlled based on clinic BP measurement with active therapy and were submitted to 24h ABPM, Doppler echocardiography, and routine laboratory workup. Exclusion criteria for patient’s selection were the presence of other risk factors for CVD. Means were compared by one-way ANOVA. Significance accepted for p⬍0.05. © 2004 by the American Journal of Hypertension, Ltd. Published by Elsevier Inc.

Kerrayem Alsuwaida, Robert Parkes, Jeffrey So, Denice Feig, Alexander Logan. Medicine, Mount Sinai Hospital, Toronto, ON, Canada.

Key Words: Hypertension, Diabetes, Masked Hypertension 0895-7061/04/$30.00