Analysis of the correlation between left ventricular hypertrophy and ambulatory blood pressure in patients with essential hypertension

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POSTERS: Blood Pressure Measurement/Monitoring

studies have estimated a BP control between 25 and 35% in developed countries. Recent results indicate that almost 90% of the patients are evaluated at the clinic under the effect of morning dose of antihypertensive treatment [Am J Hypertens. 2004;17(5):36]. We have evaluated the influence of how BP is measured at the clinic in the proper evaluation of BP control. We studied 144 patients with grade 1-2 essential hypertension (84 men), 53.3⫾13.2 years of age. All patients were on the same regimen of antihypertensive treatment with morning dosing for at least 3 months. BP was measured by ambulatory monitoring (ABPM) at 20-min intervals from 07:00 to 23:00 hours and at 30-min intervals at night for 48 consecutive hours. Clinic BP values (6 per study visit) were obtained between 09:00 and 11:00 hours with a validated automatic oscillometric device just before and after the 2 days of ABPM, once with the patients under the effect of antihypertensive medication taken that same morning, and the other time with the patients untreated for at least 24 hours, in a random order. The average of 6 clinic BP values obtained for each patient in the absence of treatment was significantly higher than the average of BP values obtained under the effect of morning dosing of antihypertensive drugs (mean difference of 13.8 and 5.6 mm Hg for systolic and diastolic BP, P⬍0.001). All patients showed a systolic BP reduction when evaluated under the effect of medication. The percentage of controlled patients (clinic BP ⬍140/90 mm Hg for systolic/diastolic BP) was 71% for subjects evaluated under the effect of treatment. This percentage was significantly reduced to just 27% when the same patients were measured without the morning dose of treatment. Clinic BP measurement should always be performed in the absence of same-day treatment. Differences between clinic and daytime ABPM measurements below the reported 15 mm Hg in systolic BP for untreated subjects could indicate that patients were indeed evaluated under the effect of treatment, invalidating conclusions on BP control and drug efficacy. Key Words: Blood Pressure Control, Clinic Blood Pressure, Treatment Efficacy

AJH–May 2005–VOL. 18, NO. 5, PART 2

P-73 REPRODUCIBILITY OF SEMI-AUTOMATIC RADIAL AUGMENTATION INDEX (HEM-9101, Omron) AND THE CORRELATION TO THE CAROTID AUGMENTATION INDEX IN PATIENTS WITH HYPERTENSION Joji Ishikawa, Kazuomi Kario, Masato Morinari, Satoshi Hoshide, Kazuo Eguchi, Hiroshi Miyashita, Kazuyuki Shimada. Cardiology, Jichi Medical School, Minamikawachi-machi 3311-1, Tochigi, Japan. Background: Augmentation index (AI), a measure of reflection wave ratio, is evaluated semi-automatically at the radial artery using newly dveloped machine, HEM-9101 (Omron); we evaluated the reproducibility of the radial AI (study 1 and 2) and it’s correlation to carotid AI (study 3). Method: Carotid AI was measured using form PWV/ABI (Colin, Komaki, Japan) in supine position and radial AI was measured using HEM-9101 (Omron, Kyoto, Japan). All of the measurements were conducted in fasting state without taking antihypertensive medications. Study 1: The evaluation of day-to-day reproducibility was conducted after 28 days interval in 20 patients with stable and treated hypertension. Study 2: The evaluation of inter-operator reproducibility was conducted after 1-hour intervalin 46 patients. Study 3: the correlation between carotid and radial AI was evaluated in 61 treated or untreated hypertensive patients (Male: 35 patients, Female 26 patients). Results: Study 1: the correlation coefficient of day-to-day measurements was 0.81(P⬍0.001) and the coefficient of variation was 13%. Study 2: the correlation coefficient of inter-operator was 0.92(P⬍0.001) and the coefficient of variation was 16%. Study 3: average age was 67.8⫾10.0 years. Blood pressur (mean⫾SD) was 141.1⫾18.6 / 78.1⫾12.5 mmHg (systolic/diastolic) and pulse rate was 66.5⫾10.0 /min. Carotid AI was 27.4⫾15.8 % and radial AI was 90.1⫾14.5 %. Female had significantly higher carotid AI and radial AI than male (Carotid; 38.4⫾13.2% vs. 20.7⫾13.5%, Radial; 97.3⫾13.9% vs. 85.0⫾12.7%). The radial AI was significantly correlated to the carotid AI (r⫽0.60, P⬍0.001) (Figure) and this correlation was stronger in male (r⫽0.52, P⫽0.001) than in female (r⫽0.43, P⬍0.05).

P-72 ANALYSIS OF THE CORRELATION BETWEEN LEFT VENTRICULAR HYPERTROPHY AND AMBULATORY BLOOD PRESSURE IN PATIENTS WITH ESSENTIAL HYPERTENSION Qi Hua, Xiurong Xing, Rongkun Liu. Cardiology, Beijing Xuanwu Hospital, Beijing, China. Objective: To investigate the correlation between left ventricular hypertrophy and ambulatory blood pressure in patients with essential hypertension. Methods: 87 patients with essential hypertension were examined with 24 hour ambulatory blood pressure monitoring and echocardiography. Results: There were positive correlation between left ventricular mass, left ventricular mass index and average systolic blood pressure, diastolic blood pressure, blood pressure loads, body mass index; negative correlation between left ventricular mass, left ventricular mass index and blood pressure decline rate of night, high density lipoprotein cholesterol. Conclusion: There were good correlation between left ventricular hypertrophy and high blood pressure, circadian rhythm of blood pressure. Control body weight and plasma lipids are also very important in reverse left ventricular hypertrophy. Key Words: Ambulatory Blood Pressure, Echocardiography, Essential Hypertension

Conclusion: Semi-automatic radial AI measured by HEM-9101 has a good reproducibility and significantly correlated to carotid AI. Key Words: Aaugmentation Index, Arterial Stiffness, Hypertension