Blood pressure morning surge and daytime bp variability and target organ damage in normotensives, hypertensives and diabetics

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a better blood pressure control. However, this treatment did not change their diurnal blood pressure pattern.

than non-LVH group (49.4⫾10.1 mmHg vs. 44.1⫾9.0 mmHg, P⬍0.001 and 133.0⫾12.9 mmHg vs. 126.2⫾12.8 mmHg, P⬍0.001). PP rose progressively with aging, and after 60 years, the rate accelerated steeply. In middle-aged and senile subjects, the increase in PP was primarily due to large-artery elasticity deterioration. And it was the important determinant of LVH.

Key Words: Nondipping, Hypertension and Diabetes Mellitus, AT1 Antagonist

P-49 IMPACTS OF AMBULATORY PULSE PRESSURE AND OFFICE PULSE PRESSURE ON LEFT VENTRICULAR HYPERTROPHY IN PATIENTS WITH ESSENTIAL HYPERTENSION Lisong Liu, Qi Hua, Jian Zhang. Department of Cardiology, Beijing Xuanwu Hospital, Beijing, Beijing, China. To evaluate the impacts of ambulatory pulse pressure(PP) and office PP on left ventricular hypertrophy(LVH) in patients with essential hypertension. Totally 337 initially untreated subjects with mild to moderate essential hypertension (age 51.9⫾8.8, 43.6% men)were included in this study. All subjects took 3 times blood pressure measurements in different days, ambulatory blood pressure monitoring and echocardiography. 1 Subjects were divided into four groups according to their ambulatory pulse pressure levels and into five groups according to their office PP levels. Compare the results respectively. 2 They were further divided into LVH and non-LVH group according to the degree of left ventricular mass index(LVMI). Both ambulatory PP and office PP were significantly correlated with age, history of hypertension, LVMI, arterial stiffness index and 24-hour heart rate. Arterial stiffness evolved progressively with PP increase, and it correlated with ambulatory PP much more significant than office PP(r⫽0.670, p⬍0.01 vs. r⫽0.399, p⬍0.01). Ambulatory PP and 24-hour systolic blood pressure(SBP) were significantly higher in LVH group than non-LVH group [(49.0⫾10.2) mmHg vs. (44.7⫾8.9) mmHg, p⬍0.001 and (132.1⫾13.1) mmHg vs. (126.5⫾12.7) mmHg, p⬍0.001]]; Ambulatory PP was associated with LVMI much stronger than office PP(r⫽0.277, p⬍0.01 vs. r⫽0.105, p⬍0.05). The increase of PP was an important determinant of LVH. Compared with office PP, ambulatory PP provided a more precise estimate of target organ damage upon hypertensives. Key Words: Hypertension, Pulse Pressure, Hypertrophy

P-50 RELATIONSHIP OF AGE, LEFT VENTRICULAR HYPERTROPHY AND 24-HOUR MEAN PULSE PRESSURE IN PATIENTS WITH ESSENTIAL HYPERTENSION Lisong Liu, Qi Hua, Jian Zhang, Beilei Pang. Department of Cardiology, Beijing Xuanwu Hospital, Beijing, Beijing, China. The study is to investigate the relationship between age, left ventricular hypertrophy(LVH) and 24-hour mean pulse pressure(PP) in patients with essential hypertension. 433 initially untreated subjects with mild to moderate essential hypertension were involved in this study. All subjects underwent 24-hour ambulatory blood pressure monitoring and echocardiography. They were divided into four groups according to their 24-hour mean PP scale, and were divided into LVH and non-LVH group according to their left ventricular mass index (LVMI) level. Patients were further divided into three age groups, group I: 40ⱕage⬍50; group II: 50ⱕage⬍60; group III: ageⱖ60, respectively. 24-hour mean PP were significantly correlated with age (r⫽0.466, P⬍0.01), arterial stiffness index (r⫽0.681, P⬍0.01), LVMI (r⫽0.279, P⬍0.01), and 24-hour heart rate (r⫽⫺0.142, P⬍0.01). Hypertensive subjects showed a progressive increase in 24-hour mean PP earlier, and the rate of rise accelerated after age 60 years. Both 24-hour mean PP and 24-hour systolic blood pressure were significantly higher in LVH group

Key Words: Pulse Pressure, Hypertrophy, Hypertension

P-51 THE LISINOPRIL EFFECTS UPON BLOOD PRESSURE DIURNAL RHYTHM AND[ LEFT VENTRICULAR MYOCARDIAL MASS IN ESSENTIAL HYPERTENSION Elena G Kupchinskaya, Elena V Bobrova, Larissa V Bezrodna, Irina V Lizogub. Hypertension, Institute of Cardiology, Kyiv, Ukraine. Objective: to study the arterial blood pressure (BP) level, left ventricular (LV) hyper- trophy and LV function dynamics in essential hypertension (EH) patients (pts) during long term angiotensin converting enzyme inhibition lisinopril (L) monotherapy ( M). Methods: we investigated 23 EH pts, which were divided into two group: 1-st with “dipper” BP diurnal rhythm type (BPDRT) (n⫽14 pts), 2-nd – “non-dipper” BPDRT (n⫽9). The BP level was studied by 24-hour ambulatory BP monitoring (ABPM), LV hypertrophy and LV function (LVF) – by echocardiography M-mode and B-mode regiments. Before L treatment the diurnal “dipper” BP type was in 14 EH pts, “non-dipper” type – in 9 EH pts. The LV myocardial mass index (LVMMI) was more than 125 gr/m2 in13 pts, 10 pts had it less than 125 gr/m2. The examination was made before and after LM in dosage 10 –20 mg daily during 6 –7 mouths. Result: the LVMMI decreasing on 10 mg/m2 and more during LM treatment were in 9 pts (all of them have LVH initial, others – LVMMI during investigate time don’t signification change). The LVMMI decrease was calling by LV posterior wall thickness (PWT), interventricular septum thickness (IVST) and LV end-diastolic diameter (EDD) decrease. The PWT, IVST and EDD dynamics were depend from LV remodelling type in certain measure. We observed the velocity of circumferential fiber shortening (Vcf) increase in all groups from (1,16⫾0,08 to 1,28⫾0,08)sec⫺1 in with LVMMI decrea sing and from (1,27⫾0,05 to 1,40⫾0,070)sec⫺1 without LVMMI change. The LM lead up to middle-diurnal, middle daily and middle-night BP meaning, their variability decreasing without growth morning dependence from LWMMI dynamics and from initial BPDRT.The diurnal index was decreased (p⬍0,01) in “non-dipper” pts (p⬎0,05) and don’t change significantly in “dipper” pts (p⬎0,05).During repeat investigation the “dipper” type was in 20 pts,“ non-dipper” – in 3 pts. Conclusion: in EH pts the long-term L intake contribute BPDRT normalization in “non-dipper” majority pts and hasn’t influence in “dipper” pts upon its character. The LVMMI important decrease was only in pts with initial LV hypertrophy. The LV regression character depended on initial LV remodelling type. The L treatment con tribute LV contractility increase without LVMMI dynamics dependence. Key Words: Blood Pressure Diurnal Rhythm, Left Ventricular Myocardial Mass, Lisinopril

P-52 BLOOD PRESSURE MORNING SURGE AND DAYTIME BP VARIABILITY AND TARGET ORGAN DAMAGE IN NORMOTENSIVES, HYPERTENSIVES AND DIABETICS Cristina Amaral, Loide Barbosa, Susana Bertoquini, Joao Maldonado, Jose A Silva, Jorge Polo´ nia. Unidade Farmacologia Clinica, Faculdade Medicina Porto, Porto, Portugal; Unidade Hipertensao Risco CV, Hospoital Pedro Hispano, Matosinhos, Portugal. Blood pressure morning surge (BP-MS) and daytime BP variability (daytime BP-VAR) have been associated with target organ damage and

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cardiovascular risk. In 135 normotensives (NT), 105 untreated hypertensives (HT-unT), 349 treated hypertensives (HT-tr) and in 92 diabetics (DM) ageing 35 to 75 yrs, we evaluate the relation of BP-MS and daytime BP-VAR (S.D. daytime BP) with albuminuria, pulse wave velocity (PWV), LV mass index (LVMI), nighttime BP fall, BP rise induced by stress (BP-stress), and Heart rate recovery 1 min after maximal exercise test (1 min EX – HR rec). In all groups, BP-MS (mm Hg) were lower (p⫽0.01) in NT 21.1 (10.0) but similar in HT-unT: 27.7 (13.2), HT-tr: 27.1 (12.4) and DM: 27.8 (14.9) (n.s.), whereas SDdaytime BP were lower (p⬍0.01) in NT: 11.1 (2.5) but similar in HT-unT: 24.5 (3.2), HT-tr: 24.8 (3.4) and in DM: 23.7 (3.6) (n.s.). In all subjects BP-MS correlate significantly (⬍0.01) with daytime BP, SDdaytime BP, BP nighttime fall, but only in HT-unT and DM with (p⬍0.01) LVMI, BP stress response and with (1 min EX - HR rec). In all subjects S.D. daytime BP correlate significantly (⬍0.01) with BP-MS, daytime BP, BP stress response, LVMI, PWV, but only in HT-unT and HT-T with BP nighttime fall (p⬍0.01). In all subjects in lowest v upper quintile of distribution of BP-MS there was a significantly (p⬍0.02) lower PWV: 9.6 (1.9) v 12.9 (2.1) m/s and lower LVMI values 79 (18) v 102 (39) g/m2. BP-MS appears to be strongly related with nighttime BP fall and possibly with stressful stimuli and with the blunting of parasympathetic system. Although higher values of BP-MS and of S.D. daytime BP may be related with worse indices of organ damage, it appears that they are not probably a direct cause of these abnormalities but a pure marker of the participation of other causal factors.

toring should be considered for those with home BP averages ⱖ 125/76 mmHg.

Key Words: BP Variability, BP Morning Surge, Organ damage

P-53 RECEIVER OPERATING CHARACTERISTICS OF HOME BLOOD PRESSURE MEASUREMENTS THATBEST DETECT AMBULATORY HYPERTENSION George A Mansoor, William B White. Section of Hypertension, Center for Cardiology and Cardiovascular Biology, University of Connecticut School of Medicine, Farmington, CT. Effective use of home blood pressure (BP) in persons with borderline hypertension should minimize the number of truly hypertensive (elevated ambulatory BP) patients who are erroneously labeled as normotensive. Therefore, the threshold home BP to diagnose hypertension should ensure that a minimum number of persons with ambulatory hypertension are denied appropriate treatment. We systematically studied 55 subjects with elevated office BP at their doctor’s office (ⱖ 140 mmHg and/or 90 mmHg) and who were not receiving antihypertensive drug therapy. Standardized office, home BP monitoring and ambulatory BP monitoring were performed with complete data being available for 49 subjects. The group’s average age was 49 ⫾ 14 years, BMI 27 ⫾ 4 kg/m2, 55% female, 8% smokers, and 95% white, with average office blood pressure 142/ 88 ⫾ 22/7 mmHg. Thirty - nine subjects had ambulatory hypertension, (daytime BP of ⱖ 135 and/or ⱖ 85 mmHg). Using the recommended value for home BP of 135/85mmHg as the cut-off, the sensitivity for detecting ambulatory hypertension is 54% and specificity is78%. Optimal thresholds for systolic and diastolic home BP were determined by generating receiver operating curves, (nonparametric models) area under the curve and their 95% confidence intervals using SPSS Software version 10.07 (SPSS Inc., Chicago, IL, USA). A minimum sensitivity of 80% to detect ambulatory hypertension was considered optimal. For home systolic BP, the area under the curve was 0.745 (SE⫽0.086, 95% CI ⫽ 0.575 to 0.914, p ⫽.018) and for home diastolic BP, the area under the curve is 0.648 (SE⫽0.077, 95% CI ⫽ 0 .586 to 0.888, p⫽.09). At a sensitvity of 80% we defined a home systolic BP of 125 mmHg (specificity of 70%) and a diastolic BP of 76 mmHg (specificity 34%). as reasonable thresholds to detect ambulatory hypertenison. Home BP can be used to identify ambulatory hypertension in patients with borderline office hypertension but a low cut-off of 125/76mmHg should be used . Using the traditional value of 135/85 mmHg fails to detect a significant minority of subjects with ambulatory hypertension. Ambulatory moni-

Home Blood Pressure Thresholds to Predict Ambulatory Hypertension HOME BLOOD PRESSURE SYSTOLIC BP

DIASTOLIC BP

BP THRESHOLD

SENSITIVITY (%)

1-SPECIFICITY (%)

120 125 130 135 140 70 75 80 85

95 82 49 38 15 92 84 41 51

78 55 11 11 0 78 67 22 11

selected cut-offs shown

Key Words: Home Blood Pressure, Receiver Operating Curves, Ambulatory Blood Pressure

P-54 IN-HOSPITAL NIGHT SHIFT MINIMALLY AFFECTS 24-HOUR BLOOD PRESSURE, EVEN IF A NOCTURNAL BP INCREASE IS SEEN Natale R Musso, Fiorella Altomonte, Claudia Brusasco, Giovanni Baldi, Vincenza De Iorgi, Claudio Vergassola. Dept. of Internal Medicine, University of Genoa Medical School, Genoa, Italy; Emergency Dept., San Martino Hospital, Genoa, Italy. Physiological decrease of BP during the night is commonly related to sleep quality. Many researchers have studied the effects of work-related night shifts on nocturnal BP. Our aim is to evaluate how much a very stressful night shift, such as in the period 8 PM - 8 AM in the emergency unit of our general hospital, can affect the nocturnal decrease of BP. 18 nurses (12 females) aged 48.0/7.5 yr (mean/SD) underwent two ABPM in two days apart, separated by 5.1/5.5 wk (mean/SD). Monitorings were recorded both during a day shift and during a night shift, in random order. Night shift is usually very busy for our nurses, the number of emergency calls ranging from 80 to 100. ABPM was performed by SpaceLabs 90207 monitors. Monitoring started at 10 AM. Monitors were withdrawn at 10 AM during the following day. ABPM were discarded in case of less than 85% successful readings. Monitoring protocol included measurements at 15 min intervals during the whole 24 hour period. Our data show that 24 hour BP is not changed by night shift, even when highly stressful. Nevertheless, significant although reduced differences were observed during both daytime and nighttime subperiods, accordingly to what expected. Our nurses are deeply trained and this may have contributed to the small differences observed here. A nondipper pattern was attained in the second monitoring, when our nurses worked around the clock during their night shifts. This may suggest that simple sleep disturbance alone may not explain, in nondipper patients, the absence of physiological nocturnal decrease in BP values. Results: ABPMI (day shift), ABPM2 (night shift) Blood Pressure

Average mmHg

SD

SYS 24 ABPM1 SYS 24 ABPM2 DIA 24 ABPM1 DIA 24 ABPM2 SYS DAY ABPM1 SYS DAY ABPM2 DIA DAY ABPM1 DIA DAY ABPM2 SYS NIG ABPM1 SYS NIG ABPM2 DIA NIG ABPM1 DIA NIG ABPM2

116.05 116.55 76.00 76.22 119.39 117.22 80.00 77.22 108.72 116.50 68.28 76.00

8.31 6.83 5.35 6.97 7.49 6.84 6.18 5.63 10.85 8.18 10.63 6.09

P (1 vs 2) 0.698 (NS) 0.819 (NS) 0.077 (NS) 0.014 0.004 0.002

Statistics: One way ANOVA. Two tailed p

Key Words: Night Shift, Nocturnal Blood Pressure, Circadian