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Similarities and differences among patients with isolated systolic or combined systolic diastolic hypertension: the life study
46A
POSTERS: Blood Pressure Measurement/Monitoring
AJH–April 2001–VOL. 14, NO. 4, PART 2
which were checked by connecting to the sphygmomanometer with a Y-connector at monthly clinic visits. Patients were asked to measure their home blood pressure in the morning within 30 minutes after awakening and in the evening just before going to bed. Subjects were divides to 2 groups according to the difference of systolic blood pressure between morning and evening (M-SBP-E-SBP); morning rise group (MR)⫽MSBP-E-SBP ⱖ 10mmHg and non-morning rise group (NMR)⫽M-SBPE-SBP ⬍ ⫾ 10mmHg. MR had a high left ventricular mass index (149 ⫾ 37 vs 122 ⫾ 21, p⬍0.001), serum creatinine (Cr, 0.88 ⫾ 0.23 vs 0.75 ⫾ 0.17 mg/dl) and urinary protein secretion (310 ⫾ 732 vs 95 ⫾ 185 mg/g Cr). These results suggested that the hypertensive patient who showed a morning rise in blood pressure had an advanced hypertensive cardiovascular complications.
A 47-year-old woman presented with new onset HTN. Initial evaluation revealed polycystic kidneys but no other abnormalities. An ambulatory blood pressure monitor (ABPM) at baseline demonstrated sustained daytime HTN, though blood pressure was lower than had been measured in the office. Medical therapy was initiated with a target blood pressure of ⬍130/80 mm Hg. Six months after her first visit she was diagnosed with normal-tension glaucoma. Over the course of two years she required higher doses of medication to control blood pressure as measured in the office. After one year of control with office systolic blood pressure readings of 137-144 mm Hg, her visual fields were noted by her ophthalmologist to be worsening. Home blood pressure measurement showed a range from 68/35 to 126/76 mm Hg. Her medication was decreased and a repeat ABPM revealed controlled blood pressure without hypotension. On lower doses of medication her visual fields stabilized. Office blood pressure remained higher than measured at home. Diurnal variations in blood pressure among patients with hypertension have been implicated as important risk factors in vision loss. Lower blood pressure is a potential etiologic factor in glaucoma and ischemic optic neuropathy. In patients with progressive visual field defects, out of office blood pressure monitoring can uncover previously unrecognized periods of hypotension associated with white-coat effect.
Key Words: morning rise, home blood pressure, cardiovascular complication
P-50 SIMILARITIES AND DIFFERENCES AMONG PATIENTS WITH ISOLATED SYSTOLIC OR COMBINED SYSTOLIC DIASTOLIC HYPERTENSION: THE LIFE STUDY Vasilios Papademetriou, Kristian Wachtell, Vittorio Palmieri, Puneet Narayan, Richard B. Devereux. 1Veterans Affairs & Georgetown University Medical Centers, Washington, DC, United States, 2Cornell University, New York, United States Both isolated systolic hypertension (ISH; SBPⱖ140 & DBP ⬍90 mm Hg) and combined (CSDH; SBPⱖ140 & DBP ⬎90 mm Hg) are powerful predictors of cardiovascular outcomes. Demographic characteristics and the comparative impact on target organs in these two groups have not been adequately described. Of the 9,190 patients with hypertension and ECG LVH, participating in the Losartan Intervention For Endpoints (LIFE) trial, 1,346 pts had ISH and 7,758 had CSDH. The remaining 86 pts had isolated diastolic HTN and were not included in this analysis. Compared to pts with CSDH, pts with ISH were older (71 vs 67 years; p⬍. 000), shorter (165 Vs 168 cm; p⬍. 000), weighed less (75 Vs 79 kg; p⬍. 000) and had lower BMI (27.4 Vs 28.1 kg/m2; p⬍. 000). By definition pts with ISH had lower DBP (83 Vs 100 mm Hg) and higher pulse pressure (PP) (91 Vs 74 mmHg), but had similar SBP (174 Vs 175 mm Hg; p⫽NS). Pts with ISH had slightly lower cholesterol (5.9 Vs 6.1 mmol; p⫽0.15), higher glucose (6.2 Vs 6.0 mmol; p⫽. 001) and lower hemoglobin (13.9 Vs 14.3 mg/dl; p⫽.001). However, both groups had similar impact on target organ disease: urinary microalbuminine (61.1 Vs 65.6 mg/dl; p⫽NS), urine/creatinine ratio (6.97 Vs 7.88; p⫽NS), LVMI (124 Vs 124 g/m2) and LVMH2.7 (58 Vs 57; p⫽NS), were similar between the two groups. Conclusion: We conclude that ISH and CSDH have similar impact on target organ disease despite mild differences in cardiovascular risk factors, and significant differences in DBP. Key Words: ISH, Combined Hypertension, LVH
P-51 IATROGENIC HYPOTENSION ASSOCIATED WITH NORMAL-TENSION GLAUCOMA K. G. Harkins, D. S. King, M. R. Wofford, S. B. Wyatt, D. W. Jones. 1 University of Mississippi Medical Center, Jackson, MS, United States Systemic hypotension is reported as a risk factor for glaucoma, but there is a paucity of data in the hypertension literature regarding its importance. Nocturnal falls in both systolic and diastolic blood pressure have been associated with progressive visual field loss. Risk may be higher in patients with hypertension (HTN) on therapy than in the normotensive population.
Key Words: Ambulatory blood pressure monitor, Glaucoma, Hypertension
P-52 AORTIC PULSE WAVE VELOCITY AND WHITE COAT EFFECT IN HYPERTENSIVES “IN OFFICE” EITHER TREATED AND UNTREATED Abilio Silveira, Anabela Mesquita, Jose A. Silva, Jorge J. Polonia. 1 Unidade Hipertensa˜o, Hospital Pedro Hispano, Matosinhos, Portugal, 2Unidade Farmacologia Clinica, Faculdade Medicina Porto, Porto, Portugal Previous studies have shown that drug treatment of hypertension may regress target-organ damage. It is still controversial whether white-coat hypertensive subjects may benefit from anti-hypertensive treatment. We measured 24h ambulatory BP monitoring, carotid-femoral (aortic) pulse wave velocity (PWV) as an index of aortic stiffness and LV mass (echo) in 88 subjects (ageing 49⫾2 yrs) with white coat hypertension (WCH, casual BP ⬎ 140/90 and daytime BP ⬍ 130/80 mm Hg), and in 115 untreated ambulatory hypertensives ageing 51⫾2 yrs (HT casual BP ⬎ 140/90 and daytime BP ⬎ 135/85). Thirty one of the WCH were treated (WCH-tr) with antihypertensive drugs for ⬎ 6 months, the remaining being untreated (WCH-untr). The magnitude of the white coat effect (casual BP-daytime BP) was greater in WCHuntr (18/10 mm Hg) and in WCHtr (16/9 mm Hg) than in HT (11/4 mm Hg). In all subjects white-coat effect did not show any association with aortic pulse wave velocity (r⫽0.08, ns) nor with ventricular mass index (r⫽0.01, ns) whereas daytime BP values correlated with PWV (r⫽0.41, p⬍0,01) and with LVMI (r⫽0.32, p⬍0.05). Both WCH groups, for similar daytime BP values (WCHuntr 125/81 ⫾2/1 and WCHtr 124/80⫾2/2mm Hg), show similar PWV (WCHuntr 9.9⫾0.4, WCHtr 10.0⫾0.5 m/s) and LVMI (WCHuntr 69⫾3, WCHtr 67⫾3 g/m2) both of which were significantly (p⬍0.05) lower than that of the group of ambulatory hypertensives PWV 11.7⫾0.4 m/s and LVMI 81⫾4 g/m2. We conclude that the magnitude of the white-coat effect both in WCH (either treated or non-treated) and in ambulatory HT does not reflect the severity of hypertension as assessed by abnormalities of aortic stiffness aortic and LV mass. Also in WCH, treatment does not seem to improve these markers of target-organ damage. Key Words: White coat hypertension, Pulse wave velocity, Ambulatory blood pressure
POSTERS: Blood Pressure Measurement/Monitoring
AJH–April 2001–VOL. 14, NO. 4, PART 2
which were checked by connecting to the sphygmomanometer with a Y-connector at monthly clinic visits. Patients were asked to measure their home blood pressure in the morning within 30 minutes after awakening and in the evening just before going to bed. Subjects were divides to 2 groups according to the difference of systolic blood pressure between morning and evening (M-SBP-E-SBP); morning rise group (MR)⫽MSBP-E-SBP ⱖ 10mmHg and non-morning rise group (NMR)⫽M-SBPE-SBP ⬍ ⫾ 10mmHg. MR had a high left ventricular mass index (149 ⫾ 37 vs 122 ⫾ 21, p⬍0.001), serum creatinine (Cr, 0.88 ⫾ 0.23 vs 0.75 ⫾ 0.17 mg/dl) and urinary protein secretion (310 ⫾ 732 vs 95 ⫾ 185 mg/g Cr). These results suggested that the hypertensive patient who showed a morning rise in blood pressure had an advanced hypertensive cardiovascular complications.
A 47-year-old woman presented with new onset HTN. Initial evaluation revealed polycystic kidneys but no other abnormalities. An ambulatory blood pressure monitor (ABPM) at baseline demonstrated sustained daytime HTN, though blood pressure was lower than had been measured in the office. Medical therapy was initiated with a target blood pressure of ⬍130/80 mm Hg. Six months after her first visit she was diagnosed with normal-tension glaucoma. Over the course of two years she required higher doses of medication to control blood pressure as measured in the office. After one year of control with office systolic blood pressure readings of 137-144 mm Hg, her visual fields were noted by her ophthalmologist to be worsening. Home blood pressure measurement showed a range from 68/35 to 126/76 mm Hg. Her medication was decreased and a repeat ABPM revealed controlled blood pressure without hypotension. On lower doses of medication her visual fields stabilized. Office blood pressure remained higher than measured at home. Diurnal variations in blood pressure among patients with hypertension have been implicated as important risk factors in vision loss. Lower blood pressure is a potential etiologic factor in glaucoma and ischemic optic neuropathy. In patients with progressive visual field defects, out of office blood pressure monitoring can uncover previously unrecognized periods of hypotension associated with white-coat effect.
Key Words: morning rise, home blood pressure, cardiovascular complication
P-50 SIMILARITIES AND DIFFERENCES AMONG PATIENTS WITH ISOLATED SYSTOLIC OR COMBINED SYSTOLIC DIASTOLIC HYPERTENSION: THE LIFE STUDY Vasilios Papademetriou, Kristian Wachtell, Vittorio Palmieri, Puneet Narayan, Richard B. Devereux. 1Veterans Affairs & Georgetown University Medical Centers, Washington, DC, United States, 2Cornell University, New York, United States Both isolated systolic hypertension (ISH; SBPⱖ140 & DBP ⬍90 mm Hg) and combined (CSDH; SBPⱖ140 & DBP ⬎90 mm Hg) are powerful predictors of cardiovascular outcomes. Demographic characteristics and the comparative impact on target organs in these two groups have not been adequately described. Of the 9,190 patients with hypertension and ECG LVH, participating in the Losartan Intervention For Endpoints (LIFE) trial, 1,346 pts had ISH and 7,758 had CSDH. The remaining 86 pts had isolated diastolic HTN and were not included in this analysis. Compared to pts with CSDH, pts with ISH were older (71 vs 67 years; p⬍. 000), shorter (165 Vs 168 cm; p⬍. 000), weighed less (75 Vs 79 kg; p⬍. 000) and had lower BMI (27.4 Vs 28.1 kg/m2; p⬍. 000). By definition pts with ISH had lower DBP (83 Vs 100 mm Hg) and higher pulse pressure (PP) (91 Vs 74 mmHg), but had similar SBP (174 Vs 175 mm Hg; p⫽NS). Pts with ISH had slightly lower cholesterol (5.9 Vs 6.1 mmol; p⫽0.15), higher glucose (6.2 Vs 6.0 mmol; p⫽. 001) and lower hemoglobin (13.9 Vs 14.3 mg/dl; p⫽.001). However, both groups had similar impact on target organ disease: urinary microalbuminine (61.1 Vs 65.6 mg/dl; p⫽NS), urine/creatinine ratio (6.97 Vs 7.88; p⫽NS), LVMI (124 Vs 124 g/m2) and LVMH2.7 (58 Vs 57; p⫽NS), were similar between the two groups. Conclusion: We conclude that ISH and CSDH have similar impact on target organ disease despite mild differences in cardiovascular risk factors, and significant differences in DBP. Key Words: ISH, Combined Hypertension, LVH
P-51 IATROGENIC HYPOTENSION ASSOCIATED WITH NORMAL-TENSION GLAUCOMA K. G. Harkins, D. S. King, M. R. Wofford, S. B. Wyatt, D. W. Jones. 1 University of Mississippi Medical Center, Jackson, MS, United States Systemic hypotension is reported as a risk factor for glaucoma, but there is a paucity of data in the hypertension literature regarding its importance. Nocturnal falls in both systolic and diastolic blood pressure have been associated with progressive visual field loss. Risk may be higher in patients with hypertension (HTN) on therapy than in the normotensive population.
Key Words: Ambulatory blood pressure monitor, Glaucoma, Hypertension
P-52 AORTIC PULSE WAVE VELOCITY AND WHITE COAT EFFECT IN HYPERTENSIVES “IN OFFICE” EITHER TREATED AND UNTREATED Abilio Silveira, Anabela Mesquita, Jose A. Silva, Jorge J. Polonia. 1 Unidade Hipertensa˜o, Hospital Pedro Hispano, Matosinhos, Portugal, 2Unidade Farmacologia Clinica, Faculdade Medicina Porto, Porto, Portugal Previous studies have shown that drug treatment of hypertension may regress target-organ damage. It is still controversial whether white-coat hypertensive subjects may benefit from anti-hypertensive treatment. We measured 24h ambulatory BP monitoring, carotid-femoral (aortic) pulse wave velocity (PWV) as an index of aortic stiffness and LV mass (echo) in 88 subjects (ageing 49⫾2 yrs) with white coat hypertension (WCH, casual BP ⬎ 140/90 and daytime BP ⬍ 130/80 mm Hg), and in 115 untreated ambulatory hypertensives ageing 51⫾2 yrs (HT casual BP ⬎ 140/90 and daytime BP ⬎ 135/85). Thirty one of the WCH were treated (WCH-tr) with antihypertensive drugs for ⬎ 6 months, the remaining being untreated (WCH-untr). The magnitude of the white coat effect (casual BP-daytime BP) was greater in WCHuntr (18/10 mm Hg) and in WCHtr (16/9 mm Hg) than in HT (11/4 mm Hg). In all subjects white-coat effect did not show any association with aortic pulse wave velocity (r⫽0.08, ns) nor with ventricular mass index (r⫽0.01, ns) whereas daytime BP values correlated with PWV (r⫽0.41, p⬍0,01) and with LVMI (r⫽0.32, p⬍0.05). Both WCH groups, for similar daytime BP values (WCHuntr 125/81 ⫾2/1 and WCHtr 124/80⫾2/2mm Hg), show similar PWV (WCHuntr 9.9⫾0.4, WCHtr 10.0⫾0.5 m/s) and LVMI (WCHuntr 69⫾3, WCHtr 67⫾3 g/m2) both of which were significantly (p⬍0.05) lower than that of the group of ambulatory hypertensives PWV 11.7⫾0.4 m/s and LVMI 81⫾4 g/m2. We conclude that the magnitude of the white-coat effect both in WCH (either treated or non-treated) and in ambulatory HT does not reflect the severity of hypertension as assessed by abnormalities of aortic stiffness aortic and LV mass. Also in WCH, treatment does not seem to improve these markers of target-organ damage. Key Words: White coat hypertension, Pulse wave velocity, Ambulatory blood pressure