Published online before print June 11, 2007, doi: 10.1161/HYPERTENSIONAHA.107.090084
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(Hypertension. 2007;50:325.)
© 2007 American Heart Association, Inc.
Original Articles |
Awake Systolic Blood Pressure Variability Correlates With Target-Organ Damage in Hypertensive Subjects
From the Institute of Cardiology and Center of Excellence on Aging (A.T., G.R., M.Z., M.S., R.D.C.), "G. d’Annunzio" University, Chieti; the Department of Cardiology (G.B., G.P.), S. Luca Hospital, Italian Auxologic Institute & Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan; and the Department of Clinical and Experimental Medicine (G.S.), the University of Perugia, Italy.
Correspondence to Raffaele De Caterina, MD, PhD, Institute of Cardiology, "G. d’Annunzio" University—Chieti, c/o Ospedale S. Camillo de Lellis, Via Forlanini, 50, 66100 Chieti, Italy. E-mail rdecater{at}unich.it
Growing evidence associates blood pressure (BP) variability with cardiovascular events in hypertensive patients. Here we tested the existence of a relationship between awake BP variability and target-organ damage in subjects referred for suspected hypertension. Systolic and diastolic BP variability were assessed as the standard deviation of the mean out of 24-hour, awake and asleep BP recordings in 180 untreated subjects, referred for suspected hypertension. Measurements were done at 15-minute intervals during daytime and 30-minute intervals during nighttime. Left ventricular mass index (by echo), intima-media thickness (by carotid ultrasonography), and microalbuminuria were assessed as indices of cardiac, vascular and renal damage, respectively. Intima-media thickness and left ventricular mass index progressively increased across tertiles of awake systolic BP variability (P for trend=0.001 and 0.003, respectively). Conversely, microalbuminuria was similar in the 3 tertiles (P=NS). Multivariable analysis identified age (P=0.0001), awake systolic BP (P=0.001), awake systolic BP variability (P=0.015) and diastolic BP load (P=0.01) as independent predictors of intima-media thickness; age (P=0.0001), male sex (P=0.012), awake systolic (P=0.0001) and diastolic BP (P=0.035), and awake systolic BP variability (P=0.028) as independent predictors of left ventricular mass index; awake systolic BP variability (P=0.01) and diastolic BP load (P=0.01) as independent predictors of microalbuminuria. Therefore, awake systolic BP variability by non-invasive ambulatory BP monitoring correlates with sub-clinical target-organ damage, independent of mean BP levels. Such relationship, found in subjects referred for recently suspected hypertension, likely appears early in the natural history of hypertension.
Key Words: hypertension • blood pressure variability • target-organ damage • intima-media thickness • left ventricular mass index
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