Pulse pressure and nocturnal fall in blood pressure are predictors of vascular, cardiac and renal target organ damage in hypertensive patients (LOD-RISK study)

Objectives To analyse the relationship between various parameters derived from ambulatory blood pressure monitoring (ABPM) and vascular, cardiac and renal target organ damage. Methods A cross-sectional, descriptive study. It included 353 patients with short-term or recently diagnosed hypertension. Primary measurements: ABPM, carotid intima-media thickness (IMT), Cornell voltage-duration product (Cornell VDP), glomerular filtration rate and albumin/creatinine ratic, to assess vascular, cardiac and renal damage. Results Two hundred and twenty-three patients (63.2%) were males, aged 56.12 +/- 11.21 years. The nocturnal fall in blood pressure was 11.33 +/- 8.41, with a dipper pattern in 49.0% (173), nondipper in 30.3% (107), extreme dipper in 12.7% (45) and riser in 79% (28). The IMT was lower in the extreme dipper (0.716 +/- 0.096 mm) and better in the riser pattern (0.794 +/- 0.122 mm) (P<0.05). The Cornell VDP and albumin/creatinine ratio were higher in the riser pattern (1818.94 +/- 1798.63 mm/ms and 140.78 +/- 366.38 mg/g, respectively) than in the other patterns. In the multivariate analysis after adjusting for age, sex and antihypertensive treatment, with IMT as dependent variable the 24-h pulse pressure (beta=0.003), with Cornell VDP the rest pulse pressure (beta=12.04), and with the albumin/creatinine ratio the percentage of nocturnal fall in systolic blood pressure (beta= -3.59), the rest heart rate (beta=1.83) and the standard deviation of 24-h systolic blood pressure (beta=5.30) remain within the equation. Conclusion The estimated pulse pressure with ABPM is a predictor of vascular and cardiac organ damage. The nocturnal fall and the standard deviation in 24-h systolic blood pressure measured with the ABPM is a predictor of renal damage. Blood Press Monit 14:145-151 (C) 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.