Ambulatory Arterial Stiffness and BP and HR nocturnal dip

Bendersky M, Baroni M, Cruz M, Della Mora A, Sala J Instituto Modelo de Cardiologa, Crdoba ,Argentina

Introduction ABPM allows us to obtain values of various markers of higher cardiovascular risk, as reduced nocturnal BP and HR dip, high ambulatory arterial stiffness (AASI), and high BP variability. All of them shows good correlation with target organ damage and poor prognostic in hypertensive patients. It is no too clear and demostrated the correlation between them in normotensive and hypertensive patients. Aim of Study 1. To analize the correlations between AASI and BP and HR nocturnal dip, and also vs BP variability, in patients that were included in a cardiovascular check up. 2. To compare BP and HR nocturnal dip, and arterial stiffness between treated hypertensives patients (controled and non controled), normotensives and patients with a new diagnosis of Hypertension. Material and Methods 1305 patients were included, 872 treated hypertensives (345 controled 24 h BP<130/80 mmHg, and 527 uncontroled) , and 433 untreated patients (156 normotensives and 277 with new diagnosis of Hypertension). Mean age 54,5 years (15-93), 62% Male. . It was performed ABPM (Meditech) with at least 70 valid measurements and at least 1 per hour. It was calculated AASI: 1-slope DBP/SBP, BP (MAP) in% and HR nocturnal dip in beats/min. BP Coefficient of Variation as SD/Average. Statistics It was used Pearson Correlations and T Test for independent samples. It was considered significant p<0.05. Results In all sample it was observed a negative correlation between AASI vs BP and HR Nocturnal Dip (r 0.44 and r 0.20, both p<0.001), clearly the smaller the nocturnal dip, the greater the stiffness. It was observed a direct ,weak, but statisticaly significant correlation between BP variability and arterial stiffness (r 0.17 p<0.001). The greater the variability, the greater AASI.

Treated hypertensive patients have greater AASI than no treated, and the uncontrolled patients have greater stiffness than controlled ones (AASI 0.46 vs 0.42,p<0.0001), and also these group (uncontrolled) has lesser BP and HR nocturnal dip.

TABLE 1
BP Nocturnal dip% HR Nocturnal dip b/p/m AASI

Treated controlled 16.7 6.91

Treated Non controlled 12.05 6.4

Non treated Normotensives 15.5 8.0

Non treated New hypertensives 14.8 8.3

0.42

0.46

0.39

0.39

AASI: p<0.02 hypertensive controled vs normotensives, and also vs new diagnostic of hypertension; p<0.001 hypertensives controled vs non controled, non controled vs normotensives ans vs new hypertensives; non significative normotensive vs new hypertensives. BP nocturnal dip: the hypertensive non controled have less BP nocturnal dip than all other patients (p<0.001 in all groups), and the hypertensive controled have greater BP nocturnal dip than normotensives (p<0.02) and new 0,95 hypertensives (p<0.005)
0,83

HR nocturnal dip: the normotensives and new hypertensives have the greater 0,71 HR nocturnal dip, even greater then hypertensive controled (p<0.01)
AASI

Conclusion In patients that consult for a CV check up, it was observed a significant and 0,34 inverse correlation between arterial stiffness and BP and HR nocturnal dip. Contrariously BP variability showed direct correlation with AASI. In the group of 0,22 0,95 treated and uncontrolled hypertensive patients it was observed the greater 0,10 0,83 arterial stiffness and the lesser BP and HR nocturnal dip.
-0,03 0,71 -11,00 -3,86 0,58 3,29 10,43 17,57 24,71 BP Nocturnal Dip % 31,86 39,00 0,46

0,58

AASI

0,46 0,34 0,22 0,10 -0,03 -11,00

-3,86

3,29

10,43 17,57 24,71 BP Nocturnal Dip %

31,86

39,00