Resting supine blood pressure as a useful indicator of hypertensive organ damage for untreated essential hypertensive patients

 

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https://storage.unitedwebnetwork.com/files/1099/d5d5b35c3920b8e3f309a4f459ec294a.pdf
Resting supine blood pressure as a useful indicator of hypertensive organ damage for untreated essential hypertensive patients

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Maiko
Ohara
Maiko Ohara michael07121123@hotmail.co.jp University of Toyama The Second Internal Medicine Toyama Japan *
Tsutomu Koike kanegon.koike@gmail.com University of Toyama The Second Internal Medicine Toyama Japan -
Shingo Yokoyama tr1250100@gmail.com University of Toyama The Second Internal Medicine Toyama Japan -
Kota Kakeshita kakeshit@med.u-toyama.ac.jp University of Toyama The Second Internal Medicine Toyama Japan -
Koichiro Kinugawa kinugawa@med.u-toyama.ac.jp University of Toyama The Second Internal Medicine Toyama Japan -
Fumihiro Tomoda tomoda@fukui-hsu.ac.jp Fukui Health Science University Faculty of Health Science Fukui Japan -
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 Previous studies suggested that supine blood pressure (BP) is an independent risk factor for cardiovascular diseases. Office BP is a less significant risk factor for cardiovascular diseases than BP self-measured at home or measured by 24-hour ambulatory BP monitoring (ABPM) according to the effects of insufficient rest during BP measurement and the white-coat phenomenon. BP measured during cardio-ankle vascular index (CAVI) assessment in a resting supine position is less affected by these factors and is therefore thought to be a more useful indicator of hypertensive organ damage than office BP, but the details remain unclear.

Seventy-five untreated essential hypertensive patients (mean age 56 years, 51 men) without chronic kidney disease (urinary albumin excretion (UAE) less than 300 mg/g of creatinine and estimated glomerular filtration rate 60 mL/min/1.73m2 or more) were studied. All patients underwent fasting blood sampling, urine sampling, 24-hour ABPM, left ventricular mass index (LVMI) measured by echocardiography, and minimum forearm vascular resistance (MVR) measured by plethysmography. Supine BP and CAVI were measured after five minutes rest period by using Vasera-VS1500 (Fukuda Denshi, Co., Ltd.). The associations between hypertensive organ damage and systolic BP measured under various conditions (office systolic BP (c-SBP), 24-hour average systolic BP (24hr-SBP) measured by ABPM, and supine BP during CAVI measurement (CAVI-SBP)) were evaluated.

UAE and MVR were positively correlated with c-SBP, 24hr-SBP, and CAVI-SBP (UAE, r = 0.26, 0.42, 0.56; MVR, r = 0.28, 0.25, 0.39; p <0.05, respectively). Plasma BNP and LVMI, indicators of heart diseases, increased with increases in c-SBP, 24hr-SBP, and CAVI-SBP (BNP, r = 0.29, 0.40, 0.55; LVMI, r = 0.34, 0.29, 0.32; p <0.05, respectively). CAVI was not associated with any of these BP. In a multiple regression analysis using UAE, plasma BNP, LVMI, and MVR as dependent variables and factors related to these indices including c-SBP, 24hr-SBP, and CAVI-SBP as explanatory variables, CAVI-SBP was an independent determinant for UAE, plasma BNP, and MVR, whereas 24hr-SBP for LVMI. On the other hand, c-SBP could not be a determinant of these indices.

These results indicate that in patients with untreated essential hypertension, resting supine BP is a more useful indicator of hypertensive organ damage than office BP. BP should be measured in a stress-free and sufficiently resting condition.

Kewords