Abstract-Whether target organ damage is associated with blood pressure (BP) variability independent of level remains debated. We assessed these associations from 10-minute beat-to-beat, 24-hour ambulatory, and 7-day home BP recordings in 256 untreated subjects referred to a hypertension clinic. BP variability indices were variability independent of the mean, maximum-minimum difference, and average real variability. Effect sizes (standardized β) were computed using multivariable regression models. In beat-to-beat recordings, left ventricular mass index (n=128) was not (P≥0.18) associated with systolic BP but increased with all 3 systolic variability indices (+2.97-3.53 g/m 2 ; P<0.04); the urinary albumin-to-creatinine ratio increased (P≤0.03) with systolic BP (+1.14-1.17 mg/mmol) and maximum-minimum difference (+1.18 mg/mmol); and pulse wave velocity increased with systolic BP (+0.69 m/s; P<0.001). In 24-hour recordings, all 3 indices of organ damage increased (P<0.03) with systolic BP, whereas the associations with BP variability were nonsignificant (P≥0.15) except for increases in pulse wave velocity (P<0.05) with variability independent of the mean (+0.16 m/s) and maximum-minimum difference (+0.17 m/s). In home recordings, the urinary albumin-to-creatinine ratio (+1.27-1.30 mg/mmol) and pulse wave velocity (+0.36-0.40 m/s) increased (P<0.05) with systolic BP, whereas all associations of target organ damage with the variability indices were nonsignificant (P≥0.07). In conclusion, while accounting for BP level, associations of target organ damage with BP variability were readily detectable in beat-to-beat recordings, least noticeable in home recordings, with 24-hour ambulatory monitoring being informative only for pulse Assessment of Organ DamageAs described in detail elsewhere, 16 LVMI by echocardiography (n=128), the urinary albumin-to-creatinine ratio (n=256), and aortic PWV (n=255) were determined as measures of organ damage. For the details of the organ damage assessment and other measurements, including body mass index, serum cholesterol, plasma glucose, and questionnaire survey on smoking and drinking habits, see Expanded Methods in the online-only Data Supplement. Statistical AnalysisFor database management and statistical analysis, we used the Statistical Analysis System software, version 9.3 (SAS Institute, Cary, NC). We limited our main analyses to systolic BP because systolic BP is the main driver of risk 17 and because we recently demonstrated in the same patient cohort that systolic BP was the main determinant of target organ damage irrespective of age. 16 Henceforth, in our article unless otherwise specified, BP refers to systolic BP. We assessed BP variability from the variability independent of the mean (VIM), 15 the difference between maximum and minimum BP (MMD), and average real variability (ARV).10,14 For the details of the computation of these variability indices, see Expanded Methods in the online-only Data Supplement.To study the association between organ damage and BP level and variabi...
Hypertension guidelines propose home or ambulatory blood pressure monitoring as indispensable after office measurement. However, whether preference should be given to home or ambulatory monitoring remains undetermined. In 831 untreated outpatients (mean age, 50.6 years; 49.8% women), we measured office (3 visits), home (7 days), and 24-h ambulatory blood pressures. We applied hypertension guidelines for cross-classification of patients into normotension or white-coat, masked, or sustained hypertension. Based on office and home blood pressures, the prevalence of white-coat, masked, and sustained hypertension was 61 (10.3%), 166 (20.0%), and 162 (19.5%), respectively. Using daytime (from 8 am to 6 pm ) instead of home blood pressure confirmed the cross-classification in 575 patients (69.2%), downgraded risk from masked hypertension to normotension ( n =24) or from sustained to white-coat hypertension ( n =9) in 33 (4.0%), but upgraded risk from normotension to masked hypertension ( n =179) or from white-coat to sustained hypertension ( n =44) in 223 (26.8%). Analyses based on 24-h ambulatory blood pressure were confirmatory. In adjusted analyses, both the urinary albumin-to-creatinine ratio (+20.6%; confidence interval, 4.4–39.3) and aortic pulse wave velocity (+0.30 m/s; confidence interval, 0.09–0.51) were higher in patients who moved up to a higher risk category. Both indexes of target organ damage and central augmentation index were positively associated ( P ≤0.048) with the odds of being reclassified. In conclusion, for reliably diagnosing hypertension and starting treatment, office measurement should be followed by ambulatory blood pressure monitoring. Using home instead of ambulatory monitoring misses the high-risk diagnoses of masked or sustained hypertension in over 25% of patients.
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