Ambulatory blood pressure, target organ damage and aortic root size in never-treated essential hypertensive patients

Abstract

The relationship between ambulatory blood pressure (ABP), target organ damage (TOD) and aortic root (AR) size in human hypertension has not been fully explored to date. We investigated the relationship between ABP, different markers of TOD and AR size in never-treated essential hypertensive patients. A total of 519 grade 1 and 2 hypertensive patients (mean age 46712 years) referred for the first time to our outpatient clinic underwent the following procedures: (1) routine examination, (2) 24 h urine collection for microalbuminuria (MA), (3) ambulatory blood pressure monitoring over two 24 h periods within 4 weeks, (4) echocardiography and (5) carotid ultrasonography. AR dilatation was defined by sex-specific criteria (X40 mm in men and X37 mm in women). AR diameter was increased in 3.7% of patients. Demographic variables (body mass index, age and male gender), average night-time diastolic blood pressure (BP) (but not clinic or average 48 h BP), left ventricular mass index and carotid intima-media (IM) thickness showed an independent association with AR size in both univariate and multivariate analyses. When TOD data were analysed in a categorical way, a stepwise increase in the prevalence of left ventricular hypertrophy (LVH) (I ¼ 17.5%, II ¼ 27.6%, III ¼ 35.8%) and carotid IM thickening (I ¼ 20.9%, II ¼ 28.8%, III ¼ 34.4%), but not in MA (I ¼ 6.8%, II ¼ 9.1%, III ¼ 8.7%) was found with the progression of AR size tertiles. Our results show that (1) AR enlargement in uncomplicated never-treated hypertensive patients has a markedly lower prevalence than traditional markers of cardiac and extracardiac TOD; (2) night-time BP, LVH and carotid IM thickening are independent predictors of AR dimension.

Sex-specific hemodynamic and non-hemodynamic determinants of aortic root size in hypertensive subjects with left ventricular hypertrophy

“…This finding argues against data obtained from population-based and untreated hypertensives showing a direct impact of body surface area on AoR size. [4][5][6][7] Nonetheless, they seem to agree with the results obtained from patients with electrocardiographic LV hypertrophy, which showed no difference in the body surface areas of patients with either enlarged or normal AoR diameter. 5 It is noteworthy that most of the subjects with dilated AoR described in this aforementioned study were of male gender, thereby supporting the notion that body size may not be a major determinant of AoR dilatation in hypertensive hypertrophic men.…”

“…3,4,8 Left ventricular (LV) hypertrophy is a major predictor of AoR dilatation in hypertensive subjects, independent of age, body size and gender. 6,7 This observation argues against the notion that changes in AoR diameter are solely explained by variations in body size and age, and points toward AoR and LV remodeling as processes with common pathophysiological mechanisms. In addition, it suggests that hypertensive patients with LV hypertrophy comprise a population with attractive features for the study of potential determinants of AoR size.…”

“…Noticeably, we reproduced data from other sources showing no association between AoR size and microalbuminuria. 6,7 Furthermore, we found that AoR size did not correlate with creatinine clearance and retinal vascular changes in both genders, thus suggesting that, in contrast to LV hypertrophy and carotid intimamedia growth, AoR dilatation might not show an expressive relationship with hypertensive microvascular damage.…”

“…1,2 Therefore, increased importance has been devoted to the study of the biological determinants of AoR size. AoR dilatation is observed more frequently in hypertensive than in normotensive individuals 3,4 and its prevalence is higher in patients with complicated hypertension, [5][6][7] supporting the idea that it is a targetorgan damage marker. However, this assumption has been challenged by several lines of evidence showing no difference in AoR diameter between hypertensive and normotensive individuals after adjusting for age and body size.…”

“…Although the use of antihypertensive medications and evaluation of clinic blood pressure levels might be major limitations to this assumption, our data agree with other studies showing no independent impact of clinic blood pressure measurements on AoR size either in treated or untreated hypertensives. [4][5][6] Conversely, a recent report showed a direct significant association between nighttime blood pressure evaluated by ambulatory blood pressure monitoring and AoR diameter in hypertensive patients, 7 supporting the notion that pressure overload might indeed influence the AoR phenotype.…”