Ambulatory Pulse Pressure

Verdecchia, Paolo; Schillaci, Giuseppe; Borgioni, Claudia; Ciucci, Antonella; Pede, Sergio; Porcellati, Carlo

doi:10.1161/01.hyp.32.6.983

Cited by 363 publications

(170 citation statements)

References 43 publications

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“…[13][14] Extensive studies have clearly demonstrated predictive information of cardiovascular outcomes in population-based surveys. [15][16][17][18][19] In addition to the mean 24-h BP, nocturnal BP has frequently been considered an important predictor of both target-organ damage and cardiovascular events. [18][19][20] A normal dipping pattern (dipper) is seen when the drop in the average SBP during the night is 410% of the mean daytime SBP.…”

Section: Discussionmentioning

confidence: 99%

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

et al. 2011

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Resistant hypertension (RHTN) includes both patients whose blood pressure (BP) is uncontrolled on three or more medications (uncontrolled RHTN (UCRH)) and patients whose BP is controlled with use of four or more drugs (controlled RHTN (CRH)). It is unknown whether endothelial function and nocturnal drop demonstrate a similar pattern in patients with CRH and UCRH. We examined circadian BP patterns and vascular function in these patients. In all, 40 CRH and 26 UCRH patients, and 25 normotensives underwent biochemical testing, ambulatory BP monitoring, determination of brachial artery responses to endothelial-dependent (flow-mediated; dilation (FMD)) and independent (nitroglycerin mediated) stimuli. The nighttime drop in systolic BP (SBP) and diastolic BP (DBP) was less pronounced in UCRH than in CRH (SBP, 1.9±1.6 versus 4.9 ± 1.7%; DBP, 7.5 ± 1.8 versus 10.9 ± 1.8%, UCRH and CRH, respectively; Po0.05). FMD was greater in control group compared with RHTN patients. Patients with UCRH had significantly impaired FMD compared with CRH (5.9 ± 2.3% versus 7.1 ± 5.1%; Po0.0001). Therefore, UCRH patients have less nocturnal dipping and a more impaired endothelial response compared with CRH patients. These findings suggest that important differences among patients with RHTN may allow identify subgroups with increased cardiovascular risk.

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Section: Discussionmentioning

confidence: 99%

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

et al. 2011

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“…[29][30][31] Haemodynamic patterns of age-related changes in BP was shown in the Framingham heart study. 32 After age 50-60 years, DBP declined, PP rose steeply and MAP reached a plateau.…”

Section: Discussionmentioning

confidence: 99%

Relationship between blood pressure parameters and pulse wave velocity in normotensive and hypertensive subjects: invasive study

et al. 2006

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Blood pressure (BP) is one of the most important contributing factors to pulse wave velocity (PWV), a classic measure of arterial stiffness. Although there have been many non-invasive studies to show the relation between arterial stiffness and BP, the results are controversial. The aim of this study is to evaluate the role of BP as an influencing factor on PWV using invasive method. We observed 174 normotensive and untreated hypertensive subjects using coronary angiography. Arterial stiffness was assessed through aorto-femoral PWV by foot-to-foot velocity method using fluid-filled system. And BP was measured by pressure wave at the right common femoral artery. From univariate analysis, age, diabetes mellitus (DM), hypertension, waist, waist-to-hip ratio, total cholesterol-tohigh-density lipoprotein cholesterol ratio, systolic BP (SBP), pulse pressure (PP) and mean arterial pressure (MAP) showed significant association with PWV. To avoid multiple colinearity among SBP, PP and MAP, we performed multiple regression analysis predicting PWV thrice. Age, DM and each BP were significantly and consistently correlated to PWV. In the first and third modules, compared to age, SBP and MAP were less strong predictors, respectively. However, PP was the stronger predictor than age and DM in the second module. Lastly, we simultaneously forced MAP and PP with other variables in the fourth multivariate analysis. Age, DM and PP remained significantly correlated with PWV, but the significance of MAP was lost. This is the first invasive study to suggest that PP has the strongest correlation with PWV among a variety of BP parameters.

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“…Cardiovascular death was defined as a sudden cardiac death or a death caused by acute myocardial infarction, acute stroke, heart failure, or other cardiovascular causes. The international standard criteria used to diagnose outcome events in the PIUMA study have been described elsewhere 15, 22…”

Section: Methodsmentioning

confidence: 99%

Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension

Verdecchia¹,

Angeli

Bartolini³

et al. 2017

JAHA

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BackgroundThe different geometric patterns of the left ventricle may or may not coexist with chamber dilatation. The prognostic impact of such a combination is unclear.Methods and ResultsWe studied a cohort of 2635 initially untreated patients with hypertension, mean age 50 years. At entry, 24‐hour ambulatory blood pressure progressively increased across the patterns of normal geometry, concentric left ventricular (LV) remodeling, eccentric nondilated LV hypertrophy (LVH), eccentric dilated LVH, concentric nondilated LVH, and concentric dilated LVH. During a mean follow‐up of 9.7 years, 360 patients developed a first major cardiovascular event at a rate (×100 patient‐years) of 1.41. The event rate was 0.93 in the group with normal LV geometry, 1.10 in the group with LV concentric remodeling, 1.40 in the group with nondilated eccentric LVH, 2.10 in the group with eccentric dilated LVH, 2.34 in the group with nondilated concentric LVH, and 4.67 in the group with dilated concentric LVH (log‐rank test: P<0.001). In a Cox model, after adjustment for several independent covariables (age, sex, diabetes mellitus, current smoking, total cholesterol, estimated glomerular filtration rate, and average 24‐hour systolic blood pressure), concentric dilated LVH was associated with a 98% excess risk of cardiovascular events (P=0.0037). However, LV geometric pattern lost statistical significance when LV mass was entered into the model.ConclusionsIn initially untreated patients with hypertension, LV dilatation adds an adverse prognostic burden to the patterns of eccentric and concentric LVH. This phenomenon is explained by the greater LV mass associated with LV chamber dilatation.

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Ambulatory Pulse Pressure

Cited by 363 publications

References 43 publications

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

Relationship between blood pressure parameters and pulse wave velocity in normotensive and hypertensive subjects: invasive study

Impact of Chamber Dilatation on the Prognostic Value of Left Ventricular Geometry in Hypertension

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