Association of left ventricular diastolic dysfunction with 24-h aortic ambulatory blood pressure: the SAFAR study

Abstract

Aortic blood pressure (BP) and 24-h ambulatory BP are both better associated with target organ damage than office brachial BP. However, it remains unclear whether a combination of these two techniques would be the optimal methodology to evaluate patients' BP in terms of left ventricular diastolic dysfunction (LVDD) prevention. In 230 participants, office brachial and aortic BPs were measured by a validated BP monitor and a tonometry-based device, respectively. 24-h ambulatory brachial and aortic BPs were measured by a validated ambulatory BP monitor (Mobil-O-Graph, Germany). Systematic assessment of patients' LVDD was performed. After adjustment for age, gender, hypertension and antihypertensive treatment, septum and lateral E/Ea were significantly associated with office aortic systolic BP (SBP) and pulse pressure (PP) and 24-h brachial and aortic SBP and PP (P ⩽ 0.04), but not with office brachial BP (P ⩾ 0.09). Similarly, 1 standard deviation in SBP was significantly associated with 97.8 ± 20.9, 86.4 ± 22.9, 74.1 ± 23.3 and 51.3 ± 22.6 in septum E/Ea and 68.6 ± 2 0.1, 54.2 ± 21.9, 37.9 ± 22.4 and 23.1 ± 21.4 in lateral E/Ea, for office and 24-h aortic and brachial SBP, respectively. In qualitative analysis, except for office brachial BP, office aortic and 24-h brachial and aortic BPs were all significantly associated with LVDD (P ⩽ 0.03), with the highest odds ratio in 24-h aortic SBP. Furthermore, aortic BP, no matter in the office or 24-h ambulatory setting, showed the largest area under receiver operating characteristic curves (P ⩽ 0.02). In conclusion, 24-h aortic BP is superior to other BPs in the association with LVDD.

Phenotypes of office systolic blood pressure according to both brachial and aortic measurements

“…Thus, the assessment of both office brachial and aortic BP might potentially refine the cardiovascular risk classification and should be further tested in mortality outcome studies. Such studies can be further facilitated by the novel brachial cuff-based automated oscillometric devices that simultaneously measure the brachial and aortic BP, in not only static [16] but also ambulatory conditions [17][18][19].…”

Northern Shanghai Study: cardiovascular risk and its associated factors in the Chinese elderly—a study protocol of a prospective study design

“…LV hypertrophy is defined as LVMI ≥115 g/m 2 (men) or LVMI ≥95 g/m 2 (women) 33. As for the arterial TODs, they are defined as increased CIMT (CIMT >0.9 mm) or peripheral artery disease (ABI<0.9).…”

Association of arteriosclerosis and/or atherosclerosis with hypertensive target organ damage in the community-dwelling elderly Chinese: the Northern Shanghai Study

“…Left ventricular hypertrophy (LVH) was defined as LVMI ≥115 g/m 2 (male) or LVMI ≥95 g/m 2 (female). Left ventricular diastolic dysfunction (LVDD) was assessed by E/Ea and other evidence of abnormal left ventricular relaxing and filling, such as enlarged left atrial volume and increased LVM 23. Specifically, diastolic dysfunction was defined as E/Ea ≥15 or 15> E/Ea >8 with the following (LVMI >149 g/m 2 [male] or LVMI ≥122 g/m 2 [female]) 23,24.…”

“…Left ventricular diastolic dysfunction (LVDD) was assessed by E/Ea and other evidence of abnormal left ventricular relaxing and filling, such as enlarged left atrial volume and increased LVM 23. Specifically, diastolic dysfunction was defined as E/Ea ≥15 or 15> E/Ea >8 with the following (LVMI >149 g/m 2 [male] or LVMI ≥122 g/m 2 [female]) 23,24. Renal TOD was defined as microalbuminuria (MAU) (UACR >30) and renal dysfunction (RD) (creatinine clearance rate <60 mL/min/1.73 m 2 ).…”