Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients

Abellán-Huerta, José; Valiente, Luis; Consuegra-Sánchez, Luciano; Montoro-García, Silvia; Salguero-Merino, A.B.; Morales-López, R.; Abellan-Alemán, J.; Soria-Arcos, Federico

doi:10.1016/j.hipert.2017.04.001

Cited by 6 publications

(3 citation statements)

References 30 publications

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“…41 The addition of non-invasive assessments of target organ damage can reclassify individuals with such risk markers present into higher-risk groups. 42 The present findings require confirmation in other populations but, if they are reproducible, then IAD measurement may offer an opportunity to identify, at a preclinical stage, those people most likely to benefit from aggressive preventive strategies. 20…”

Section: Comparison With Existing Literaturementioning

confidence: 67%

Systolic inter-arm blood pressure difference and risk of cognitive decline in older people: a cohort study

et al. 2020

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BackgroundSystolic inter-arm difference in blood pressure (IAD) and cognitive decline are both associated with cardiovascular disease; therefore, it was hypothesised that IAD may be predictive of cognitive decline.AimTo examine associations of IAD with cognitive decline in a community population.Design and settingA prospective study of older Italian adults enrolled in the InCHIANTI study.MethodUnivariable and multivariable associations of IAD were explored with declines in mini mental state examination (MMSE) scores, Trail Making Test A and B scores, and a composite outcome representing substantial decline in any of these scores. Backward stepwise regression was used to adjust observed associations of IAD with cognitive decline.ResultsThe rate of decline for MMSE scores in 1133 participants was greater with IAD ≥5 mmHg or ≥10 mmHg. On univariable analyses continuous IAD was associated with the composite outcome (odds ratio [OR] 1.16 per 5 mmHg of IAD, 95% confidence interval [CI] = 1.02 to 1.31). Substantial decline in MMSE score was seen with IAD ≥5 mmHg (OR 1.41, 95% CI = 1.03 to 1.93), and in the composite outcome with IAD ≥5 mmHg (OR 1.44, 95% CI = 1.10 to 1.89) or ≥10 mmHg (OR 1.39, 95% CI = 1.03 to 1.88). After multivariable adjustment, an IAD ≥ 5 mmHg remained associated with reductions in the composite outcome, reflecting declining cognitive performance (OR 1.46, 95% CI = 1.05 to 2.03).ConclusionAn IAD ≥5 mmHg is associated with cognitive decline in a representative older population. Given that systolic inter-arm differences in blood pressure are easily measured, confirmation of these findings could inform individualised treatment for the prevention of cognitive decline and dementia.

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Section: Comparison With Existing Literaturementioning

confidence: 67%

Systolic inter-arm blood pressure difference and risk of cognitive decline in older people: a cohort study

et al. 2020

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“…To date there have been a number of studies in large cohorts assessing the relationship between cPP versus pPP with TOD. cfPWV has been shown to be related to TOD in asymptomatic hypertensive patients, [14]. In a recent meta-analysis by Kollias et al [13], cPP was shown to be more closely associated with indices of subclinical TOD, quantified as cfPWV, left ventricular mass index, carotid IMT, and urine ACR, when compared with peripheral PP [13].…”

Section: Discussionmentioning

confidence: 99%

Association of Haemodynamic Indices of Central and Peripheral Pressure with Subclinical Target Organ Damage

Zuo

Chu

Tan

et al. 2017

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Background: Central aortic pressure has often been shown to be more closely associated with markers of vascular function and incidence of cardiovascular events compared to peripheral pressure. However, the potential clinical use of central aortic or peripheral haemodynamic indices as markers of target organ damage (TOD) has not been fully established. Methods: We evaluated associations of TOD with central aortic and peripheral haemodynamic indices (central aortic [cPP] and peripheral pulse pressure [pPP], central aortic augmentation index, and central and peripheral waveform factor) in 770 hospital inpatients (age 60 ± 10 years, 473 males) with primary hypertension. TOD was quantified in terms of arterial stiffness as measured by carotid-femoral pulse wave velocity (cfPWV), carotid intima-media thickness (IMT), and urine albumin-to-creatinine ratio (ACR). Subclinical TOD was defined as carotid IMT >0.9 mm, urine ACR >3.5 mg/mmol in females and >2.5 mg/mmol in males and/or cfPWV >12 m/s. Results: Both cPP and pPP showed significant correlation with cfPWV (r = 0.41 vs. 0.40; p < 0.01), ACR (r = 0.24 vs. 0.27; p < 0.01) and carotid IMT (r = 0.14 vs. 0.15; p < 0.01). Each SD increase in pPP and cPP was associated with increased risk of cfPWV >12 m/s (odds ratio [OR] = 2.7 and 2.9 for pPP and cPP, respectively), ACR >2.5 mg/mmol (OR = 1.2 and 1.4, respectively), and carotid IMT >0.9 mm (OR = 1.46 and 1.53, respectively). Compared to pPP, cPP had higher predictive power for TOD for age ≥60 years (OR = 3.07, p < 0.001). Conclusions: Although both pPP and cPP show an association with TOD in a hypertensive population, cPP provides additional information beyond pPP associated with TOD in a hypertensive cohort. Central aortic haemodynamic indices as potential biomarkers of subclinical TOD need to be validated by further prospective studies.

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“…TOD is a major risk factor for cardiovascular morbidity and mortality, and early detection of TOD can help in the prevention and management of hypertension-related complications [5,6]. Several clinical and laboratory parameters have been used to assess the presence and severity of TOD in hypertensive patients, including blood pressure levels, electrocardiogram (ECG) findings, and imaging studies [3,5,7].…”

Section: Introductionmentioning

confidence: 99%

The Potential of Nocturnal Heart Rate as a Predictor of Target Organ Damage in Individuals Diagnosed with Hypertension

2023

medsc

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Background: Elevated nocturnal heart rate (NHR) has been linked to an increased risk of cardiovascular events and mortality in hypertensive patients. However, the ability of NHR to predict the occurrence and progression of target organ damage (TOD) in these patients requires further investigation. This study aims to evaluate the predictive value of NHR in forecasting the presence and severity of TOD in hypertensive patients, using a combination of clinical and laboratory parameters. Methods: A total of 145 hypertensive patients were monitored for blood pressure and nocturnal heart rate. Patients were categorized into two groups based on the presence or absence of TOD and their NHR. The left ventricular mass index (LVMI), glomerular filtration rate (GFR), carotid intima media index (CTIM), and left ventricular ejection fraction (LVEF) were measured, and multiple linear regression was used to determine the predictive value of NHR on these indices. Results: The group with TOD had significantly higher NHR than the group without TOD. LVMI, GFR, CTIM, and LVEF varied significantly among the three subgroups, with the NHR3 group showing marked differences compared to the NHR2 and NHR1 groups (p < 0.01 or p < 0.05). Excessively rapid NHR had diverse impacts on all categories of target organs, particularly on LVMI and CTIM. Conclusion: Augmentation of nocturnal heart rate causes heightened harm to the target organs, with the most significant impact observed in LVMI and CTIM. No significant difference in the severity of TOD was observed between patients with an NHR of less than 70 bpm and those with an NHR between 70 and 80 bpm. However, an NHR above 80 bpm resulted in more severe TOD. These findings suggest that monitoring NHR in hypertensive patients may help prevent and manage TOD.

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Most advisable strategy in search of asymptomatic target organ damage in hypertensive patients

Cited by 6 publications

References 30 publications

Systolic inter-arm blood pressure difference and risk of cognitive decline in older people: a cohort study

Systolic inter-arm blood pressure difference and risk of cognitive decline in older people: a cohort study

Association of Haemodynamic Indices of Central and Peripheral Pressure with Subclinical Target Organ Damage

The Potential of Nocturnal Heart Rate as a Predictor of Target Organ Damage in Individuals Diagnosed with Hypertension

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