Yonsei Med J.  2018 Mar;59(2):265-272. 10.3349/ymj.2018.59.2.265.

Impact of Ambulatory Blood Pressure on Early Cardiac and Renal Dysfunction in Hypertensive Patients without Clinically Apparent Target Organ Damage

• Kim D
• Shim CY
• Hong GR
• Park S
• Cho IJ
• Chang HJ
• Ha JW
• Chung N

• KMID: 2418790
• DOI: http://doi.org/10.3349/ymj.2018.59.2.265

Abstract

PURPOSE
Impaired left ventricular (LV) global longitudinal strain (GLS) and the presence of microalbuminuria indicate early cardiac and renal dysfunction. We aimed to determine the relationships among 24-h ambulatory blood pressure (BP) variables, LV GLS, and urine albumin creatinine ratio (UACR) in hypertensive patients.
MATERIALS AND METHODS
A total of 130 hypertensive patients (mean age 53 years; 59 men) underwent 24-h ambulatory BP monitoring, measurements of peripheral and central BPs, and transthoracic echocardiography. Patients with apparent LV systolic dysfunction (LV ejection fraction < 50%) or chronic kidney disease were not included. LV GLS was calculated using two-dimensional speckle tracking, and UACR was analyzed from spot urine samples.
RESULTS
In simple correlation analysis, LV GLS showed the most significant correlation with mean daytime diastolic BP (DBP) (r=0.427, p < 0.001) among the various BP variables analyzed. UACR revealed a significant correlation only with night-time mean systolic BP (SBP) (r=0.253, p=0.019). In multiple regression analysis, daytime mean DBP and night-time mean SBP were independent determinants for LV GLS (β=0.35, p=0.028) and log UACR (β=0.49, p=0.007), respectively, after controlling for confounding factors. Daytime mean DBP showed better diagnostic performance for impaired LV GLS than did peripheral or central DBPs, which were not diagnostic. Night-time mean SBP showed satisfactory diagnostic performance for microalbuminuria.
CONCLUSION
There are different associations for daytime and night-time BP with early cardiac and renal dysfunction. Ambulatory BP monitoring provides more relevant BP parameters than do peripheral or central BPs regarding early cardiac and renal dysfunction in hypertensive patients.

Keyword

Ambulatory blood pressure monitoring; global longitudinal strain; microalbuminuria

MeSH Terms

Blood Pressure/physiology
*Blood Pressure Monitoring, Ambulatory
Echocardiography
Female
Heart/*physiopathology
Humans
Hypertension/diagnostic imaging/*physiopathology
Kidney/*physiopathology
Kidney Function Tests
Male
Middle Aged
Regression Analysis
Systole/physiology
Ventricular Dysfunction, Left/physiopathology
Ventricular Function, Left/physiology

Figure

• 

  Fig. 1 Associations between daytime mean DBP and subclinical LV dysfunction. (A) Association between daytime mean DBP and LV mass index in overall patients. (B) Association between daytime mean DBP and LV GLS in overall patients. (C) Association between daytime mean DBP and LV GLS in patients without LVH. (D) Association between daytime mean DBP and LV GLS in patients with LVH. DBP, diastolic blood pressure; LV, left ventricle; GLS, global longitudinal strain; LVH, left ventricular hypertrophy.

• 

  Fig. 2 Associations between night-time mean SBP and log UACR. SBP, systolic blood pressure; UACR, urine albumin creatinine ratio.

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  Fig. 3 Diagnostic performances for subclinical LV dysfunction (A) and presence of microalbuminuria (B). LV, left ventricle; GLS, global longitudinal strain; DBP, diastolic blood pressure; SBP, systolic blood pressure; AUC, area under the receiver operating characteristic curve.

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