Abstract P248: Office and Ambulatory Brachial and Aortic Blood Pressure in Relation to Renal, Cardiac, and Vascular Organ Damage in Hypertension

Abstract

It has been suggested that aortic BP could be a better predictor of target organ damage (TOD) than peripheral BP. However, studies examining such relationship by using ABPM are scarce. We aimed to examine such relationship in a cohort of hypertensive patients. A total of 208 patients (34% women; mean age: 57±12 years, 90% on antihypertensive treatment) were recruited from 4 hospital clinics in the area of Barcelona, Spain. The presence of TOD was determined if one of the following were present: cardiac, defined as the presence of LVH (LVMI ≥ 115 g/m 2 in men or ≥ 95 g/m 2 in women); renal, defined as the presence of either albuminuria (UAE ≥ 30mg/g) or reduced eGFR (< 60 ml/min/1.73 m 2 , by CKD-EPI formula), or both; vascular: aortic PWV ≥ 10 m/s. Clinic (mean of 4 measurements) and 24-h brachial and aortic BP were determined by the use of the portable automated Mobil-O-Graph device. LVH was present in 37%, albuminuria (17%), reduced eGFR (14%), or both were present in 26%, and elevated aortic PWV in 18%. Overall, 51% of patients presented TOD in at least one organ, whereas 6.3% have all renal, cardiac, and vascular alterations. After adjustments for age, gender, and the use of antihypertensive treatment, odds ratios for clinic, 24-hour, daytime, and nighttime brachial and aortic SBP and pulse pressure (PP) were all significantly associated with the presence of TOD. Higher odds ratios were observed for PP, compared to SBP, and for 24-hour estimates, compared to clinic, daytime or nighttime values. The OR for 5 mmHg increase in brachial and aortic PP were respectively 1.38 (1.16-1.60) and 1.41 (1.14-1.70). PP amplification or augmentation index (clinic or 24-h-derived) were not significantly associated with the presence of TOD, after adjustments. Considering specific organ alterations, aortic SBP and PP estimates were associated with LVH and aortic PWV, but not with albuminuria or reduced eGFR. Both aortic SBP and PP are associated with the presence of TOD in hypertensive patients. The association is stronger for 24-h PP and for LVH and arterial stiffness, whereas renal alterations show a weaker association. The use of ABPM including aortic BP measurement can be of interest in predicting cardiovascular alterations in hypertension.