AMBULATORY BLOOD PRESSURE MONITORING IN PATIENTS WITH MEDIAL ARTERIAL CALCIFICATION

Abstract

Objective: Several studies have shown that reduced ankle-brachial pressure index (ABI) is a reliable warning sign of increased cardiovascular risk. But also ABI values above 1.3 in the presence of medial arterial calcification (MAC) are associated with increased mortality due to cardiovascular causes. Aim of the study was in a group of patients with MAC using ambulatory blood pressure monitoring (ABPM) to document frequent occurence of arterial hypertension, with also frequent diurnal pattern loss, as significant factors in patients prognosis. Design and method: We examined 41 patients (25 men, 16 women) with identified MAC. Mean age 59 years (50-79 years). All patients have been treated for diabetes mellitus, type 2, most of them, 23 (56.1 %) with insulin. The mean duration of diabetes was 12.6 years. MAC was detected by the BOSO, ABI system 100 (Germany), using the oscillometric method of measuring blood pressure. ABI value was calculated as the ratio of the value of higher pressure in the leg to a higher pressure on the upper extremities. ABPM was performed with the Cardiosoft-Tonoport V, General Electric (USA). Results: 35 patients (85,4 %) had arterial hypertension, most of them, 20 (48,8 %) grade 3 hypertension (according to ESC/ESH Guidelines). 14 patients (40 %) had a preserved diurnal rhythm (dipping), 18 (51.4 %) had it disturbed (non-dippers or risers). In 3 patients (8.6 %) we did not determine the diurnal sign for night vigil. Conclusions: In patients with MAC, we found a high prevalence of arterial hypertension, and a diurnal rhythm disorder was also very frequent. This fact may also contribute to the worsened cardiovascular prognosis of these patients. Therefore ABPM in patients with MAC is highly recommended, since subsequent cardiology management can improve their prognosis.