AMBULATORY BLOOD PRESSURE PARAMETERS IN UNCONTROLLED ESSENTIAL HYPERTENSIVE PATIENTS

Abstract

Objective: Ambulatory blood pressure monitoring (ABPM) is a modern diagnosis tool for blood pressure measurement, however, the explanatory value of some ABPM parameters like pulse and mean blood pressure in controlled hypertension status has not been well-established. The goal of this study was to evaluate the association between 24 h-ABPM-parameters with controlled and uncontrolled blood pressure level in hypertensive patients with sinus rhythm. Design and method: We studied 43 essential hypertensive patients (Ehs) (62 [56 - 65] years, 53 % female) in antihypertensive therapy with well controlled 24 h- systolic blood pressure (SBP) (less 130 mmHg) and 24 h- diastolic BP (DBP) (less 80 mmHg) and 102 Ehs (59 [53 - 70] years, 39 % female) in antihypertensive therapy with uncontrolled 24 h- systolic BP and 24 h- DBP, who underwent 24-h ABPM and 24-h ECG. We calculated averages and parameters of variability of SBP, DBP, pulse pressure (PP), mean arterial pressure (MAP) and blood pressure loads for SBP, DBP. According to the degree of nocturnal SBP, DBP fall, patients were sub-classified as dippers, mild dippers, extreme dippers, reverse dippers. A bivariate logistic regression analysis was performed to evaluate the explanatory value of ABPM parameters for uncontrolled hypertension status. Results: Comparisons between groups showed no differences in age, sex, diabetes status, as well as in SBP dippers (p = 0.480), mild dippers (p = 0.794), extreme dippers (p = 0.799), reverse dippers (p = 0.248) and DBP (p = 0.627), mild dippers (p = 0.996), extreme dippers (p = 0.852), reverse dippers (p = 0.372). The best fitting model for explanatory uncontrolled hypertension (log likelihood = −6,50; AUC ROC = 0,9981) after adjustment for age, sex (male vs female), diabetes status (yes vs no) with ORs was: 24-h PP (2.63; CI 95% 1.15–6.0, p = 0.022), 24-h MAP (3.30; CI 95% 1.33–8.22, p = 0.010), 24-h normalized square index DBP (12.47; CI 95% 1.11–140.0, p = 0.041). VIF for all included variables was <10.0. Conclusions: 24-h PP, 24-h MAP, 24-h normalized square index DBP are the ABPM parameters that were more closely associated with uncontrolled hypertension status in Ehs with sinus rhythm.