Blood pressure variability and target organ damage in hypertensive patients in the area of Blida (Algeria)

Abstract

The aim of the study was to examine the relationship between blood pressure variability (BPV) and target organ damage (TOD) in treated hypertensives patients. We enrolled 1065 consecutive essential hypertensives. Markers of sub clinical TOD [left ventricular mass index (LVMI), pulse wave velocity (PWV), total arterial compliance (TAC), ankle-brachial index (ABI) and estimated glomerular filtration rate (eGFR)] and 24 h ambulatory blood pressure were evaluated in all patients. Systolic BP variability was higher in patients with stroke (10.9 ± 1.2 mm Hg) and CKD (11.3 ± 1.41 mmHg) compare with patients without complications (6.23 ± 1.02 mm Hg, P < 0.05). Carotid-femoral PWV was 8.91 ± 3.4 m/sec. In multivariable regression analysis, all four variables of BPV exhibited significant association with LVMI ( P = 0.01, P = 0.01, P = 0.02 and P < 0.001, respectively), PWV ( P = 0.02, P = 0.01, P = 0.05 and P = 0.06, respectively) and TAC ( P = 0.05, P = 0.02, P = 0.03 and P = 0.06, respectively). ABI and eGFR were not associated with indices of BPV. BPV indices were not associated with markers of TOD ( P > 0.05). The mean SBP and the number of diagnoses had a negative correlation with TOD, respectively OR 0.98 (95% CI 0.96–0.99 P = 0.08), and OR 0.95 (95% CI 0.91–0.99 P = 0.03). The length of hospital stay ( P = 0.54) and gender ( P = 0.18) had no statistical significance in the prediction of TOD. However, only age, e-GFR, 24 h average of SBP, 24 h average of DBP, 24 h SD-SBP and 24 h SD-DBP ( P < 0.05 for all) remained significant predictors of carotid-femoral PWV, even after adjustment for other factors. The variability of blood pressure is an independent predictor of TOD. Our findings support a complex relationship between BPV and target organ damage in hypertension. Specifically, BPV is more closely related to markers of ventricular and vascular compliance than other markers of target organ damage in hypertension.