Effects of pulse, systolic, diastolic and average blood pressure on endothelium function damage, left ventricular hypertrophy in patients with essential hypertension

Abstract

To investigate the relationship between pulse pressure (PP),systolic blood pressure(SBP),diastolic blood pressure (DBP),mean blood pressure (MBP) and endothelium dysfunction,left ventricular hypertrophy in patients with essential hypertension. Clinical blood pressure, 24h ambulatory blood pressure monitoring, two-dimensional echocardiography, plasma endothelins (ET) and nitric oxide (NO) were examined in 555 initially untreated patients (275 men and 280 women, aged 47.1±12.7 years). The patients were divided into four groups according to clinical pulse pressure (CPP) or ambulatory pulse pressure (APP) respectively: They were also divided into age matched 2 groups according to their left ventricular mass index (LVMI), left ventricular hypertrophy (LVH) group. With increased clinical or ambulatory pulse pressure plasma NO significantly decreased and ET and ET/NO increased, there were significant correlations between them (between NO and 24hAPP, dPP, nPP and cPP: r=-0.269, p<0.001;r=-0.259, p<0.001;r=-0.167, p<0.01;r=-0.141, p<0.05; r=0.314, p<0.001;between ET and 24hAPP, dPP, nPP and cPP: r=0.299, p<0.001; r=0.234, p<0.001;r=0.171, p<0.01;and r=0.377, p<0.001;r=0.366, p<0.001;between ET/NO and 24hAPP, dPP, nPP and cPP: r=0.284, p<0.001;r=0.208, p<0.001). There were no correlation between DBP or ABP with NO or ET. SBP and PP were significantly higher in LVH group than in non-LVH group (p all less than 0.05), There were no significant difference in DBP between two groups. Multiple step analysis was showed that SBP was the only independent factor which influenced LVH. PP was the only independent factor which influenced endothelium function [clinical blood pressure data: ET=0.497xcPP+44.613 (P<0.01, R2=0.029);NO= -0.398xcPP+100.454. 24h blood pressure data:ET=1.269x24hPP+12.536 (P<0.001, R2=0.090); NO= -015x24hPP+130.266 (P<0.001,R2=0.072)]. Vascular endothelium dysfunction was associated with increased PP. APP may be a better way than CPP in evaluating endothelium function. SBP was one of the most important factors in influencing LVH, PP was one of the most important factors in influencing endothelium function. Neither DBP nor MAP could influence vascular endothelium function and LVH.