Factors associated with high probability of target blood pressure non-achievement in hypertensive patients

Abstract

One of the topic issue of modern cardiology is factors of target blood pressure level non-achievement clarifying due to a better understanding how we can reduce cardiovascular complications. The aim of the study is to determine the factors of poor blood pressure control using the ambulatory blood pressure monitoring parameters and adenosine 5'-diphosphate-induced platelet aggregation parameters in patients with arterial hypertension. Material and methods. The study involved 153 patients with essential hypertension (EH) stage II, II degree. The ambulatory blood pressure monitoring (ABPM) was performed in patients during at least two of first-line antihypertensive drugs in optimal daily doses usage by the ABPM bifunctional device (Incart, S.-P., R.F.). Platelet aggregation was carried out using light transmittance aggregation by optical analyzer (Solar, R.B.) with adenosine 5'-diphosphate (Sigma-Aldrich) at final concentration of 10.0 × 10 -6 mol / L. The first group were inadequately controlled essential hypertensive individuals with high systolic or/and diastolic BP level according to the ABPM results, and the second one were patients with adequately controlled EH. Groups of patients were comparable in age (60.39 ± 10.74 years vs. 62.80 ± 9.63; p = 0.181, respectively). In the group of EH patients who reached the target level of blood pressure, women predominated (60% vs. 39.81%; p = 0.021, respectively). We used the binary logistic regression analysis to determine the predictors of target blood pressure level poor reaching using ABPM and platelet aggregation parameters. Results According to the univariate logistic regression analysis, the dependent factors influencing the target blood pressure level poor reaching are the average diurnal diastolic blood pressure (DBP) (OR = 44.8); diurnal variability of systolic blood pressure (SBP) (OR = 4.4); square index of hypertension for diurnal periods SBP (OR = 318.9); square index of hypertension for diurnal periods DBP (HS = 36,6); the average pulse blood pressure (OR = 65.9), the rate of morning rise of SBP (OR = 3.6), and the maximum aggregation time of 5-minute ADP-induced platelet aggregation (OR = 3.5). Independent factors influencing the target blood pressure level pure reaching are the average diurnal DBP (OR = 47.8); variability of diurnal SBP (HS = 4.6); the maximum aggregation time of ADP-induced platelet aggregation (OR = 3.4). Female sex is associated with the best prognosis for the target level of BP reaching (OR = 0.4; 95% CI = 0.2‒0.8; p = 0.012). Conclusions . The independent factors influencing the target blood pressure level poor reaching in patients with EH are two ABPM parameters (the average diurnal diastolic blood pressure of more than 76 mm Hg and the variability of SBP diurnal more than 17 mm Hg); and one ADP-induced platelet aggregation parameter (the maximum aggregation time more than 143 seconds). The female sex is associated with better prediction of achieving the target level of blood pressure.