PP.01.06] AMBULATORY BLOOD PRESSURE CHARACTERISTICS IN PATIENTS WITH AUTONOMIC DYSFUNCTION

Abstract

Objective: To study prevalence and characteristics of patients with cardiovascular autonomic dysfunction (AD), assessed with ambulatory blood pressure monitoring (ABPM). Design and method: 1,000 consecutive subjects referred to our clinic for ABPM were examined. The ABPM analysis focused on the following parameters: a reverse dipping pattern and/or orthostatic (OH) or post-prandial hypotension (PH) were considered as major diagnostic criteria. Reduced dipping pattern and elevated BP variability were considered as minor criteria. Patients were divided into 5 subgroups according to the underlying cause of AD: diabetes mellitus (group 1), chronic kidney disease (group 2), neurological disease (Parkinson or multiple system atrophy, group 3), alpha-lytic drugs use (group 4), other causes (group 5). Results: AD was present in 6.8% of the subjects. Among these patients 54.4% were in group 1, 4.4 % in group 2, 17.6% in group 3, 7.4 % in group 4 and 16.2 % in group 5. Insulin use (45.9% vs 23.5%, p = 0.027) and renal impairment (37.1% vs 6.5%, p = 0.001) were more common in diabetics with AD than in a control group of diabetics without AD. OH was less frequent among diabetics (31.4%) compared to the other groups (100% in group 2 and 4, 83% in group 3, 90.9% in group 5) (p < 0.001). PH was more frequent among group 2 and 3 (33.3 % for both) compared to others (8.6% group 1, 0% group 4 and 18.2% in group 5). Daytime systolic Standard Deviation was higher in group 2 and 3 (23.1 ± 7.3 mmHg and 20.3 ± 8.0 mmHg) compared to others (14.9 ± 4.3 mmHg group 1, 18.2 ± 3.7 mmHg in group 4, 15.9 ± 4.7 mmHg in group 5) (p = 0.024). Reverse dipping for systolic BP was more pronounced among group 2 (16.9 ± 14.0 mmHg) and 4 (12.6 ± 17.7 mmHg), compared to group 3 (6.1 ± 7.1 mmHg) and 5 (3.5 ± 9.03), group 1 presented reduced dipping pattern (p = 0.003). Conclusions: AD is not so uncommon as usually believed. OH, abnormal dipping pattern and increased BP variability are well known predictors of poorer prognosis. These findings are frequent in patients with AD and ABPM represents a useful tool for better defining the cardiovascular risk profile of these patients.