Abstract
BackgroundHypertension guidelines recommend ambulatory blood pressure (ABP), central aortic pressure (CAP), and pulse wave velocity (PWV) as parameters for estimating blood pressure (BP) control and vascular impairment. Recent advances in technology have enabled devices to combine non-invasive estimation of these parameters over the 24-hour ABP monitoring. However, currently there is limited evidence on the usefulness of such an approach for routine hypertension management.ObjectiveWe recently launched an investigator-initiated, international, multicenter, observational, prospective study, the Vascular health Assessment Of The Hypertensive patients (VASOTENS) Registry, aimed at (1) evaluating non-invasive 24-hour ABP and arterial stiffness estimates (through 24-hour pulse wave analysis, PWA) in hypertensive subjects undergoing ambulatory blood pressure monitoring (ABPM) for clinical reasons; (2) assessing the changes in estimates following treatment; (3) weighing the impact of 24-hour PWA on target organ damage and cardiovascular prognosis; (4) assessing the relationship between arterial stiffness, BP absolute mean level and variability, and prognosis; and (5) validating the use of a 24-hour PWA electronic health (e-health) solution for hypertension screening.MethodsApproximately 2000 subjects, referred to 20 hypertension clinics for routine diagnostic evaluation and follow-up of hypertension of any severity or stage, will be recruited. Data collection will include ABPM, performed with a device allowing simultaneous non-invasive assessment of 24-hour CAP and arterial stiffness (BPLab), and clinical data (including cardiovascular outcomes). As recommended by current guidelines, each patient will be followed-up with visits occurring at regular intervals (ideally every 6 months, and not less than once a year depending on disease severity). A Web-based telemedicine platform (THOLOMEUS) will be used for data collection. The use of the telemedicine system will allow standardized and centralized data collection, data validation by experts and counseling to remote centers, setup and maintenance of the Registry, and prompt data analysis.ResultsFirst follow-up results are expected to be available in the next 2 years.ConclusionsThe results of the VASOTENS Registry will help define the normalcy thresholds for current and future indices derived from 24-hour PWA, according to outcome data, and will also provide supporting evidence for the inclusion of this type of evaluation in hypertension management.Trial registrationClinicaltrials.gov NCT02577835; https://clinicaltrials.gov/ct2/show/NCT02577835 (Archived by WebCite at http://www.Webcitation.org/6hzZBKY2Q)
Highlights
Literature ReviewCentral aortic pressure (CAP) and pulse wave velocity (PWV) are independent predictors for the development of cardiovascular (CV) diseases [1-3]
The results of the VASOTENS Registry will help define the normalcy thresholds for current and future indices derived from 24-hour Pulse-wave analysis (PWA), according to outcome data, and will provide supporting evidence for the inclusion of this type of evaluation in hypertension management
Pulse-wave analysis (PWA), including evaluation of central aortic pressure (CAP), and Augmentation Index (AIx), may provide additional information concerning wave reflections and may be useful for risk stratification and evaluation of the effectiveness of treatment, but more evidence is needed before recommending the routine clinical use of these vascular indices [1,5]
Summary
Central aortic pressure (CAP) and pulse wave velocity (PWV) are independent predictors for the development of cardiovascular (CV) diseases [1-3]. Notwithstanding the consistent evidence for superior and independent prognostic value, with respect to conventional office BP of either indices of central hemodynamics and stiffness assessed in controlled office condition at rest [2,3,8,9], currently there are no studies that evaluated the long-term predictive ability for CV events of vascular indices (ie, PWV, AIx, and CAP), measured in dynamic conditions over the 24-hours by ambulatory blood pressure monitoring (ABPM). Hypertension guidelines recommend ambulatory blood pressure (ABP), central aortic pressure (CAP), and pulse wave velocity (PWV) as parameters for estimating blood pressure (BP) control and vascular impairment. Currently there is limited evidence on the usefulness of such an approach for routine hypertension management
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