Giulia Maruelli

Central blood pressure assessment using 24-hour brachial pulse wave analysis

License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php Journal of Vascular Diagnostics 2014:2 141–148 Journal of Vascular Diagnostics Dovepress

UNATTENDED VS ATTENDED BP MEASUREMENT: MEAN VALUES AND DETERMINANTS OF THE DIFFERENCE

Objective: The results of the SPRINT study have called attention on the possible differences between blood pressure (BP) values obtained by health-care professionals in the office, during the visit (“attended BP”) as compared to those obtained in the office leaving the patient alone (“automated office BP” or “unattended BP”). Only few studies have compared the two techniques and none of them implemented the approach for unattended BP measurement used in SPRINT by the use of completely automated device for both attended and unattended BP and by the measurement of 3 values after 5 minutes of rest,. Design and method: In 261 consecutive outpatients attending the outpatient clinic at an ESH Excellence Centre, BP values were measured by the physician with an automated oscillometric device (Omron HEM 9000Ai, mean of 3 measurements), after 5 minutes of rest. After the measurement of BP by the physician, the patient was left alone in the room, and the device was programmed to automatically perform 3 BP measurements after 5 minutes. Results: Mean age was 61 ± 16 yrs, 60% F, BMI 26.1 ± 4.2, 88 % with a previous diagnosis of hypertension (64 % treated). Unattended systolic BP (SBP) and diastolic BP (DBP) were both lower as compared to attended SBP (130.1 ± 15.7vs138.6 ± 17.2 mmHg) and DBP (77.1 ± 11.7vs78.9 ± 12.2 mmHg). The differences (Delta) between the values obtained using the two techniques were 8.5 ± 7.9 mmHg for SBP and 1.8 ± 5.6 mmHg for DBP. Delta SBP was directly correlated with age (r = 0.235 p < 0001) and with attended BP values (r = 0.407 p < 0.0001); Delta SBP was significantly lower in males than in females. At multivariate analysis Delta SBP remained independently correlated with age and attended SBP. Delta DBP was directly correlated with attended DBP (r = 0,322 p < 0.001) and was lower in males. Conclusions: Our findings indicate that “unattended BP” measurement provides values significantly lower as compared to measurements obtained in the presence of the physician. Interestingly, the difference between the values obtained by the two approaches is not constant for all patients, being significantly affected by age, gender and BP values

RELATIONSHIP BETWEEN UNATTENDED AND ATTENDED BP VALUES AND PRECLINICAL ORGAN DAMAGE

Objective: It has been suggested that measurement of “unattended” or “automated oscillatory (AOBP)” blood pressure values may provide advantages over conventional BP measurement; some hypertension guidelines now suggest this approach as the preferred one for measuring office BP. Data on the relationship between AOBP and cardiovascular events are much less solid as compared to those obtained with the standard BP measurement; on the other hand, some study suggested that AOBP might be more strictly correlated with hypertensive target organ damage than “attended” BP. The aim of our study was to evaluate the relationship between “attended” or “unattended” BP values and target organ damage in 261 subjects attending the outpatient clinic of an ESH Excellence Centre. Design and method: BP values were measured by the physician with an automated oscillometric device (Omron HEM 9000Ai, mean of 3 measurements), after 5 minutes of rest; thereafter, the patient was left alone and unattended BP was measured automatically after 5 minutes (3 measurements at 1 minute interval). Results: Patients mean age was 61 ± 16 yrs, mean BMI 26.1 ± 4.2, 60% were female, 88 % had a previous diagnosis of hypertension (64% treated). Systolic unattended BP was lower as compared to attended SBP (130.1 ± 15.7vs138.6 ± 17.2 mmHg). Left ventricular mass index (LVMI) was similarly correlated with unattended and attended SBP (r = 0.132 and r = 0.133, p < 0.05, respectively). LVMI was similarly correlated with unattended and attended pulse pressure (PP) (r = 0.277 and r = 0.299, p < 0.05, respectively). Carotid IMT was significantly and similarly correlated with both attended and unattended BP values (CBMaxIMT: r = 0.172 and r = 0.153 for attended and unattended SBP, p < 0.05 and: r = 0.459 and r = 0.436 for attended and unattended PP, p < 0.001). The differences between correlations were not statistically significant. Conclusions: Measurement of BP “unattended” or “unattended” provides different values, being unattended BP lower as compared to attended BP. Our results suggest that attended and unattended BP values are similarly related with cardiac and vascular hypertensive target organ damage.

Definitions and Epidemiological Aspects of Hypertensive Urgencies and Emergencies

Acute blood pressure (BP) elevation represents a frequent reason of concern for clinicians in everyday clinical practice. The terms “hypertensive emergencies” and “hypertensive urgencies” may be used in order to better define the so called “hypertensive crises”. A hypertensive emergency may be defined as a condition characterized by an acute and severe elevation of blood pressure (BP) associated to a new onset or worsening organ damage (OD). A hypertensive urgency may be defined as a condition characterized by an isolated elevation of BP values without evidence of acute hypertensive OD. This article will review the definition, the prevalence, and the prognostic implications of hypertensive emergencies and urgencies.

[BP.09.01] ASSESSMENT OF LEFT VENTRICULAR SYSTOLIC FUNCTION IN MASKED AND ISOLATED OFFICE HYPERTENSION IN A GENERAL POPULATION IN NORTHERN ITALY: THE VOBARNO STUDY

Objective: Previous studies have demonstrated that ambulatory blood pressure monitoring (ABPM) provides useful information in hypertensive patients and in the general population. Few data are available on LV function according to BP categories as defined by clinic and 24 hours BP measurement. The aim of our study was to evaluate indices of left ventricular (LV) function in normotensive subjects (NT), in patients with isolated office hypertension (IOH), with masked hypertension (MHT) and with sustained hypertension (HT) defined according to clinic and 24 hours blood pressure (BP) monitoring. Design and method: Out of 585 subjects, we identified 294 untreated subjects (mean age 56 ± 9 years, 45% males) participating in our ongoing population study (Vobarno study). All subjects underwent standard laboratory examinations and clinic and 24 hours blood pressure measurement. Standard echocardiography was performed in all patients, and indices of systolic function were calculated. Furthermore in all patients, myocardial mechanoenergetic efficiency (MEE) was calculated as stroke volume/heart rate and indexed to LV mass (MEEi = MEE/LVM)(de Simone et al, 2016). Results: 39.5% of subjects were classified as NT, 17% as IOH, 18.5% as MH and 25% as HT. MEEi was significantly lower in IOH, MH and HT as compared to NT (0.52 ± 0.12, 0.54 ± 0.13,0.51 ± 12 vs 0.67 ± 0.16 ANOVA p < 0.05). The difference between groups remained statistically significant after adjusting for all possible confounders. Midwall fractional shortening (absolute value and % of predicted), was significantly lower in IOH, MH and EH as compared to NT, while no differences in fractional shortening and ejection fraction were observed among the four groups of subjects. Conclusions: Left ventricular myocardial mechanoenergetic efficiency and midwall function are depressed not only in patients with sustained hypertension, but also in patients with isolated office and masked hypertension.

[OP.7C.11] RELATIONSHIP BETWEEN DIMENSIONS OF THE ASCENDING AORTA AND CLINIC AND 24 HOURS BLOOD PRESSURE IN A GENERAL POPULATION IN NORTHERN ITALY

Objective: Epidemiological studies have suggested that even mild enlargement of the ascending aorta may have independent prognostic significance for cardiovascular events. Therefore, some Authors have proposed that dilatation of the ascending aorta could be considered as a form of preclinical vascular damage in hypertensive patients. Aim of our study: was to assess the correlation between clinic and 24 hours BP values and the dimensions of the aorta, measured at level of the sinuses of Valsalva (Val), at the left ventricular outflow tract (LVOT), and at the level of the proximal ascending aorta (AscAO) in subjects from a general population. Design and method: 250 subjects (43% males, mean age 56 ± 4 years, 42% hypertensives-HT) underwent laboratory examinations, clinic and 24 hours BP measurement, cardiac and carotid ultrasound, carotid-femoral pulse wave velocity measurement (AoPWV). Results: Aortic diameters were greater HT as compared to NT (Val: 3.41 ± 0.54 vs 3.25 ± 0.41 cm, LVOT 2.10 ± 0.28 vs 2.04 ± 0.26, AscAo 3.39 ± 0.45 vs 3.18 ± 0.38, all p < 0.05). Aortic diameters were all correlated to clinic and 24 hours BP values. The coefficients of correlation were greater for 24 hours BP (Tab). Val, AscAo, LVOT were also significantly correlated with left ventricular mass (r = 0.61, r = 0.48, and r = 0.43, all p < 0.001), meanmax intima media thickness (r = 0.13, r = 0.24, and r = 0.13, all p < 0.05) and with AoPWV (r = 0.16, p < 0.05, r = 0.28 p < 0.001, r = 0.08 p = ns). Figure. No caption available. Conclusions: The dimensions of the proximal ascending aorta are significantly related to BP values in normotensive subjects and in hypertensive patients. Aortic dimension are more strictly related to twenty-four hours BP values than to clinic BP values. In this sample of general population a significant correlation between aortic dimensions and measures of cardiac and vascular organ damage was also observed, confirming the parallelism between different forms of organ damage

[OP.7C.04] ARTERIAL STIFFNESS IS INDEPENDENTLY CORRELATED WITH MYOCARDIAL MECHANOENERGETIC EFFICIENCY IN A GENERAL POPULATION IN NORTHERN ITALY: THE VOBARNO STUDY

Objective: A non-invasive approach for the estimation of mechanical efficiency through the calculation of the ratio between stroke work and HR–pressure product has been recently proposed by de Simone et al. This index, which expresses the amount of blood pumped in a single beat in 1 second by the heart, may be easily obtained by echocardiography. The aim of our study was to evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), calculated as as stroke volume/heart rate and indexed to LV mass (MEEi = MEE/LVM) in a large general population sample in Northern Italy. Design and method: We evaluated 478 subjects participating in a general population study in Northern Italy (Studio Vobarno). All subjects underwent a physical examination with measurement of clinic blood pressure (BP). In all subjects laboratory examinations, 24 hours blood pressure measurement, echocardiography, and assessment of carotid-femoral pulse wave velocity (PWV) were performed. Results: Subjects had a mean age of 58 ± 10 years, a BMI of 26 ± 4, 44% were males, 69% had arterial hypertension (55% treated). MEEi was lower in males and in patients with increased PWV. MEEi was inversely correlated with age, BMI, waist circumference, clinic and 24 hours BP, glucose, uric acid, triglycerides and directly correlated with HDL. MEEI was also inversely correlated with relative wall thickness (RWT) and PWV. At linear regression multivariate (?) analysis MEEi remained independently related to male gender (&bgr; = 0.16, p < 0.001), BMI (&bgr; = −0.13, p < 0.005), RWT (&bgr; = −0.56, p < 0.001) and PWV (&bgr; = −0.10, p < 0.05). Conclusions: In a large sample of general population in Northern Italy myocardial mechanoenergetic efficiency was inversely correlated with arterial stiffness, independently of multiple possible confounders.

Myocardial mechanoenergetic efficiency index (MMEI) and arterial stiffness: Association in a general population in norther Italy

To cite this article: Fabio Bertacchini, Massimo Salvetti, Anna Paini, Giulia Rubagotti, Deborah Stassaldi, Carlo Aggiusti, Giulia Maruelli, Chiara Arnoldi, Giovanni Saccà, Enrico Agabiti Rosei, Maria Lorenza Muiesan (2017) P41: MYOCARDIAL MECHANOENERGETIC EFFICIENCY INDEX (MMEI) AND ARTERIAL STIFFNESS: ASSOCIATION IN A GENERAL POPULATION IN NORTHER ITALY, Artery Research 20:C, 67–67, DOI: https://doi.org/10.1016/j.artres.2017.10.071

[OP.4B.09] CARDIAC ORGAN DAMAGE IN HYPERTENSIVE PATIENTS ACCORDING TO ON-TREATMENT BLOOD PRESSURE VALUES.

Objective: The recent results of the SPRINT study suggest that “intensive” reduction of systolic blood pressure (BP) (to less than 120 mmHg) might provide greater cardiovascular protection as compared to less intensive (<140 mmHg) reduction of BP, at least in some subsets of patients. Only few studies, have investigated the possible effect of tight blood pressure control on indices of left ventricular hypertrophy, and have been mainly based on electrocardiography. Aim of our study: was to evaluate cardiac organ damage according to “on treatment” blood pressure values in a large cohort of hypertensive patients undergoing echocardiography (2D, M-mode with conventional and tissue Doppler analysis) at the echo-lab of an ESH Excellence Centre in Italy. Design and method: The analysis included 976 treated hypertensive patients (43% female, age 59 ± 12 yrs, age range 15–90). Patients were subdivided in three groups according to BP values at the time of the echocardiogram, defined as follows: uncontrolled (UC; SBP >or equal to 140 mmHg), controlled <140 (C140; SBP between 139 and 120 mmHg) and controlled <120 (C120; SBP <120 mmHg). Results: In 407 patients (42%) SBP values were >140 mmHg, 449 patients (46%) had SBP was between 139 and 120 mmHg (C140) and in 120 (12%) SBP was <120 mmHg (C120). Left ventricular mass (LVM) and LVM index (LVMI) were progressively lower in UC, C140 and C120 (LVM: 162 ± 51, 159 ± 47 and 149 ± 44 gr respectively, p for trend <0,001; LVMI: 40 ± 11,38 ± 10 and 35 ± 9 gr/m2.7 respectively, p for trend <0,001). No significant difference was observed for relative wall thickness. Left atrial volume (LAV) and LAV/BSA were progressively lower in UC, C140 and C120 (LAV/BSA: 25.6 ± 7.6, 23.7 ± 7.9, 22.7 ± 8.5, respectively, p for trend <0,001). These differences remained significant even after adjusting for possible confounders. Conclusions: Lower achieved BP targets are associated with a progressive lower left ventricular mass, left ventricular mass index and left atrial volumes. These findings are in line with previous results indicating a favorable effect of tight BP control on electrocardiographic indices of LV hypertrophy. Prospective studies are needed to confirm the possible favorable effect of tight BP control on echocardiographic indices of LVH, and their relation to CV events.

OS 14-02 ON TREATMENT BLOOD PRESSURE VALUES AND CARDIAC ORGAN DAMAGE IN HYPERTENSIVE PATIENTS.

Objective: The recent results of the SPRINT study suggest that “intensive” reduction of systolic blood pressure (BP) (to less than 120 mmHg) might provide greater cardiovascular protection as compared to less intensive (< 140 mmHg) reduction of BP, at least in some subsets of patients. Only few studies, have investigated the possible effect of tight blood pressure control on indices of left ventricular hypertrophy, and have been mainly based on electrocardiography. Aim of our study was to evaluate cardiac organ damage according to “on treatment” blood pressure values in a large cohort of hypertensive patients undergoing echocardiography (2D, M-mode with conventional and tissue Doppler analysis)at the echo-lab of an ESH Excellence Centre in Italy. Design and Method: The analysis included 976 treated hypertensive patients (43% female, age 59 ± 12 yrs, age range 15–90). Patients were subdivided in three groups according to BP values at the time of the echocardiogram, defined as follows: uncontrolled (UC; SBP >or equal to140 mmHg), controlled <140 (C140; SBP between 139 and 120 mmHg) and controlled <120 (C120; SBP <120 mmHg). Results: In 407 patients (42%) SBP values were>140 mmHg, 449 patients (46%) had SBP was between 139 and 120 mmHg (C140) and in 120 (12%) SBP was <120 mmHg (C120). Left ventricular mass (LVM) and LVM index (LVMI) were progressively lower in UC, C140 and C120 (LVM: 162 ± 51, 159 ± 47 and 149 ± 44 gr respectively, p for trend < 0,001; LVMI: 40 ± 11, 38 ± 10 and 35 ± 9 gr/m 2.7 respectively, p for trend < 0,001). No significant difference was observed for relative wall thickness. Left atrial volume (LAV) and LAV/BSA were progressively lower in UC, C140 and C120 (LAV/BSA: 25.6 ± 7.6, 23.7 ± 7.9, 22.7 ± 8.5, respectively, p for trend < 0,001). These differences remained significant even after adjusting for possible confounders. Conclusions: Lower achieved BP targets are associated with a progressive lower left ventricular mass, left ventricular mass index and left atrial volumes. These findings are in line with previous results indicating a favorable effect of tight BP control on electrocardiographic indices of LV hypertrophy. Prospective studies are needed to confirm the possible favorable effect of tight BP control on echocardiographic indices of LVH, and their relation to CV events.