title: Association of clinic and ambulatory blood pressure with vascular damage in the elderly: the EPICARDIAN study.
abstract: OBJECTIVE
  In middle-aged adults, vascular damage correlates better with ambulatory than with clinic blood pressure. This study aimed to determine whether vascular damage evaluated by carotid ultrasonography in the elderly is also more closely related to ambulatory than to clinic blood pressure, and which blood pressure variables are better associated with vascular damage.
  
  
  METHODS
  Cross-sectional study of 292 randomly selected >65 years old participants who underwent 24-h noninvasive ambulatory blood pressure monitoring. Blood pressure variables analyzed were (a) clinic blood pressure: systolic and diastolic blood pressure, pulse pressure; (b) ambulatory blood pressure monitoring: mean values of systolic and diastolic blood pressure, systolic and diastolic blood pressure load, pulse pressure, as well as variability, evaluated within 24 h, diurnal and nocturnal periods; and day-night blood pressure difference. A clinical history, physical examination, carotid ultrasonography and laboratory tests were performed. To estimate the relationship between blood pressure and vascular damage, univariate and multivariate analyses were performed.
  
  
  RESULTS
  Mean age: 73+/-6 years, 45% men, 76.7% hypertensive patients. In the simple regression analysis, the best significant correlations (P<0.05) were common carotid intima-media thickness with 24-h and nocturnal pulse pressure (r=0.32), and common carotid diameter with 24-h systolic blood pressure load (r=0.47). In the multivariate analysis, the significant associations (P<0.05) were (a) linear regression: nocturnal pulse pressure with common carotid intima-media thickness, and diurnal pulse pressure as well as 24-h systolic blood pressure load with common carotid diameter; (b) logistic regression, adjusted odds ratio: nocturnal pulse pressure and nocturnal diastolic blood pressure load with the presence of carotid atherosclerotic plaques 1.03 and 0.98, respectively.
  
  
  CONCLUSIONS
  In the elderly, ambulatory blood pressure monitoring is better associated with carotid damage than clinic blood pressure. Systolic blood pressure variables are the best associated, blood pressure load and pulse pressure being better associated with carotid damage than the mean levels of ambulatory blood pressure.
authors.affiliation: Service of Internal Medicine, Hospital de la Princesa, Autonomous University of Madrid, Madrid, Spain. fblanco@fundacionies.com
authors.forename: Francisco
authors.initials: F
authors.lastname: Blanco
authors.forename: Paloma
authors.initials: P
authors.lastname: Gil
authors.forename: Carmen Del
authors.initials: CD
authors.lastname: Arco
authors.forename: Teresa
authors.initials: T
authors.lastname: Sáez
authors.forename: Río
authors.initials: R
authors.lastname: Aguilar
authors.forename: Isabel
authors.initials: I
authors.lastname: Lara
authors.forename: Juan J
authors.initials: JJ
authors.lastname: de la Cruz
authors.forename: Rafael
authors.initials: R
authors.lastname: Gabriel
authors.forename: Carmen
authors.initials: C
authors.lastname: Suárez
mesh_terms: D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory; D002339:Carotid Arteries / Q000473:pathology / Q000503:physiopathology*; D020212:Carotid Artery Injuries / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology*; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D011674:Pulse; D013030:Spain; D017539:Tunica Intima / Q000293:injuries / Q000473:pathology / Q000503:physiopathology*