title: From treatment to organ damage; a 5-year follow-up study of ambulatory blood pressure in essential hypertension. Diversity between development of left ventricular hypertrophy and urinary albumin excretion.
abstract: This study aimed to assess blood pressure (BP) profile, BP control, left ventricular hypertrophy (LVH) and albumin/creatinine ratio (ACR) in urine after 5 years of antihypertensive treatment in subjects with newly diagnosed essential hypertension. Fifty-four subjects were included and prescribed calcium-channel blocker in monotherapy during an 8-week period, and later 46 subjects (34 men, 12 women, 53.1+/-8.6 years) attended a 5-year follow-up visit at the hypertension clinic. They underwent 24-h ambulatory BP monitoring (ABPM), ECG and ACR at baseline and after 5 years. Echocardiography performed after 5 years revealed LVH in 54% of the subjects, while there was no change in Cornell product, an ECG criterion for LVH. BP control assessed by office BP was 33%, and only 20% using 24-h ABP. Night-time fall in BP was significantly attenuated from 13.2+/-5.9% to 10.7+/-6.0%, p = 0.01 for systolic BP and from 13.3+/-6.9% to 9.8+/-6.8%, p = 0.004 for diastolic BP. The number of dippers decreased after 5 years, but this did not reach statistical significance. In contrast to the lack of change in Cornell product, there was a significant decrease in ACR, and 93% of the subjects had ACR<1.5 mg/mmol after 5 years compared with 57% at baseline (p<0.001). Thus, ABPM should be encouraged in the follow-up of all hypertensive subjects as it reveals better inadequate BP control than office BP and gives information about night-time fall, as this may explain the high prevalence of LVH. The diversity in development of LVH and ACR during antihypertensive treatment needs to be verified.
authors.affiliation: Department of Nephrology, Ullevål University Hospital, University of Oslo, Oslo, Norway. a.e.stenehjem@medisin.uio.no
authors.forename: Aud-E
authors.initials: AE
authors.lastname: Stenehjem
authors.forename: Reidar
authors.initials: R
authors.lastname: Bjørnerheim
authors.forename: Ingrid
authors.initials: I
authors.lastname: Os
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000453:epidemiology*; D018660:Blood Pressure Monitoring, Ambulatory; D003404:Creatinine / Q000652:urine; D004452:Echocardiography; D004562:Electrocardiography; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence
chemical_list: D003404:Creatinine