title: Pulse pressure and nocturnal fall in blood pressure are predictors of vascular, cardiac and renal target organ damage in hypertensive patients (LOD-RISK study).
abstract: OBJECTIVE
  To analyse the relationship between various parameters derived from ambulatory blood pressure monitoring (ABPM) and vascular, cardiac and renal target organ damage.
  
  
  METHODS
  A cross-sectional, descriptive study. It included 353 patients with short-term or recently diagnosed hypertension.
  
  
  METHODS
  ABPM, carotid intima-media thickness (IMT), Cornell voltage-duration product (Cornell VDP), glomerular filtration rate and albumin/creatinine ratio to assess vascular, cardiac and renal damage.
  
  
  RESULTS
  Two hundred and twenty-three patients (63.2%) were males, aged 56.12+/-11.21 years. The nocturnal fall in blood pressure was 11.33+/-8.41, with a dipper pattern in 49.0% (173), nondipper in 30.3% (107), extreme dipper in 12.7% (45) and riser in 7.9% (28). The IMT was lower in the extreme dipper (0.716+/-0.096 mm) and better in the riser pattern (0.794+/-0.122 mm) (P<0.05). The Cornell VDP and albumin/creatinine ratio were higher in the riser pattern (1818.94+/-1798.63 mm/ms and 140.78+/-366.38 mg/g, respectively) than in the other patterns. In the multivariate analysis after adjusting for age, sex and antihypertensive treatment, with IMT as dependent variable the 24-h pulse pressure (beta = 0.003), with Cornell VDP the rest pulse pressure (beta = 12.04), and with the albumin/creatinine ratio the percentage of nocturnal fall in systolic blood pressure (beta = -3.59), the rest heart rate (beta = 1.83) and the standard deviation of 24-h systolic blood pressure (beta = 5.30) remain within the equation.
  
  
  CONCLUSIONS
  The estimated pulse pressure with ABPM is a predictor of vascular and cardiac organ damage. The nocturnal fall and the standard deviation in 24-h systolic blood pressure measured with the ABPM is a predictor of renal damage.
authors: Primary Care Research Unit of La Alamedilla Health Centre, Salamanca University Hospital, Salamanca, Spain. Lgarciao@usal.es
authors: Luis
authors: L
authors: García-Ortiz
authors: Manuel A
authors: MA
authors: Gómez-Marcos
authors: Javier
authors: J
authors: Martín-Moreiras
authors: Luis J
authors: LJ
authors: González-Elena
authors: Jose I
authors: JI
authors: Recio-Rodriguez
authors: Yolanda
authors: Y
authors: Castaño-Sánchez
authors: Gonzalo
authors: G
authors: Grandes
authors: Carlos
authors: C
authors: Martínez-Salgado
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests