Evolution of target organ damage by different values of self-blood pressure measurement in untreated hypertensive patients.
BACKGROUND
To determine the prognostic value of various self-blood pressure (BP) monitoring (SBPM) cutoff at the time of diagnosis.


METHODS
Cohort of 466 newly diagnosed and never-treated hypertensive patients. At baseline and at 1 year, the patients underwent a physical examination, clinic BP (CBP), SBPM, and ambulatory BP monitoring (ABPM), fasting blood and urine analysis, electrocardiogram (ECG), and retinography. The diagnosis of hypertension was made based on CBP average of two readings, separated by 2 min, taken over three different days, with results ≥ 140/90 mm Hg. At 1-year follow-up, target organ damage (TOD) evolution was classified as favorable or unfavorable.


RESULTS
Mean age was 57.4 years, 56.8% were men. Adjusted multivariate analysis showed that hypertensive patients with baseline SBPM <135/85 mm Hg had a more favorable evolution of left ventricular hypertrophy (LVH) (odds ratio (OR): 1.9; 95% confidence interval (CI): 1.5-2.5), high urinary albumin excretion rate (UAER) (OR: 6.9; 95% CI: 3.4-14.4), and more favorable amount of TOD evolution (OR: 1.7; 95% CI: 1.4-2.0) than those with baseline SBPM ≥ 135/85 mm Hg. Patients with baseline SBPM <130/80 mm Hg, or <125/80 mm Hg had a more favorable evolution of the amount of TOD (OR: 2.7; 95% CI: 2.0-3.6, and OR: 2.9; 95% CI: 2.1-4.1, respectively) at 1 year than those with baseline SBPM <135/85 mm Hg.


CONCLUSIONS
Baseline SBPM values <130/80 mm Hg is associated with better evolution of amount of TOD than SBPM values <135/85 mm Hg. These results would support a clinical trial to test a SBPM threshold <130/80 as an optimal pressure not needing pharmacological treatment among those with CBP ≥ 140/90.
Research Unit, Healthcare Institute, Girona, Spain. gabriel.coll@ias.scs.es
Gabriel
G
Coll-de-Tuero
Marc
M
Saez
Carmen
C
Roca-Saumell
Antonio
A
Rodriguez-Poncelas
Pilar
P
Franco
Antoni
A
Dalfó
Laia
L
Calvó-Perxas
Antonio
A
Pose-Reino
Joan
J
Bayó-Llibre
D000368:Aged; D000419:Albuminuria / Q000453:epidemiology / Q000503:physiopathology; D001774:Blood Chemical Analysis; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology / Q000503:physiopathology; D007674:Kidney Diseases / Q000453:epidemiology / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012164:Retinal Diseases / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D016482:Urinalysis