title: Abnormal Pulsatile Hemodynamics in Hypertensive Patients With Normalized 24-Hour Ambulatory Blood Pressure by Combination Therapy of Three or More Antihypertensive Agents.
abstract: It remains uncertain whether intensive antihypertensive therapy can normalize pulsatile hemodynamics resulting in minimized residual cardiovascular risks. In this study, office and 24-hour ambulatory systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure, carotid-femoral pulse wave velocity (PWV), and forward (Pf) and reflected (Pb) pressure wave from a decomposed carotid pressure wave were measured in hypertensive participants. Among them, 57 patients whose 24-hour SBP and DBP were normalized by three or more classes of antihypertensive medications were included. Another 57 age- and sex-matched normotensive participants were randomly selected from a community survey. The well-treated hypertensive patients had similar 24-hour SBP, lower DBP, and higher PP values. The treated patients had higher PWV (11.7±0.3 vs 8.3±0.2 m/s, P<.001), Pf, Pb, Pb/Pf, and left ventricular mass index values. After adjustment for age, sex, body mass index, and office SBP, the differences for PWV, Pb, and Pb/Pf remained significant. Hypertensive patients whose 24-hour SBP and DBP are normalized may still have markedly increased arterial stiffness and wave reflection.
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Clinical Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Dai-Yin
authors.initials: DY
authors.lastname: Lu
authors.affiliation: Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Li-Kai
authors.initials: LK
authors.lastname: You
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Cardiovascular Research Center, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shih-Hsien
authors.initials: SH
authors.lastname: Sung
authors.affiliation: Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.|Cardiovascular Research Center, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Public Health, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hao-Min
authors.initials: HM
authors.lastname: Cheng
authors.affiliation: Cardiovascular Research Center, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Medical Reserarch, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Shing-Jong
authors.initials: SJ
authors.lastname: Lin
authors.affiliation: Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Fu-Tien
authors.initials: FT
authors.lastname: Chiang
authors.affiliation: Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.|Cardiovascular Research Center, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Public Health, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chen-Huan
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Cardiovascular Research Center, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Medicine, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Wen-Chung
authors.initials: WC
authors.lastname: Yu
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D011379:Prognosis; D011673:Pulsatile Flow / Q000502:physiology*; D063177:Pulse Wave Analysis; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents