A total of 25% of patients with hypertension and 33% with hypertension and diabetes had microalbuminuria (MAB) and elevated urinary albumin excretion (UAE), of a total of 7673 patients receiving care in a primary care setting in Spain. In this epidemiologic study, the Spanish patients were on average 64 years old, 53% women, 26% were smokers, 47% had dyslipidemia, and 39% were obese. Their baseline blood pressure was 143/84 mmHg. Dr. De la Sierrapresented this study at the 15th European Meeting on Hypertension.
The median UAE was 13 mg/g in the 4952 patients giving fresh urine samples, and 20.9 mg/24 hours in the 4536 patients undergoing 24-hour urine collection. Overt proteinuria was found in 3% of the 4454 hypertensive patients and 4% of the 3219 hypertensive diabetic patients.
Notably, there was a stepwise increase in both the rate of UAE and prevalence of MAB as the severity of blood pressure increased, as categorized by the ESH-ESC guidelines, with about 14% of patients with optimal blood pressure having MAB and 30% of patients with grades 2+3 blood pressure having MAB. Further, the presence of other cardiovascular risk factors also correlated with a higher prevalence of MAB.
Pulse pressure increased over 10-year period in persons with white coat hypertension
White coat hypertension (WCH) may not be benign condition, according to a 10-year follow-up study of ambulatory blood pressure monitoring showing a significant increase in pulse pressure in this population compared to persons with established hypertension or normotension, even when comparing treated and untreated persons. Pulse pressure is an established risk factor for cardiovascular morbidity and mortality and is considered a measure of increased arterial stiffness. The study was presented by Dr. P.H. Gustavsen from the NaestvedUniversityHospital in Naestved, Denmark, who commented that the differences in pulse pressure may in part help to explain the higher 10-year morbidity in the patients with WCH in their study population.
Gustavsen and colleagues were able to study 412 of the 566 participants in the original study that compared office and ambulatory blood pressure measurements. WCH was defined as an office blood pressure <140/90 mmHg and a daytime ambulatory blood pressure <135/90 mmHg. In this 10-year follow-up study, 23.3% of the persons with established hypertension were not receiving treatment, and 49.2% of the WCH and 80.9% of the normotensive groups.
The table summarizes the pulse pressure results at the 10-year follow-up in the 3 groups.
|Normotensive (n=110)||White Coat Hypertensive (n=61)||Established Hypertension (n=241)|
|Baseline daytime PP||50.2||39.9||51.2|
|10-yr Follow-up Daytime PP||58.0||56.4||59.7|
|Daytime PP difference||7.8||16.5**||8.5*|
|Baseline Office PP||60.2||61.4||64.5|
|Office PP difference||13.1||14.1||9.4|
PP, pulse pressure; *p<0.05 vs normotensive; **p<0.001 vs normotensive and p<0.002 vs established hypertension
Prehypertension status and nondipping associated with risk for target organ damage
A study of 563 Greek men revealed a higher incidence of an abnormal exercise blood pressure response and increased left ventricular mass and diastolic dysfunction in the hypertensive and prehypertensive men who were nondippers. Dr. Pittaras reported the study at the 15th European Meeting on Hypertension in Milan.
The men were on average 51 years of age, nonsmokers, without overt heart disease, COPD or sleep apnea, and were not taking cardiac or antihypertensive drugs. Of the 563 men, 316 were prehypertensive (SBP 120-139 mmHg or DBP 80-89 mmHg) and 220 were nondippers (<10% nighttime blood pressure drop). Extensive echocardiographic testing, Bruce exercise stress test, and ambulatory blood pressure monitoring was performed.
The nondippers were older (54 years) and had an increased left ventricular mass index (LVMI (130 vs 122 for dippers, p=0.015) and a larger aortic root and left atrium compared to nondippers. Also, the prehypertensive nondippers, compared to nondippers, had a 2.5 higher relative risk for an abnormal E/A ratio and a 2.04 higher relative risk for abnormal DT, measures of diastolic function.
Historical survey showed no increase CV death in high normal hypertensives
The 33-year follow-up of 2362 employed men born in France (mean age 33 years) originally surveyed for cardiovascular risk factors showed that of the 203 total mortality, only 34 were cardiovascular (16.7%) while 109 (53.7%) were cancer deaths. The age-adjusted cardiovascular mortality for an optimal blood pressure (ESH-ESC criteria) was 2.6%, a normal blood pressure 2.8%, and a high normal blood pressure only 2.2%.
On multivariate analysis, the significant predictors for cardiovascular mortality were age (hazard ratio 1.08), smoking (HR 3.74), and serum cholesterol (HR 1.87), while the hazard ratios for a normal blood pressure and high normal blood pressure were only 0.83 and 0.74, respectively. The study was reported by Milon and colleagues.
Correlation in risk prediction between baPWV and Framingham risk scores
A cross-sectional study of 1044 patients undergoing a routine checkup at a university hospital cardiovascular center showed that brachial-ankle pulse wave velocity (baPWV)and the Framingham risk score (FRS) are strongly correlated (r=0.447, p<0.001), and the baPWV is a strong surrogate marker for predicting future coronary event risk in asymptomatic patients with ≥ 1coronary risk factors. Dr. E. Kim of HallymUniversitySacredHeartHospital in Korea reported the study at the 15th European Meeting on Hypertension in Milan.
The baPWV was also shown to be an independent risk factor to predict CV risk (p<0.001). For screening the high CHD risk group (FRS>20%), the cut-off PWV value was 1649 cm/sec, with a sensitivity of 61.9% and specificity of 74.3%. The upper quartile (1820 cm/sec) of PWV was the most potent predictor of CHD over conventional risk factors.