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Abstract

High values of PP have recently been implicated in the development and progression of large vessel atherosclerosis, small vessel disease and in the occurrence of cardiovascular (CV) events. Furthermore the ratio of stroke volume (SV) to PP, a measure of conduit vessel stiffness, has been proposed as a predictor of CV morbidity.

The aim of the present study is to investigate the link between PP and subclinical organ damage in a cohort of patient (163 m, 107 f) with EH.

PP was calculated as the difference between systolic and diastolic blood pressure (BP). Left ventricular mass index (LVMI), relative wall thickness (RWT) and SV were assessed by M-B mode echocardiography (LVH= LVMI ≥51g/m2.7). Carotid intima-media thickness (IMT) was evaluated by high resolution US scan. Albuminuria was measured as albumin to creatinine ratio (ACR) in three first morning urine samples.

PP was positively correlated with early signs of TOD (namely LVMI P=0.001, IMT P<0.0001 and ACR P=0.03) and with selected clinical variables (gender P=0.01, duration of disease P=0.001, age P<0.0001, total cholesterol P<0.0001 and LDL cholesterol P=0.04). Multiple linear regression analysis showed that PP and ACR independently influence LVMI (F=11.1229, r2 0.16, P<0.0001) and IMT (F=17.155, r2 0.28, P<0.0001).When data were analyzed on the basis of PP values, patients in the upper quartile showed higher LVMI (F=4.596, P=0.004), higher ACR (F=2.841, P<0.05) as well as thicker carotid walls (F=6.265, P<0.001). Furthermore patients with LVH and those with IMT values above the median showed higher values of PP (57.07±1.3, LVH+ vs 53.9±1.07 mmHg, LVH-; P=0.06; 60±2.3, IMT+ vs 54.5±1.2 mmHg, IMT-; P<0.0001). Reduced SV/PP was associated with concentric LV geometry either with or without an increase in LVMI (Remodeling, 1.25±0.006; Normal, 1.55±0.006; Concentric LVH, 1.48±0.006; Eccentric LVH, 1.66±0.006 ml; P<0.0001). Moreover RWT was inversely correlated with SV/PP (P<0.0001) suggesting a link between arterial stiffness and unfavorable cardiac geometry.

In conclusion, PP is an independent marker of preclinical CV damage in EH and therefore can be useful to identify patients at higher risk of CV events.

pulse pressure, target organ damage, microalbuminuria
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© American Journal of Hypertension, Ltd. 2001
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