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European Heart Journal 1994 15(8):1037-1043;
Copyright © 1994 by the European Society of Cardiology.
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© 1994 The European Society of Cardiology

Characteristic abnormal findings of ambulatory blood pressure indicative of hypertensive target organ complications

Y.-Z. TSENG, C.-D. TSENG, H. M. LO, F.-T CHIANG and K.-L. HSU

Department of Internal Medicine, National Taiwan University Hospital Taipei, Taiwan, R. O.C

Received 9 June 1993; revised 18 March 1994; .

Correspondence: Dr Yüng-Zu Tseng, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan S. Road, Taipei, Taiwan 100, Republic of China.

Abstract

To study the correlation between ambulatory blood pressure and target organ complications of hypertension, ambulatory blood pressure monitoring was performed on 290 patients with mild to moderate essential hypertension before treatment. Their target organ complications of hypertension were assessed by ECG, chest X-ray, urinalysis and an eye-fundus examination.

An average ambulatory diastolic blood pressure value greater than the casual diastolic blood pressure was found in 35% of subjects with ECG evidence of left ventricular hypertrophy (LVH) and 5. 2% of subjects without (P<0.0001); in 36. 5% of patients with chest roentgenographic evidence of LVH and 8.4% of patients without (P< 0.0001); in 38. 5% of patients with proteinuria and 11% of patients without (P< 0. 0001); and in 27. 1% of subjects with retinopathy and 10. 7% of subjects without (P<0.01). A similar result was observed for the systolic blood pressure. A reversed circadian pattern of ambulatory diastolic blood pressure was observed in 32. 5% of patients with ECG evidence of LVH and 12. 9% without (P< 0. 0001); in 28. 8% of patients with chest roentgenographic evidence of LVH and 16% without (P<0. 05); in 26. 9% of subjects with proteinuria and 17. 4% without (P<0. 05); in 37. 5% of patients with retinopathy and 14. 5% without (P<0.0001). A similar result was also demonstrated for ambulatory systolic blood pressure. There was a close relationship between the blood pressure load and hypertensive target organ complications in terms of LVH and proteinuria, and between significant nocturnal reduction of ambulatory systolic blood pressure and LVH. The ambulatory blood pressure average also seemed to bear a good relationship to LVH.

In this study, 24 h ambulatory blood pressure monitoring revealed a close relationship between hypertensive target organ damage (ECG and chest roentgenographic evidence of L VH, proteinuria and retinopathy) and the parameters of such measurements in terms of blood pressure pattern (reversed circadian pattern), comparisons between casual blood pressure and ambulatory blood pressure in addition to pressure load, and blood pressure average.

Key Words: Ambulatory blood pressure • casual blood pressure • circadian rhythm • target organ complication


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