Tuesday, 3 December 2013

SBP of 130mmHg linked to target organ damage

by Lynda Williams, Medwire News
A study of Chinese patients warns of the risk for target organ damage from untreated hypertension, especially for younger patients.
The ambulatory blood pressure (BP) monitoring survey conducted in 1047 patients attending the Ruijin Hospital in Shanghai, China, showed that 24-hour systolic BP of 130 mmHg or higher alone or in combination with a diastolic BP of 80 mmHg or above significantly and independently increased the risk for organ damage independently of age.
In addition, increases in diastolic blood pressure alone were associated with significant elevation in the left ventricular mass index in patients aged less than 55 years old.
“[O]ur current study highlights the necessity to treat both systolic and diastolic hypertension to target in particular at younger age when the prevalence of isolated diastolic hypertension and combined hypertension is higher than in the elderly, among whom isolated systolic hypertension is more prevalent,” write Yan Li, from the hospital, and co-authors in Hypertension.
For patients aged less than 55 years, each 1-standard deviation (SD) increase in systolic BP was associated with a 3.31 g/m2 increase in left ventricular mass index, a 0.54 m/s increase in aortic pulse wave velocity, and a 1.15 mg/mmol increase in the urinary albumin to creatinine ratio.
For patients aged 55 years or older, the values were 3.58 g/m2, 0.76 m/s, and 1.23 mg/mmol, respectively.
Each 1-SD increase in diastolic pressure in younger patients was associated with significantly increased urinary albumin to creatinine ratio (1.14 mg/mmol). In older patients, it was associated with significantly reduced pulse wave velocity (–0.49 m/s), but had no other impact on target organ measures of damage.
In the whole population, mixed systolic and diastolic hypertension was associated with a significant increase in left ventricular mass index (4.31 g/m2), pulse wave velocity (0.76 m/s), and urinary albumin to creatinine ratio (1.63 mg/mmol), after adjusting for confounders including age, heart rate, and smoking.
Noting that International Collaboration Study of Cardiovascular Disease in Asia findings indicate that less than half of Chinese patients are aware of their hypertension and that less than 10% achieve blood pressure control, Li et al conclude: “These results along without our current findings underscore the need to develop strategies not only in China but worldwide to improve prevention, detection, and treatment of hypertension, including isolated diastolic hypertension.”
 Source: Medwire News

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