From treatment to organ damage; A 5-year follow-up study of ambulatory blood pressure in essential hypertension. Diversity between development of left ventricular hypertrophy and urinary albumin excre

Blood Press. 2007;16(2):87-94.
Stenehjem AE, Bjørnerheim R, Os I.
Department of Nephrology.

This study aimed to assess blood pressure (BP) profile, BP control, left ventricular hypertrophy (LVH) and albumin/creatinine ratio (ACR) in urine after 5 years of antihypertensive treatment in subjects with newly diagnosed essential hypertension.

Fifty-four subjects were included and prescribed calcium-channel blocker in monotherapy during an 8-week period, and later 46 subjects (34 men, 12 women, 53.1+/-8.6 years) attended a 5-year follow-up visit at the hypertension clinic. They underwent 24-h ambulatory BP monitoring (ABPM), ECG and ACR at baseline and after 5 years.

Echocardiography performed after 5 years revealed LVH in 54% of the subjects, while there was no change in Cornell product, an ECG criterion for LVH. BP control assessed by office BP was 33%, and only 20% using 24-h ABP. Night-time fall in BP was significantly attenuated from 13.2+/-5.9% to 10.7+/-6.0%, p = 0.01 for systolic BP and from 13.3+/-6.9% to 9.8+/-6.8%, p = 0.004 for diastolic BP. The number of dippers decreased after 5 years, but this did not reach statistical significance. In contrast to the lack of change in Cornell product, there was a significant decrease in ACR, and 93% of the subjects had ACR<1.5 mg/mmol after 5 years compared with 57% at baseline (p<0.001).

Thus, ABPM should be encouraged in the follow-up of all hypertensive subjects as it reveals better inadequate BP control than office BP and gives information about night-time fall, as this may explain the high prevalence of LVH. The diversity in development of LVH and ACR during antihypertensive treatment needs to be verified.




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