Objective: It has been suggested that measurement of “unattended” or “automated oscillatory(AOBP)” blood pressure values may provide advantages over conventional BP measurement and some hypertension guidelines now suggest this approach as the preferred one for measuring office BP. Data on the strength of the relationship between AOBP and cardiovascular events are limited as compared to those obtained with the standard BP measurement; conflicting data are available on the relationship between hypertensive organ damage and “attended” and “unattended” BP. The aim of our study was to evaluate the relationship between “attended” or “unattended” BP values and arterial stiffness in 108 subjects undergoing a visit and assessment of arterial stiffness at an ESH Excellence Centre. Design and method: Both “unattended” BP (patient alone in the room, an oscillometric device programmed to perform 3 BP measurements, at 1 minute intervals, after 5 minutes) and “attended” BP were measured with the same device, on the same day of arterial stiffness assessment, in random order. Results: Patient's mean age was 65 ± 15 yrs, mean BMI 26 ± 4, 43% female, 72 % had hypertension (59% treated). Systolic unattended BP was lower as compared to attended SBP (132.7 ± 17.7vs124.9 ± 15.3 mmHg). A similar correlation was observed between PWV and systolic unattended BP or attended SBP (r = 0.530 and r = 0.535, p < 0.0001, respectively) and between PWV and mean unattended and attended BP (r = 0.408 and r = 0.381, p < 0.0001, respectively). Similar correlations were also observed between PWV and unattended and attended pulse pressure (r = 0.459 and r = 0.480, p < 0.0001). The differences between correlations were not statistically significant (Steiger's Z test). No significant difference was observed between the ROC curves of attended and unattended SBP for the presence of increased arterial stiffness (AUC 0.706 vs. AUC 0.730, p for the comparison = ns). Conclusions: Measurement of BP “unattended” or “unattended” provides different values, being unattended BP lower as compared to attended BP. Our results suggest that unattended measurement of BP values does not change the relationship with the gold standard measure of arterial stiffness.
Objective: The VASOTENS international, multicenter, observational, non-randomized, prospective study aims at evaluating the impact of 24-hour pulse wave analysis of ambulatory blood pressure (BP) recordings on target organ damage and cardiovascular prognosis of hypertensive patients. In the present analysis of study baseline data we checked whether organ damage of hypertension i) is better associated with 24-hour central than peripheral BP and ii) is related to ambulatory arterial stiffness, estimated by pulse wave velocity (PWV) and augmentation index (AIx). Design and method: In 334 hypertensive patients (mean age 53+/−15, 52% males, 45% treated) we obtained 24-hour ABPMs, echocardiograms, carotid ultrasonograms and serum creatinine. Hypertensive organ damage was estimated by calculation of left ventricular mass index (LVMI, cardiac damage), intima-media thickness (IMT, vascular damage) and creatinine clearance (CC, renal damage). 24-hour hemodynamics and stiffness were estimated through the validated VASOTENS technology, based on transfer function analysis of brachial oscillograms. 24-hour brachial (bSBP) and aortic systolic BP (aSBP), standard deviation of bSBP, PWV and AIx were obtained. Relation of vascular indices with LVMI, IMT and CC was evaluated by bivariate and multivariate analysis (stepwise linear regression analysis). Results: In the bivariate analysis a statistically significant relation was found for age, bSBP and aSBP vs. LVMI and IMT (see table, correlation coefficients or r). IMT was also significantly related to SBP variability and arterial stiffness, whereas increasing age, SBP variability and AIx were significantly associated with a decline of renal function.In the multivariate analysis, including all variables entered in the bivariate model, adjusted by sex, statistically significant (p < 0.001) association was observed for aSBP and age with LVMI (standardized regression coefficient 0.25 and 0.18, respectively), and for age with IMT (0.56) and CC (−0.53). Conclusions: In hypertensive patients age appears to be the major determinant of organ damage, with central SBP, and marginally peripheral SBP, PWV and AIx, also playing a significant role. Our results suggest that estimation of 24-hour central hemodynamics and arterial stiffness in ambulatory conditions may help improve the individualized assessment of the BP-associated organ damage of hypertension
