Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.
Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.
Am J Hypertens. 2024 Nov 15;37(12):978-986. doi: 10.1093/ajh/hpae106.
Evidence on the association of arterial stiffness and left ventricular (LV) concentric remodelling/LVH assessed by echocardiography, with abnormal blood pressure (BP) phenotypes, defined by office and ambulatory BP monitoring (ABPM) in the community is scanty. Thus, we investigated this issue in the participants to the Pressioni Monitorate E Loro Associazioni (PAMELA) study.
The present study included 491 participants who attended the second and third survey of the PAMELA study performed after 10 and 25 years from the initial evaluation. Data collection included medical history, anthropometric parameters, blood examinations, office, ABPM, echocardiographic and Cardio-Ankle Vascular Index (CAVI) measurements.
In the whole study sample (age 66+10 years, 50% males), the prevalence rates of sustained normotension (NT), white coat hypertension (WCH), masked hypertension (MH), sustained hypertension (SH) and non-dipping (ND) were 31.2, 10.0, 24.2, 34.6, and 35.8% and respectively. The likelihood of having SH, the BP phenotype carrying the greatest CV risk, was four times higher (OR= 4.31, CI:2.39-7.76, p<0.0001) in participants with increased CAVI and LV remodelling/LVH compared to their counterparts without organ damage. This association showed an incremental value in discriminating SH compared to both isolated markers of organ damage (OR=1.92,p=0.03 for increased CAVI and OR= 2.02, p=0.02 for LV remodelling/LVH). The presence of isolated but also combined organ damage was unrelated to ND.
Our study provides new evidence of the incremental value of looking for both vascular and cardiac target organ damage to optimize the identification and clinical management of SH in the general population.
关于通过超声心动图评估的动脉僵硬度和左心室（LV）向心性重构/肥厚与异常血压（BP）表型的关系的证据，通过社区中的诊室和动态血压监测（ABPM）来定义，在社区中是很少的。因此，我们在参加 Pressioni Monitorate E Loro Associazioni（PAMELA）研究的参与者中研究了这个问题。
本研究包括 491 名参与者，他们参加了 PAMELA 研究的第二次和第三次调查，这两次调查分别在初始评估后 10 年和 25 年进行。数据收集包括病史、人体测量参数、血液检查、诊室、ABPM、超声心动图和心血管脚踝血管指数（CAVI）测量。
在整个研究样本（年龄 66+10 岁，50%男性）中，持续性正常血压（NT）、白大衣高血压（WCH）、隐匿性高血压（MH）、持续性高血压（SH）和非杓型（ND）的患病率分别为 31.2%、10.0%、24.2%、34.6%和 35.8%。与没有器官损伤的参与者相比，CAVI 增加和 LV 重构/肥厚的参与者发生 SH 的可能性要高出四倍（OR=4.31，95%CI：2.39-7.76，p<0.0001），SH 是 CV 风险最大的 BP 表型。与孤立的器官损伤标志物相比，这种关联在区分 SH 方面具有增量价值（CAVI 增加的 OR=1.92，p=0.03，LV 重构/肥厚的 OR=2.02，p=0.02）。孤立的但也有联合的器官损伤的存在与 ND 无关。
我们的研究提供了新的证据，表明寻找血管和心脏靶器官损伤具有增量价值，可以优化一般人群中 SH 的识别和临床管理。
