Blood pressure profile is associated with microalbuminuria and retinopathy in hypertensive nondiabetic patients
- 102 Downloads
Target organ damage is important for global cardiovascular risk assessment. The aim of this study was to explore the association between the blood pressure profile and end-organ damage in a hypertensive non-diabetic cohort.
A total of 560 consecutive hypertensive nondiabetic patients (mean age: 58.2 ± 13.3 years, 221 men) were included in the study. All patients underwent thorough physical examination including fundoscopic examination. First morning urine samples were obtained from each patient and measurement of the albumin-to-creatinine ratio in first morning urine collection samples was used for diagnosis of microalbuminuria. All patients underwent a 24-h ambulatory blood pressure monitoring and were grouped as dippers and non-dippers according to the presence or absence of >10% decrease in blood pressure during the night, respectively.
The non-dipper group consisted of 247 patients with a non-dipper blood pressure profile, 31 patients with reverse dipping and 4 patients with extreme dipping. Non-dipper patients were significantly older. Coronary artery disease, cerebrovascular disease, hypertensive retinopathy and microalbuminuria were significantly more prevalent in the non-dipper patients. Non-dipping hypertension increased the risk of hypertensive retinopathy by 1.89 times (95% confidence interval, CI:1.35–2.65, p < 0.001) and the risk of microalbuminuria by 2.23 times (95% CI:1.49–3.33, p < 0.001). Non-dipping hypertension was still significantly associated with hypertensive retinopathy and microalbuminuria when adjusted by age and sex.
Non-dipping hypertension was associated with increased risk of hypertensive retinopathy and microalbuminuria. Blood pressure profiles should also be considered in assessing the risk for hypertensive patients.
KeywordsNon-dipping Hypertension Microalbuminuria Retinopathy
Compliance with ethical guidelines
Conflict of interest
B. Karadag, T. Ozyigit, Z. Serindag, A. Ilhan, and B. Ozben declare that they have no competing interests.
The investigation conforms with the principles outlined in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study was approved by the local ethics committee and all participants gave written informed consent.
- 2.Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13.CrossRefPubMedGoogle Scholar
- 3.Neal B, MacMahon S, Chapman N, Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet. 2000;356(9246):1955–64.CrossRefPubMedGoogle Scholar
- 4.Sega R, Facchetti R, Bombelli M, et al. Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation. 2005;111(14):1777–83. https://doi.org/10.1161/01.CIR.0000160923.04524.5B.CrossRefPubMedGoogle Scholar
- 6.Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219. https://doi.org/10.1093/eurheartj/eht151.CrossRefPubMedGoogle Scholar
- 7.Chughtai IS, Peixoto AJ. Ambulatory blood pressure monitoring: a review of its clinical and prognostic relevance. Hosp Physician. 2003;39(3):47–56.Google Scholar
- 11.Nakano Y, Oshima T, Ozono R, et al. Non-dipper phenomenon in essential hypertension is related to blunted nocturnal rise and fall of sympatho-vagal nervous activity and progress in retinopathy. Auton Neurosci. 2001;88(3):181–6. https://doi.org/10.1016/S1566-0702(01)00238-7.CrossRefPubMedGoogle Scholar
- 15.Hayreh SS. Structure and blood supply of the optic nerve. In: Heilmann K, Richardson KT, editors. Glaucoma: Conceptions of a Disease, Pathogenesis, Diagnosis, Therapy. Philadelphia: WB Saunders; 1978. pp. 78–96.Google Scholar
- 20.Henskens LH, Kroon AA, van Oostenbrugge RJ, Haest RJ, Lodder J, de Leeuw PW. Different classifications of nocturnal blood pressure dipping affect the prevalence of dippers and nondippers and the relation with target-organ damage. J Hypertens. 2008;26(4):691–8. https://doi.org/10.1097/HJH.0b013e3282f4225f.CrossRefPubMedGoogle Scholar
- 27.Torun D, Sezer S, Arat Z, Pelit A, Yigit F, Ozdemir FN. The frequency of combined target organ damage and the beneficial effect of ambulatory blood pressure monitoring in never treated mild-to-moderate hypertensive patients. Int Heart J. 2005;46(6):1073–82. https://doi.org/10.1536/ihj.46.1073.CrossRefPubMedGoogle Scholar