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Impact of Ambulatory Blood Pressure on Early Cardiac and Renal Dysfunction in Hypertensive Patients without Clinically Apparent Target Organ Damage

Authors
 Darae Kim  ;  Chi Young Shim  ;  Geu Ru Hong  ;  Sungha Park  ;  In Jeong Cho  ;  Hyuk Jae Chang  ;  Jong Won Ha  ;  Namsik Chung 
Citation
 Yonsei Medical Journal, Vol.59(2) : 265-272, 2018 
Journal Title
 Yonsei Medical Journal 
ISSN
 0513-5796 
Issue Date
2018
MeSH
Blood Pressure/physiology ; Ambulatory *Blood Pressure Monitoring ; Echocardiography ; Female ; Heart/*physiopathology ; Humans ; Hypertension/diagnostic imaging/*physiopathology ; Kidney/*physiopathology ; Kidney Function Tests ; Male ; Middle Aged ; Regression Analysis ; Systole/physiology ; Left/physiopathology Ventricular Dysfunction ; Left/physiology Ventricular Function
Keywords
Ambulatory blood pressure monitoring ; global longitudinal strain ; microalbuminuria
Abstract
PURPOSE: Impaired left ventricular (LV) global longitudinal strain (GLS) and the presence of microalbuminuria indicate early cardiac and renal dysfunction. We aimed to determine the relationships among 24-h ambulatory blood pressure (BP) variables, LV GLS, and urine albumin creatinine ratio (UACR) in hypertensive patients. MATERIALS AND METHODS: A total of 130 hypertensive patients (mean age 53 years; 59 men) underwent 24-h ambulatory BP monitoring, measurements of peripheral and central BPs, and transthoracic echocardiography. Patients with apparent LV systolic dysfunction (LV ejection fraction <50%) or chronic kidney disease were not included. LV GLS was calculated using two-dimensional speckle tracking, and UACR was analyzed from spot urine samples. RESULTS: In simple correlation analysis, LV GLS showed the most significant correlation with mean daytime diastolic BP (DBP) (r=0.427, p<0.001) among the various BP variables analyzed. UACR revealed a significant correlation only with night-time mean systolic BP (SBP) (r=0.253, p=0.019). In multiple regression analysis, daytime mean DBP and night-time mean SBP were independent determinants for LV GLS (beta=0.35, p=0.028) and log UACR (beta=0.49, p=0.007), respectively, after controlling for confounding factors. Daytime mean DBP showed better diagnostic performance for impaired LV GLS than did peripheral or central DBPs, which were not diagnostic. Night-time mean SBP showed satisfactory diagnostic performance for microalbuminuria. CONCLUSION: There are different associations for daytime and night-time BP with early cardiac and renal dysfunction. Ambulatory BP monitoring provides more relevant BP parameters than do peripheral or central BPs regarding early cardiac and renal dysfunction in hypertensive patients.
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DOI
10.3349/ymj.2018.59.2.265
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김다래(Kim, Da Rae)
박성하(Park, Sung Ha) ORCID logo https://orcid.org/0000-0001-5362-478X
심지영(Shim, Chi Young) ORCID logo https://orcid.org/0000-0002-6136-0136
장혁재(Chang, Hyuck Jae) ORCID logo https://orcid.org/0000-0002-6139-7545
정남식(Chung, Nam Sik)
조인정(Cho, In Jeong)
하종원(Ha, Jong Won) ORCID logo https://orcid.org/0000-0002-8260-2958
홍그루(Hong, Geu Ru) ORCID logo https://orcid.org/0000-0003-4981-3304
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/162040
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