3D.03: INFLUENCE OF AORTIC ATHEROSCLEROSIS ON THE PROGNOSTIC VALUE OF POSTURAL BLOOD PRESSURE CHANGES. (June 2015)

• Record Type: Journal Article
• Authors: Courand, P.Y.; Fay, H.; Harbaoui, B.; Khettab, F.; Fauvel, J.P.; Bricca, G.; Milon, H.; Lantelme, P.
• Is Part Of: Journal of hypertension. Volume 33(2015)Supplement 1
• Publication Date: 2015-06
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000467456.01139.e9
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Orthostatic blood pressure (BP) variations have been related with cardiovascular events in hypertensive patients; they are associated with autonomic and neurohormonal abnormalities. Large vessels damages, i.e. aortic atherosclerosis (ATS), may exaggerate this BP deregulation and thus, amplify its prognostic consequence. This study aimed at investigating the interaction of ATS on the prognostic value of postural BP changes. Design and method: In a cohort of 958 hypertensive patients with an aortography available (mean age 44 ± 11 years, 61% of men, 26.5% of secondary prevention), BP was measured with a manual sphygmomanometer after 10 minutes of rest in the supine position and in the standing position, one minute after assuming the upright position. Supine and standing SBP were each the average of six measurements. Postural BP change was recalculated as absolute value of the difference between mean supine SBP and mean standing SBP. ATS was assessed by a 2-modality score: absent or mild vs. moderate or severe. All-cause and cardiovascular deaths were assessed after 15 years of follow-up. Results: BP was 182/110 mm Hg, on average. During the follow-up, 167 cardiovascular and 280 all-cause death occurred. As illustrated in the figure, an increased risk of death was observed across tertiles of increasing level of postural BP changes in the presence of moderate or severe ATS but not if ATS was absent or mild. In a multivariable Cox Regression analysis adjusted for major cardiovascular risk factors, postural BP change was statistically associated with all-cause and cardiovascular mortality only in the presence of moderate or severe ATS: tertile 2 vs. 1: 2.19 [1.10–4.39] and 2.02 [0.82–4.96] respectively; tertile 3 vs. 1: 3.21 [1.73–5.94] and 4.65 [2.20–9.80] respectively (P for interaction 0.006 for all-cause mortality and 0.002 for cardiovascular mortality). We did not observe such interaction with ECG left ventricular hypertrophy, history of heart failure and anti-hypertensive treatment. Conclusions: The prognostic significance of postural BP changes is markedly influenced by aortic damage in hypertensive patients. Figure. No caption available.