Abstract：
BACKGROUND: 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. We investigated this issue in the participants to the Pressioni Monitorate E Loro Associazioni (PAMELA) study.
METHODS: The 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.
RESULTS: 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.
CONCLUSIONS: Our study provides new evidence of the incremental value of looking for both vascular and cardiac organ damage to optimize the identification and clinical management of SH in the general population.
METHODS: The 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.
RESULTS: 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.
CONCLUSIONS: Our study provides new evidence of the incremental value of looking for both vascular and cardiac organ damage to optimize the identification and clinical management of SH in the general population.
摘要：
背景：通过超声心动图评估动脉僵硬度与左心室（LV）同心重塑/LVH相关的证据，异常血压（BP）表型，社区中由办公室和动态BP监测(ABPM)定义的很少。我们在PressioniMonitorateELoroAssociazioni（PAMELA）研究的参与者中调查了这个问题。
方法：该研究包括491名参与者，他们参加了从初始评估开始10年和25年后进行的PAMELA研究的第二次和第三次调查。数据收集包括病史，人体测量参数,血液检查,office,ABPM,超声心动图和心踝血管指数（CAVI）测量。
结果：在整个研究样本中（年龄66+10岁，50%男性），持续正常值(NT)的患病率，白大衣高血压（WCH），隐性高血压（MH），持续性高血压(SH)和非浸渍性高血压(ND)分别为31.2,10.0,24.2,34.6和35.8%.有SH的可能性，携带最大CV风险的BP表型，与没有器官损伤的参与者相比，CAVI和LV重塑/LVH增加的参与者高出四倍（OR=4.31，CI：2.39-7.76，p<0.0001）。与两种分离的器官损伤标志物相比，这种关联显示出区别SH的递增值（对于CAVI增加，OR=1.92，p=0.03，对于LV重塑/LVH，OR=2.02，p=0.02）。孤立但合并的器官损伤的存在与ND无关。
结论：我们的研究提供了新的证据，证明在普通人群中寻找血管和心脏器官损伤对优化SH的识别和临床管理具有递增的价值。
方法：该研究包括491名参与者，他们参加了从初始评估开始10年和25年后进行的PAMELA研究的第二次和第三次调查。数据收集包括病史，人体测量参数,血液检查,office,ABPM,超声心动图和心踝血管指数（CAVI）测量。
结果：在整个研究样本中（年龄66+10岁，50%男性），持续正常值(NT)的患病率，白大衣高血压（WCH），隐性高血压（MH），持续性高血压(SH)和非浸渍性高血压(ND)分别为31.2,10.0,24.2,34.6和35.8%.有SH的可能性，携带最大CV风险的BP表型，与没有器官损伤的参与者相比，CAVI和LV重塑/LVH增加的参与者高出四倍（OR=4.31，CI：2.39-7.76，p<0.0001）。与两种分离的器官损伤标志物相比，这种关联显示出区别SH的递增值（对于CAVI增加，OR=1.92，p=0.03，对于LV重塑/LVH，OR=2.02，p=0.02）。孤立但合并的器官损伤的存在与ND无关。
结论：我们的研究提供了新的证据，证明在普通人群中寻找血管和心脏器官损伤对优化SH的识别和临床管理具有递增的价值。
