Pressão sistólica central (PSc), velocidade de onda de pulso (VOP) e Augmentation Index (AIx), avaliados por monitorização de 24 horas em indivíduos normotensos e hipertensos com e sem tratamento anti-hipertensivo

Abstract

Several studies with central systolic pressure (PSc), Augmentation Index (AIx) and pulse wave velocity (PWV) have been performed. These data, for the most part, were obtained through isolated measures. Little is known about the behavior of these variables when analyzing 24-hour measures. The objective of this study was to evaluate the behavior of PSc, VOP and AIx in the office and in 24 hours monitoring, by the phenotypes of hypertension in subjects without antihypertensive treatment (normotension - NT, white coat hypertension - WH, masked hypertension - MH and sustained hypertension (SH), and in subjects with antihypertensive treatment (controlled hypertension -CH uncontrolled white coat hypertension - WUCH, uncontrolled masked hypertension - MUCH, uncontrolled sustained hypertension - SUCH). We evaluated 454 untreated individuals (age = 45 ± 15 years, 50% male) and 238 treated subjects (age = 52 ± 15 years, 45% male) submitted to the measurement of brachial and central BP, PWV and AIx in the office and at 24 hours using the Mobil-O-Graph® device. In analysis adjusted for age and sex, WH had higher (p<0.05) office PWV (7.53±0.09 vs 6.89±0.05), office AIx (27.9±1.3 vs 23.8±0.8) and daytime AIx (24.6±0.7 vs 22.7±0.4) compared with NT, while WUCH had higher (p<0.05) office PWV (8.28±0.11 vs 7.43±0.08) and 24h PWV (7.54±0.09 vs 7.21±0.07) than CH. MH had higher (p<0.05) 24h PWV (7.00±0.09 vs 6.69±0.04) and 24h AIx (24.3±0.9 vs 21.9±0.4) than NT, whereas MUCH had higher (p<0.05) 24h PWV (7.64±0.13 vs 7.21±0.07) than CH. Lastly, SH or SUCH had significantly higher office and 24h PWV and AIx than NT and CH, respectively. In conclusion, these results suggest that individuals with masked hypertension phenotypes have increased out-of-office maskers of vascular stiffness, while individuals with white-coat phenotypes have increased office and out-of-office markers of vascular stiffness compared with individuals with normal BP levels. These data may contribute to explain the adverse outcomes reported in individuals with white-coat and masked hypertension.