APBM HYPERTENSIVE INDEX TIME, IN TREATED HYPERTENSIVE PATIENTS, CAN PREDICT VENTRICULAR REMODELING AND CARDIOVASCULAR EVENTS

Objective: It is currently known that intensive blood pressure reduction in hypertensive patients would lead to more lower risk of left ventricular hipertrophy (LVH), effect that partially explains the long term cardiovascular benefits. We use in our study the ABPM hypertensive time index (HTI), as an indirect marker for the level of blood pressure reduction and presence of target organ damage. Design and method: We include in our study 600 patients (men age 61,5 years, 38%women) with hypertension and no diabetes, with ABPM recorded in the first month after randomization. We appreciate the HTI as marker of blood pressure control and target organ damage and compare patients with HTI more (group A) and less (group B) than 40%. Progression and regression of LVH as defined by Cornell voltage criteria was recorded and baseline and biannual during a medium follow-up of 3 years. The effect of BP lowering pattern had been analyzed on cardiovascular(CVD) outcome (myocardial infarction, acute coronary syndrome, stroke, heart failure and CV death), before and after adjustment for LVH as a time-varying co-variate. Results: Patients with HTI < 40% without LVH(n = 552, 91,84%) at randomization had a 52% lower risk of developing LVH (hazard ratio = 0.60, 95% confidence interval, 0.45–0.70). Hypertensive patients with baseline HVS (n = 49, 8,16%), with HTI < 40% were more likely to regress their LVH (hazard ratio = 1.60, 95% confidence interval, 1.25–2.20). Adjustment for LVH as a time-varying covariate did not attenuate the effect of HTI on CVD(hazard ratio in patients with HTI < 40% vs. HTI > 40%, 0.71[95% confidence interval 0.62–0.91] and 0.80[95% confidence interval, 0.63–0.92]. before and after adjusting for LVH as a time-varying covariate). Conclusions: In patients with hypertension but no diabetes, ABPM appreciated hypertension index time less than 40%, is associated with lower rates of developing new LVH in those without LVH, and regression of LVH in those with previous LVH. The positive effect on global cardiovascular events, is the result of the reduced target organ damage at a global scale, not only on left ventricular remodeling.