Abstract:
Introduction
Blood pressure variability (BPV) has been proved to be
promising in providing a great influence on the target
organ damage (TOD) and intrarenal circulation.
Purpose
The aim of our study is to analyze the complex
interconnection between the intrarenal hemodynamics
(IRH), TOD and BPV.
Material and methods
We included 30 patients aged 18-75 years, 53% were men
and 47% were women. Patients underwent physical
examination, blood biochemistry, echocardiography, 24-
hours ambulatory blood pressure monitoring (ABPM),
intrarenal Doppler obtaining: renal resistive index (RRI),
renal pulsatile index (RPI), acceleration time (AT), carotid
Doppler ultrasound on internal and common carotid
arteries (ICA, CCA).
Results
The study of nictemeral BP patterns revealed four major phenotypes: dipper,
non-dipper, reverse-dipper and extreme-dipper. according to SBP data, 3%
of the studied population were assessed as night-peakers, 47%- non-dippers,
43% were dippers and 7 % - extreme dippers. The analysis of DBP variations
included 3% of night-peakers, 43% - non-dippers, 40% - dippers and 13% of
patients were assessed as extreme dippers. The comparative analysis of
nictemeral SBP and DBP variations with IRH parameters revealed that RRI
recorded the highest values in night-peakers followed by non-dippers,
dippers, whereas the lowest being in extreme dippers (0,679 ± 0,0452 vs.
0,675 ± 0,0373 vs. 0,662 ± 0,0321 vs. 0,641 ± 0,0256, p ˂ 0,01). Similar
correlations were assessed for RPI and AT but statistically insignificant (p >
0,05). The comparative analysis of HMOD parameters, left ventricle mass
index (LVMI) and the indexed volume of the LA (left atrium) with SBP
nictemeral variability patterns showed statistically significant differences in
LVMI values that depend upon the assessed profile. Thus, the highest values
for LVMI were found in patients with night-peaker patterns, followed by
non-dippers and the lowest in extreme-dippers (105,75 vs 104,149 vs
102,247 vs 100,286, p ˂0,05); the assessment of IMT in both CCA and ICA
showed the highest values for both CCA and ICA variables in patients with
night-peaker patterns, whereas the lowest CCA values were found in dippers
(1,1 vs 1,074 vs. 1,021 vs 1,057, p ˂0,05). The selective analysis of LVMI, IMT
CCA and IMT ICA, and fasting glucose with nictemeral DBP variations
revealed similarities with SBP variability.
Conclusions
The results of our study show the strong connection between IRH, TOD and
BPV definitively shifting the paradigm to the complex evaluation of the
cardiovascular patient (including ABPM, IRH and the careful evaluation of the
TOD), from present status of research issue to being acknowledged as a
compulsory algorithm in the prognostic stratification of hypertensive
patients
