Estimated pulse wave velocity can help in patient selection for ambulatory blood pressure monitoring to detect masked hypertension

János Nemcsik, Zsófia Kekk, Johanna Takács, Akos Koller, Péter Torzsa, Dénes Páll, Dorottya Pásztor, Zoltán Járai

Keywords: hypertension, ambulatory blood pressure monitoring, pulse wave velocity

Background:

Arterial stiffening can predict the development of hypertension. Estimated pulse wave velocity (ePWV) can provide an approximation of the progression arterial stiffness.

Research questions:

The aim of our study was to explore the utility of ePWV to predict masked hypertension (MH) in patients with optimal, normal or high-normal office blood pressure (oBP), to help patient selection for ambulatory blood pressure monitoring (ABPM).

Method:

Data of the Hungarian ABPM Registry between September 2020 and November 2023 were used in our analysis. ePWV was calculated based on previously published formulas.

Results:

Out of 38 720 uploaded ABPM curves with clinical data, 7386 participants had optimal, normal or high-normal oBP. 5644 (76.4%) of them were on regular antihypertensive medication. MH was diagnosed with ABPM in 4348 cases. Mean ePWV was 9.27±2.02 m/s, which did not differ in MH or non-MH groups (9.28±1.98 m/s and 9.25±2.07 m/s, respectively). In MH group male sex and obesity were more frequent compared to non-MH (46.1% versus 28.1% and 23% versus 14.6% respectively, p<0.05). In a model adjusted for male sex and obesity, ePWV >8 m/s was independently associated with MH in the total population (adjusted odds ratio (aOR):1.15 (95% confidence interval (CI):1.04-1.27), B=0.140, p=0.007). This association was more pronounced in untreated subjects (aOR:1.44 (95%CI: 1.18-1.76), B=0.365, p<0.001), where the model had 40.3% sensitivity and 78.7% specificity.

Conclusions:

In obese male subjects besides normal oBP, ePWV >8 m/s can be a marker of MH, a finding, which can help in patient selection for ABPM, especially in untreated patients.

Points for discussion:

The clinical importance of masked hypertension.

The usefullness of ABPM in the GP practice.

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