Relationship Between Central Pressure Augmentation Index And Target Organ Damage In Patients With Essential Hypertension

BackgroundHypertension,a highly prevalent disease worldwide,is considered as a major and modifiable risk factor for stroke,cardiovascular and renal disease.Hypertension played a critical role for total disease burden,and accounted for 25.0 and 45.0%of all-cause mortality and cardiovascular mortality in adults worldwide,respectively.And blood pressure-lowering treatment could markedly produce relative reductions in cardiovascular risk.The target organ damage caused by hypertension are common problem in clinical practice.Central pressures do not correspond to brachial pressures due to pressure pulse amplification of a varying degree when moving from the aorta to the periphery.Importantly,more and more clinical studies have indicated that central hemodynamic variables confer a statistically significant predictive value of cardiovascular events and all-cause mortality.Additionally,though similar effects on brachial pressure,antihypertensive therapy have differential effects on central pressure in recent trials.So,it is meaningful to measure central pressure in routine clinical practice to estimate the probability of the presence of target organ damage in hypertension patients.The aim of our study was to investigate the correlation between non-inasive central arterial pressure augmentation index(AI)and target organ damage in patients with essential hypertension.There were three parts in our studies.The first part was to evaluate the association between left ventricular hypertrophy and non-invasive central arterial pressure AI in essential hypertension.The second part was to evaluate the association between intima-media thickness increase and non-invasive central arterial pressure AI in essential hypertension.The third part was to evaluate the association between microalbuminuria and non-invasive central arterial pressure AI in essential hypertension.Objectives1.To investigate the correlation between non-invasive central arterial pressure AI and target organ damage in patients with essential hypertension.2.To explore the predictive value of non-invasive central arterial pressure AI and other risk factors for target organ damage in patients with essential hypertension.MethodsA total of 1657 community-living individuals with essential hypertension,admitted to the Community Health Center of Liaobu County,Dongguan City,Guangdong Province,China,from July 2017 to December 2017,were enrolled in this cross-sectional study.All participants were interviewed and completed a standardized questionnaire and physical examinations.The Al was evaluated by HEM-9000 Al type detection device.Among 1657 essential hypertension individuals,493 patients underwent comprehensive transthoracic echocardiography measurement,559 patients underwent carotid ultrasound measurement,and 605 patients collected morning urine to measure urinary albumin creatinine ratio.Results1.The association between left ventricular hypertrophy and non-invasive central arterial pressure AI in essential hypertension.493 essential hypertension patients were classified into two groups:patients with left ventricular hypertrophy(n = 149)and patients without left ventricular hypertrophy(n = 344).The non-invasive central arterial pressure AI was found to be significantly higher in the left ventricular hypertrophy group(33.5±9.2 vs.25.0±8.6%;P<0.001).The correlation analysis pointed out positive correlations between LVMI and non-invasive central arterial pressure AI(r = 0.200,P<0.001).Multiple logistic regression analyses showed that a higher non-invasive central arterial pressure AI level was significantly associated with Ieft ventricular hypertrophy(OR,1.107;95%CI,1.075-1.141,P<0.001).The optimal non-invasive central arterial pressure AI cutoff value for detecting left ventricular hypertrophy was 30.8%,based on ROC analysis with a sensitivity of 62.4%and a specificity of 80.8%.2.The association between intima-media thickness increase and non-invasive central arterial pressure AI in essential hypertension.559 essential hypertension patients were classified into two groups:patients with intima-media thickness increase(n = 231)and patients without intima-media thickness increase(n = 328).The non-invasive central arterial pressure Al was found to be significantly higher in the intima-media thickness increase group(34.0±10.8 vs.22.3±10.7%;P<0.001).The correlation analysis pointed out positive correlations between IMT and non-invasive central arterial pressure AI(r = 0.407,P<0.001).Multiple logistic regression analyses showed that a higher non-invasive central arterial pressure AI level was significantly associated with intima-media thickness increase(OR 1.104,95%CI 1.061-1.118,P<0.001).The optimal non-invasive central arterial pressure AI cutoff value for detecting intima-media thickness increase was 26.8%,based on ROC analysis with a sensitivity of 75.0%and a specificity of 73.0%.3.The association between microalbuminuria and non-invasive central arterial pressure AI in essential hypertension.605 essential hypertension patients were classified into two groups:patients with microalbuminuria(n = 276)and patients without microalbuminuria(n = 329).The non-invasive central arterial pressure AI was found to be significantly higher in the microalbuminuria group(32.0±9.4 vs.21.5±8.4%;P<0.001).The correlation analysis pointed out positive correlations between UACR and non-invasive central arterial pressure AI(r = 0.210,P<0.001).Multiple logistic regression analyses showed that a higher non-invasive central arterial pressure AI level was significantly associated with microalbuminuria(OR 1.169,95%CI 1.135-1.204,P<0.001).The optimal non-invasive central arterial pressure AI cutoff value for detecting microalbuminuria was 25.2%,based on ROC analysis with a sensitivity of 75.7%and a specificity of 74.8%.Conclusion1.The non-invasive central arterial pressure Al was significantly associated with left ventricular hypertrophy,and could help predicting the presence of left ventricular hypertrophy in essential hypertension.2.The non-invasive central arterial pressure Al was significantly associated with intima-media thickness increase,and could help predicting the presence of intima-media thickness increase in essential hypertension.3.The non-invasive central arterial pressure Al was significantly associated with microalbuminuria,and could help predicting the presence of microalbuminuria in essential hypertension.