SPC365

Ambulatory Pulse Pressure monitoring as a Prognostic Indicator for Cardiovascular Events in a Hypertensive population

Session: Sessão de Posters 07 - Hipertensão arterial
Speaker: Simão Pedro Almeida Carvalho

Congress: CPC 2024
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.14 Risk Factors and Prevention - Other
Session Type: Cartazes
FP Number: ---
Authors: Simão De Almeida Carvalho; Carlos Costa; Tiago Aguiar; Adriana Pacheco; Diana Carvalho; Andreia Fernandes; J. Mesquita Bastos
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In hypertension, Pulse Pressure (PP) is a key predictor of adverse cardiovascular outcomes seen in diabetes, older individuals, and recently, in resistant hypertension. The spectrum of hypertensive severity varies, from controlled cases to challenging-to-manage resistant hypertension. Understanding these differences is crucial for tailored treatments. Ambulatory Blood Pressure Monitoring (ABPM) provides comprehensive insights, going beyond clinic assessments, crucial in precise evaluation and management.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To investigate the correlation between pulse pressure and cardiovascular events across various phenotype types of hypertensive populations to ascertain the predictive value of this relationship for individualized risk assessment.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">898 hypertensive patients underwent ABPM in a retrospective study. Clinical and lab data were collected. Parametric tests (Independent-Samples T Test, Chi-square, Kaplan-Meier with log-rank test in SPSS) were used for variables with a normal distribution.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Patients were categorized by office blood pressure, ABPM, and anti-hypertensive meds into groups: Ambulatory Resistant Hypertension (ARH), Ambulatory Non-Resistant Hypertension (ANRH), White Coat Uncontrolled Resistant Hypertension (WCURH), Controlled Hypertension (CH).</span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Using a 60mmHg threshold, pulse pressure was compared between two groups, aligning with past studies - clinical trials and meta-analyses - on cardiovascular risk factors.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Demographics, follow-up duration, patients, and blood pressure metrics for the hypertensive groups are detailed in Table 1. Pulse pressure varied notably among the groups, with controlled hypertension at 46.7 &plusmn; 8.4 mmHg and resistant hypertension at 60.9 &plusmn; 12.2 mmHg.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A composite outcome including stroke, acute coronary syndrome, heart failure hospitalization, peripheral artery disease, and death was established for endpoint analysis.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">When the event rate in the ambulatory non-resistant hypertension and resistant hypertension groups was calculated as a percentage of pulse pressure greater than 60mmHg, an analysis of event-free Kaplan-Meier curves revealed a statistically significant event rate with the worst outcome for those with PP greater than 60mmHg.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In summary, within the groups of resistant hypertension and ambulatory non-resistant hypertension, our study reveals a notable correlation between elevated pulse pressure levels and adverse cardiovascular events, indicating its potential as a valuable prognostic marker. This emphasizes the necessity for customized risk assessment approaches, highlighting the predictive value of pulse pressure in the management of cardiovascular risks among these particular subsets of hypertensive individuals.</span></span></span></p>