Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Ambulatory blood pressure, target organ damage and aortic root size in never-treated essential hypertensive patients

Journal of Human Hypertension volume 21, pages 531–538 (2007)Cite this article

Abstract

The relationship between ambulatory blood pressure (ABP), target organ damage (TOD) and aortic root (AR) size in human hypertension has not been fully explored to date. We investigated the relationship between ABP, different markers of TOD and AR size in never-treated essential hypertensive patients. A total of 519 grade 1 and 2 hypertensive patients (mean age 46±12 years) referred for the first time to our outpatient clinic underwent the following procedures: (1) routine examination, (2) 24 h urine collection for microalbuminuria (MA), (3) ambulatory blood pressure monitoring over two 24 h periods within 4 weeks, (4) echocardiography and (5) carotid ultrasonography. AR dilatation was defined by sex-specific criteria (⩾40 mm in men and ⩾37 mm in women). AR diameter was increased in 3.7% of patients. Demographic variables (body mass index, age and male gender), average night-time diastolic blood pressure (BP) (but not clinic or average 48 h BP), left ventricular mass index and carotid intima-media (IM) thickness showed an independent association with AR size in both univariate and multivariate analyses. When TOD data were analysed in a categorical way, a stepwise increase in the prevalence of left ventricular hypertrophy (LVH) (I=17.5%, II=27.6%, III=35.8%) and carotid IM thickening (I=20.9%, II=28.8%, III=34.4%), but not in MA (I=6.8%, II=9.1%, III=8.7%) was found with the progression of AR size tertiles. Our results show that (1) AR enlargement in uncomplicated never-treated hypertensive patients has a markedly lower prevalence than traditional markers of cardiac and extracardiac TOD; (2) night-time BP, LVH and carotid IM thickening are independent predictors of AR dimension.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Seder JD, Burke JF, Pauletto FJ . Prevalence of aortic regurgitation by color flow Doppler in relation to aortic root size. J Am Soc Echocardiogr 1990; 3: 316–319.

    Article  CAS  Google Scholar 

  2. Roman MJ, Devereux RB, Kramer-Fox R, O'Loughlin J . Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol 1989; 64: 507–512.

    Article  CAS  Google Scholar 

  3. Isselbacker EM, Eagle KA, Sesanctis RW . Diseases of aorta.In: Braunwald E (ed.). Heart Disease: A Textbook of Cardiovascular Medicine. WB Saunders: Philadelphia, PA, 1997, pp 1546–1581.

    Google Scholar 

  4. Rayner BL, Goodman H, Opie LH . The chest radiograph, a useful investigation in the evaluation of hypertensive patients. Am J Hypertens 2004; 17: 507–510.

    Article  Google Scholar 

  5. Kim M, Roman MJ, Cavallini MC, Schwartz JE, Pickering TG, Devereux RB . Effect of hypertension on aortic root size and prevalence of aortic regurgitation. Hypertension 1996; 28: 47–52.

    Article  CAS  Google Scholar 

  6. Iarussi D, Caruso A, Galderisi M, Covino FE, Dialetto G, Bossone E et al. Associations of left ventricular hypertrophy and aortic dilation in patients with acute thoracic aortic dissection. Angiology 2001; 52: 447–455.

    Article  CAS  Google Scholar 

  7. Palmieri V, Bella JN, Arnett DK, Roman MJ, Oberman A, Kitzman DW et al. Aortic root dilatation at sinuses of valsalva and aortic regurgitation in hypertensive and normotensive subjects. The hypertension genetic epidemiology network study. Hypertension 2001; 37: 1229–1235.

    Article  CAS  Google Scholar 

  8. Pearson AC, Gudipati C, Nagelhout D, Sear J, Cone JD, Labovitz AJ . Echocardiographic evaluation of cardiac structure and function in elderly subjects with isolated systolic hypertension. J Am Coll Cardiol 1991; 17: 422–430.

    Article  CAS  Google Scholar 

  9. Reed CM, Richey PA, Pulliam DA, Somes GW, Alpert BS . Aortic dimensions in tall men and women. Am J Cardiol 1993; 71: 608–610.

    Article  CAS  Google Scholar 

  10. Vasan RS, Larson MG, Levy D . Determinants of echocardiographic aortic root size. Circulation 1995; 91: 734–740.

    Article  CAS  Google Scholar 

  11. Tell GS, Rutan GH, Kronmal RA, Bild DE, Polak JF, Wong ND et al. Correlates of blood pressure in community-dwelling older adults. Hypertension 1994; 23: 59–67.

    Article  CAS  Google Scholar 

  12. Cuspidi C, Meani S, Fusi V, Valerio C, Sala C, Zanchetti A . Prevalence and correlates of aortic root dilatation in patients with essential hypertension: relationship with cardiac and extracardiac target organ damage. J Hypertens 2006; 24: 573–580.

    Article  CAS  Google Scholar 

  13. Fagard RH, Staessen JA, Thjis L . Prediction of cardiac structure and function by repeated clinic and ambulatory blood pressure. Hypertension 1997; 29: 22–29.

    Article  CAS  Google Scholar 

  14. Zanchetti A, Bond MG, Hennig M, Neiss A, Mancia G, Dal Palu' C et al. Risk factors associated with alterations in carotid intima-media thickness in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis. J Hypertens 1998; 116: 949–961.

    Article  Google Scholar 

  15. Mancia G, Sega R, Bravi C, De Vito G, Valagussa F, Cesana G et al. Ambulatory blood pressure normality: results from the PAMELA study. J Hypertens 1995; 13: 1377–1390.

    Article  CAS  Google Scholar 

  16. Verdecchia P, Schillaci G, Guerrieri M, Gatteschi C, Benemio G, Boldrini F et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 1990; 81: 528–536.

    Article  CAS  Google Scholar 

  17. Sahn DJ, DeMaria A, Kisslo J, Weyman A . Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58: 1076–1083.

    Google Scholar 

  18. Devereux RB, Reickek N . Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 1977; 55: 613–618.

    Article  CAS  Google Scholar 

  19. de Simone G, Devereux RB, Daniels SR, Koren MJ, Meyer RA, Laragh JH . Effect of growth on variability of left ventricular mass; assessment of allometric signals in adults and children and their capacity to predict cardiovascular risk. J Am Coll Cardiol 1995; 25: 1056–1062.

    Article  CAS  Google Scholar 

  20. Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba TG et al. Patterns of left ventricular geometry and geometric remodelling in essential hypertension. J Am Coll Cardiol 1992; 19: 1550–1558.

    Article  CAS  Google Scholar 

  21. Pignoli P, Tremoli E, Poli A, Paoletti R . Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986; 74: 1399–1408.

    Article  CAS  Google Scholar 

  22. Salonen R, Haapanen A, Salonen JT . Measurement of intima-media thickness of common carotid arteries with high-resolution B-mode ultrasonography: inter and intra observer variability. Ultrasound Med Biol 1991; 17: 225–230.

    Article  CAS  Google Scholar 

  23. Guidelines Committee. European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–1053.

    Article  Google Scholar 

  24. Hodis HN, Mack WJ, LaBree L, Selzer RH, Liu C, Liu C et al. The role of carotid intima-media thickness in predicting clinical coronary events. Ann Intern Med 1998; 128: 262–269.

    Article  CAS  Google Scholar 

  25. Executive Summary. The Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in adult (Adult Treatment Panel III). JAMA 2001; 285: 2486–2497.

    Article  Google Scholar 

  26. Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003; 289: 2560–2572.

    Article  Google Scholar 

  27. Bella JN, Wachtell K, Boman K, Palmieri V, Papademetriou V, Gerdts E et al. Relation of left ventricular geometry and function to aortic root dilatation in patients with systemic hypertension and left ventricular hypertrophy (The LIFE Study). Am J Cardiol 2002; 89: 337–341.

    Article  Google Scholar 

  28. Staessen JA, Thijs L, Fagard R, O' Brien ET, Clement D, de Leeuw PW et al. Predicting cardiovascular risk using conventional versus ambulatory blood pressure in older patients with systolic hypertension. Systolic hypertension in Europe trial investigators. JAMA 1999; 282: 539–546.

    Article  CAS  Google Scholar 

  29. Ohkubo T, Iami Y, Tsuji I, Nagai K, Watanabe N, Minami N et al. Relation between nocturnal decline in blood pressure and mortality: the Ohasama Study. Am J Hypertens 1997; 10: 1201–1207.

    Article  CAS  Google Scholar 

  30. Sega R, Facchetti R, Bombelli M, Cesana G, Corrao G, Grassi G et al. Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population. Circulation 2005; 111: 1777–1783.

    Article  Google Scholar 

  31. Cuspidi C, Meani S, Salerno M, Valerio C, Fusi V, Severgnini B et al. Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure. J Hypertens 2004; 22: 273–280.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy

    C Cuspidi & G Mancia

  2. Policlinico di Monza, Milan, Italy

    C Cuspidi & A Esposito

  3. Istituto di Medicina, Cardiovascolare Università degli Studi di Milano and Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena, Milan, Italy

    S Meani, C Valerio, C Sala & M Maisaidi

  4. Centro Interuniversitario di Fisiologia Clinica e Ipertensione, Milan, Italy

    C Sala, A Zanchetti & G Mancia

Authors
  1. C Cuspidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Meani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C Valerio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A Esposito
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C Sala
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M Maisaidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A Zanchetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. G Mancia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C Cuspidi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cuspidi, C., Meani, S., Valerio, C. et al. Ambulatory blood pressure, target organ damage and aortic root size in never-treated essential hypertensive patients. J Hum Hypertens 21, 531–538 (2007). https://doi.org/10.1038/sj.jhh.1002200

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1002200

Keywords

This article is cited by

Search

Advanced search

Quick links