ARTERIAL STIFFNESS, BLOOD PRESSURE VARIABILITY, ATHEROSCLEROTIC PLAQUE AND MICROALBUMINURIA IN ELDERLY ADULTS

MILEI J; SANCHEZ GELOS DIEGO F; GOMEZ-LLAMBI H.; OTERO-LOSADA M

London

Congreso; 22nd European Meeting on Hypertension and Cardiovascular Protection; 2012

European Society of Hypertension

OBJECTIVE. To evaluate the relation of carotid wall morphology and microalbuminuria (Alb) with arterial stiffness, blood pressure variability (BPVar) and other cardiovascular parameters in elderly subjects, following our previous observations in relation with blood pressure morning surge and target organ damage.  DESIGN AND METHODS. Fifty nine patients >65 years old (44 women, 74±1 years and 15 men, 76±2 years) were enrolled. Ambulatory BPVar was estimated as the standard deviation of the 24-h mean (systolic and diastolic) blood pressure recording. Pulse wave velocity (PWV) was obtained from the pressure values of digitized carotid and femoral arteries. Eco-Doppler from heart and supra aortic vessels and microalbuminuria (Alb) were also assessed. Data was evaluated by bivariate correlation analysis using the Pearson's coefficient (r).   RESULTS. Microalbuminuria and BPVar showed differential changes according with the degree of carotid damage. 1) The presence of atherosclerotic plaque was related to Alb increase (16% explained variance, r=0.394, p<0.01, n=39). The strength of plaque-Alb association was dependent on the diagnosis of hypertension (22% explained variation, r=0.468, p < 0.01, n=28 hypertensives), nocturnal dipping (32% explained variance, r=0.562, p<0.007, n=22 dippers) and sex (36% explained variance, r=0.600, p<0.001, n=28 women). 2) BPVar was directly related to carotid wall thickening (13% explained variance, r=0.363, p<0.01, n=49). This association varied according with diagnosis of hypertension (19% explained variation, r=0.431, p<0.008, n=37 hypertensives) and dipping condition (29% explained variation, r=0.537, p<0.005, n=26 dippers). 3) A direct relationship was found between PWV and Alb (14% explained variation, r=0.352, p<0.03, n=37) and increased after controlling for carotid status (17% explained variance, r=0.415, p<0.01, n=34). Actually PWV-Alb association was particularly strong in carotid plaque-bearing patients (38% explained variance, r=0.616, p<0.01, n=15).  CONCLUSION. These results suggest that arterial wall pathology increases the likelihood of abnormal glomerular filtration according with nocturnal dipping and diagnosis of hypertension. Integration of the pathophysiological mechanisms involved in age-dependent progressive kidney function decline with those of atherogenesis and hypertension has still a long way to go.