P2.12 A NOVEL MARKER EXPRESSES THE EFFECT OF THE NONLINEARITY IN THE ARTERIAL PRESSURE-VOLUME RELATIONSHIP ON THE PULSE PRESSURE: CHARACTERISTICS AND PROGNOSTIC SIGNIFICANCE IN HYPERTENSIVE PATIENTS
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Arterial pressure-volume relationship frequently deviates from the linearity expected from an ideal elastic tube. As a result, pulse pressure (PP) can be split into an ‘elastic’ component (elPP) and an excess value PP-elPP. We define the ratio (PP-elPP)/elPP as arterial nonlinearity marker (NLM). OBJECTIVE: Determining NLM from ambulatory BP (ABP) measurements and investigating its clinical and demographic characteristics and prognostic significance in hypertensive patients. METHODS: Following a previously described model-based procedure, NLM was determined from the variability of systolic BP (SBP) and diastolic BP (DBP). The predictive power of NLM was estimated using Cox proportional hazards regression adjusted for age, gender, body mass index, mean heart period, SBP- and heart-rate dipping and hypoglycemic and antihypertensive medication status. NLM variation with age or DBP changes in 10-years or 10-mmHg intervals, respectively, was evaluated using adjusted ANOVA and pairwise comparisons for the grouped variables. RESULTS: We analyzed 1,999 ABP records of individual hypertensive patients,(age 56±16 years, 55% women, 60% on antihypertensive medication and 9% with diabetes, average BP 139/79mmHg, median DBP 78mmHg), followed 5 years for all-cause mortality, of whom 103 died. Mean(SD) [range] for PP were 60(14)[27–132] mmHg and for NLM 0.20(0.14)[−0.22–1.00]. PP and NLM were positively correlated (r=0.53). NLM increased for increasing age (20–80y) and decreasing DBP (100-60mmHg). Standardized hazard ratio (HR) mean[95% confidence interval](p-value) for NLM was 1.7[1.18–2.45](p=0.005) for DBP<=78mmHg (63 deaths) and 0.78[0.47–1.30](p=0.34) DBP>78mmHg (40 deaths). Similar HR values were found without adjustment. CONCLUSION: Arterial nonlinearity predicts mortality in hypertensive patients with low ambulatory DBP.
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TY - JOUR AU - Benjamin Gavish* AU - Michael Bursztyn PY - 2015 DA - 2015/11 TI - P2.12 A NOVEL MARKER EXPRESSES THE EFFECT OF THE NONLINEARITY IN THE ARTERIAL PRESSURE-VOLUME RELATIONSHIP ON THE PULSE PRESSURE: CHARACTERISTICS AND PROGNOSTIC SIGNIFICANCE IN HYPERTENSIVE PATIENTS JO - Artery Research SP - 8 EP - 9 VL - 12 IS - C SN - 1876-4401 UR - https://doi.org/10.1016/j.artres.2015.10.218 DO - https://doi.org/10.1016/j.artres.2015.10.218 ID - Gavish*2015 ER -