BLOOD PRESSURE PHENOTYPES IN TREATED HYPERTENSIVE PATIENTS IN SUMMER AND WINTER: FOCUS ON MASKED UNCONTROLLED HYPERTENSION. Part 2. The main markers

Abstract

Background. Seasonal variability of cardiovascular morbidity and mortality emphasizes the need for the development of new preventive approaches. One of them could be early diagnostics of the unfavorable blood pressure (BP) phenotypes.Aim. To evaluate markers of the masked uncontrolled hypertension (MUH) phenotype in winter and summer in ambulatory treated hypertensive patients.Material and methods. We selected patients from the database (n=477; Ivanovo and Saratov residents) according to the following criteria: regular antihypertensive treatment (AHT), clinical BP<140/90 mm Hg, available clinical and ambulatory BP monitoring (ABPM) data both in winter and summer (MUH and “optimal AHT effect” phenotypes).Results. The patients with MUH in Ivanovo had a significantly higher body mass index in comparison with patients with optimal AHT effect in winter (29.1±4.4 kg/m2 vs 27.3±3.4 kg/m2; p<0.01), and a higher level of clinical BP. Similar differences were found for clinical heart rate (HR), orthostatic BP and HR. These patients with MUH in summer had significantly higher values of clinical BP and orthostatic systolic BP. In Saratov patients, the MUH phenotype in winter was characterized by a higher prevalence in men (56% vs 38%; p<0.05), a relatively high body height and weight vs these in patients with optimal AHT effect. Similar to the patients from Ivanovo, Saratov patients with MUH in winter had higher clinical and orthostatic BP levels compared to patients with optimal AHT effect. In summer, Saratov patients with MUH had significantly higher body mass index, clinical BP, orthostatic HR and systolic BP. In multivariate analysis, MUH was associated with male sex (p<0.05), obesity Stage 1 (p<0.05) and Stage 2 (p<0.01), and diastolic BP in orthostasis (in particular, diastolic BP≥85 mmHg; p<0.0001). No significant associations were observed for season, city, and other selected factors.Conclusion. According to our study ABPM could be useful for “unmasking” of the probable MUH both in winter and in summer in patients with target clinical BP on AHT who are obese, have orthostatic diastolic BP ≥85 mmHg and especially in men. Further studies in this area are required, in particular the assessment of the prognostic value of the seasonal dynamics and interrelation of clinical and ambulatory BP.

Keywords

• hypertension
• ambulatory blood pressure monitoring
• blood pressure phenotypes
• masked hypertension
• masked uncontrolled hypertension
• seasonal variability