END-ORGAN DAMAGE IN TREATED SEVERE HYPERTENSION - CLOSE RELATION TO NOCTURNAL BLOOD-PRESSURE

In an attempt to improve therapeutic decision-making in severe hypertension, different blood pressures (BP) were correlated with target organ damage in a cross-sectional study of 20 asymptomatic patients. Casual BP was 191/117 (s.d. 31/10) mm Hg despite therapy. Each subject was assigned an end-organ score on the basis of the number of silent cerebrovascular damages detected by magnetic resonance imaging, funduscopic retinopathy, cardiac hypertrophy by echocardiography, and ren;si involvement evaluated by isotopic renography. The pooled scores for target organ damage showed significant correlations with an elevated asleep mean ambulatory (amb-) brachial systolic (r = 0.84) and diastolic BP (r = 0.88) but not with either awake amb-BP (means or peak values), casual BP or invasive radial BP at the clinic. Night-time amb-DBP increased with age in contrast to the daytime DBPs. Furthermore, the nocturnal fall in mean arterial amb-BP was significantly less in patients aged greater than or equal to 60 years, average 5%, than in patients < 60 years, 16%. This may have prognostic implications even if, after age adjustment, the inverse relation (r = -0.78) between the end-organ scores and the dip in BP did not reach independent significance. The close association of cardiovascular complications with night-time rather than daytime BP emphasises the importance of making a prospective study in this field, trying to optimise the nocturnal BP in severe hypertension.