Anticipating the hypertension mediated organ damage using arterial stiffness and pulse wave velocity in resistant hypertensive patients in a south indian city

Abstract

Introduction. Pulse wave velocity (PWV) is considered as the gold standard for assessment of arterial stiffness. Arterial stiffness has been long identified as an independent marker for predicting target organ damage. Non-invasive cuff based methods for measuring PWV are the future for identifying the patients with an early target organ damage and their immediate management. Resistant hypertension (RHp) means failure to control blood pressure despite a change in the patients lifestyle and also a prescription of at least three anti-hypertensives (including a diuretic) systolic (SPB) and diastolic blood pressure (DBP) to a level of (<140/90 mmHg), according to the European society of hypertension guidelines released in 2018. Aim. To measure the PWV and arterial stiffness values in patients with resistant hypertension in a South Indian city using a cuff based non invasive device. Methods and materials. Our study included 80 patients with resistant hypertension without concomitant diseases like acute heart failure, coronary artery disease, chronic kidney disease, structural heart diseases and low cardiac output states. The diagnosis of RHp was made on the basis of failure to control blood pressure despite using three or more drugs. These drug combinations include angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), beta blockers (BB), calcium channel blockers (CCB) and diuretics (D). Combinations like ACEI+CCB+D and in 30% potassium sparing diuretic were preferred. We measured the central blood pressure (CBP), PWV, arterial stiffness, mean arterial pressure (MAP), pulse pressure (PP), brachial pressure (BP) using the noninvasive Agedio B900 device (Germany). Statistical data was processed in SPSS software, significant differences were considered at p<0,01. The patients classified with the diagnosis RHp were included in the registrar of Kasturba medical hospital, Mangaluru in the duration from July 2018 – August 2018. In this study an appropriate cuff-size was used to avoid poor blood pressure measurement. An informed consent of the patients was obtained as a rule. The study was approved by local institutional ethics committee.