Hemodynamic profiles of arterial hypertension with ambulatory blood pressure monitoring

Blood pressure (BP) measurements obtained during a twenty-four-hour ambulatory blood pressure monitoring (24 h ABPM) have not been reliably applied to extract arterial hemodynamics. We aimed to describe the hemodynamic profiles of different hypertension (HT) subtypes derived from a new method for total arterial compliance (C t ) estimation in a large group of individuals undergoing 24 h ABPM. A cross-sectional study was conducted, which included patients with suspected HT. Cardiac output, C t , and total peripheral resistance (TPR) were derived through a two-element Windkessel model without having a pressure waveform. Arterial hemodynamics were analyzed according to HT subtypes in 7434 individuals (5523 untreated HT and 1950 normotensive controls [N]). The individuals mean age was 46.2 ± 13.0 years; 54.8% were male, and 22.1% were obese. In isolated diastolic hypertension (IDH), the cardiac index (CI) was greater than that in normotensive (N) controls (CI: IDH vs. N mean difference 0.10 L/m/m 2 ; CI 95% 0.08 to 0.12; p value <0.001), with no significant clinical difference in C t . Isolated systolic hypertension (ISH) and divergent systolic-diastolic hypertension (D-SDH) had lower C t values than nondivergent HT subtype (C t : divergent vs. nondivergent mean difference −0.20 mL/mmHg; CI 95% −0.21 to −0.19 mL/mmHg; p value <0.001). Additionally, D-SDH displayed the highest TPR (TPR: D-SDH vs. N mean difference 169.8 dyn*s/cm −5 ; CI 95% 149.3 to 190.3 dyn*s/cm −5 ; p value <0.001). A new method is provided for the simultaneous assessment of arterial hemodynamics with 24 h ABPM as a single diagnostic tool, which allows a comprehensive assessment of arterial function for hypertension subtypes. Main hemodynamic findings in arterial HT subtypes with regard to C t and TPR. The 24 h ABPM profile reflects the state of C t and TPR. Younger individuals with IDH present with a normal C t and frequently increased CO. Patients with ND-SDH maintain an adequate C t with a higher TPR, while subjects with D-SDH present with a reduced C t , high PP and high TPR. Finally, the ISH subtype occurs in older individuals with significantly reduced C t , high PP and a variable TPR proportional to the degree of arterial stiffness and MAP values. There was an observed increase in PP with age in relation to the changes in C t (see also text). SBP: systolic blood pressure; DBP: diastolic blood pressure; MAP: mean arterial pressure; PP: pulse pressure; N: normotension; HT: hypertension; IDH: isolated diastolic hypertension; ND-SDH: nondivergent systole-diastolic hypertension; D-SDH: divergent systolic-diastolic hypertension; ISH: isolated systolic hypertension; C t : total arterial compliance; TPR: total peripheral resistance; CO: cardiac output; 24 h ABPM: 24 h ambulatory blood pressure monitoring.