Control status of ambulatory blood pressure and its relationship with arterial stiffness in the China nationwide registry of treated hypertensive patients: the REACTION-ABP study

Abstract

The control rate of ambulatory blood pressure (BP) is unclear in Chinese hypertensive patients, and whether it would be associated with the ambulatory arterial stiffness indices is also unknown. From June 2018 until December 2022, 4408 treated hypertensive patients (52.8% men, average age 58.2 years) from 77 hospitals in China were registered. Ambulatory BPs were measured with validated monitors and analyzed with a web-based standardized Shuoyun system ( www.shuoyun.com.cn ). The BP control rate was the highest in the office (65.7%), moderate in the daytime (45.0%), low in the morning (34.1%), and the lowest in the nighttime (27.6%, P < 0.001). Only 21.0% had their 24 h BP perfectly controlled. The stepwise regression analyses identified that the factors associated with an imperfect 24 h BP control included male sex, smoking and drinking habits, a higher body mass index, serum total cholesterol and triglycerides, and the use of several specific types of antihypertensive drugs. After adjustment for the above-mentioned factors, the 24 h pulse pressure (PP) and its components, the elastic and stiffening PPs, were all significantly associated with an uncontrolled office and ambulatory BP status with the standardized odds ratios ranging from 1.09 to 4.68 (P < 0.05). The ambulatory arterial stiffness index (AASI) was only associated with an uncontrolled nighttime and 24 h BP status. In conclusion, the control rates of 24 h ambulatory BP, especially that in the nighttime and morning time windows, were low in Chinese hypertensive patients, which might be associated with arterial stiffness in addition to other common risk factors.

Keywords: Ambulatory blood pressure monitoring; Arterial stiffness; Morning hypertension; Nighttime hypertension; Pulse pressure.

Fig. 1

Control rates of the ambulatory blood pressure in the 4088 patients registered in the REACTION-ABP study. For the definitions of daytime, nighttime and morning blood pressure (BP) control, please refer to the Methods. Perfect 24 h BP control means that the 24 h, daytime and nighttime BPs were all controlled. Pairwise comparisons of the rates were all statistically significant (P < 0.001)

Fig. 2

Common clinical factors in relation to the perfect 24 h BP control status. Odds ratios and 95% confidence intervals were determined by stepwise regression with the P value for independent variables to enter and stay in the model set at 0.10. In addition to the variables shown in the figure, other factors in the model included age, fasting plasma glucose, serum creatinine, low-density lipoprotein cholesterol, the use of angiotensin-converting enzyme inhibitors, and the use of diuretics. BMI body mass index, ARB angiotensin receptor blockers, CCB calcium channel blockers, SPC single pill combination

Fig. 3

Control rates of ambulatory blood pressure by median of the ambulatory arterial stiffness indices. BP blood pressure, ABP ambulatory blood pressure, PP pulse pressure, AASI ambulatory arterial stiffness index. Comparison between the groups ^*P < 0.001. ^†P < 0.05. ^‡P < 0.01