Nkoo Woo P, Dipombe L , Poka-Nguepnang V, Bitchocka S, Tonye D, Ndjebet J 

Authors’ affiliations : Centre Cardiovasculaire de Douala

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Abstract

Background

The Pooled cohort equations were developed to predict an individual’s 10-year risk of an atherosclerotic cardiovascular disease (ASCVD) event. While the predictive value of ambulatory blood pressure monitoring (ABPM) for first-ever and recurrent stroke has been well established.

Aim

To determine the subgroup of patients, in which we must emphasize the primary prevention strategy  knowing the level of their ASCVD score risk and their ABPM parameters.

Methods and results

We sought to evaluate retrospectively and cross-sectionally the association of ABPM parameters with ASCVD score in a   sample of 200 consecutive stroke-free individuals who consulted at our out patient clinic, 40 to 79 years of age, (mean age: 55.0±12.9, 57.2% male) and who underwent 24-hour ABPM, the patients  included were free  of cardiovascular disease especially stroke ,and had data on factors needed to calculate ASCVD risk.

True hypertensives showed significantly higher ASCVD risk (10.2.2±2.0) compared to the normotensives (7.2±2.0, p<0.001), while subjects with white coat hypertension also had higher ASCVD risk  (9.5±2.0) than normotensives (7.2±2.0, p<0.001). Compared to dippers that exhibited the lowest ASCVD risk(<5%), non-dippers and reverse-dippers exhibited significantly higher ASCVD  . In univariate analyses, the ABPM parameters that had the strongest correlation with ASCVD risk were 24-hour (r=0.440, p<0.001), daytime (r=0.435, p<0.001) and night-time (r=0.423; p<0.001) pulse pressure (PP). The best fitting model for predicting ASCVD risk (R²=24.6%) on multiple linear regression analyses after adjustment for vascular risk factors not included in ASCVD risk comprised the following parameters in descending order: 24-hour PP ( p<0.001), daytime SBP variability ( p<0.001), mean 24-hour HR ( p<0.001), BMI ( p<0.001) and dipping percentage ( p=0.001). 24-hour PP and daytime SBP variability are the two ABPM parameters that were more strongly associated with ASCVD risk-score.

Conclusions :We must emphasize the primary cardiovascular prevention in all true hypertensive’s and patients with white coat Hypertension; There are several parameters which can guide us in this struggle but the most important are the 24 hour pulse pressure and the day-time SBP variability.

Keywords: Ambulatory blood pressure monitoring; Atherosclerotic Cardiovascular Disease Risk, Cardiovascular prevention, pulse pressure, Systolic Blood pressure.