Exploring the cardiovascular disease continuum: blood pressure and target organ damage

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dc.contributor.advisor Kearney, Patricia M. en
dc.contributor.advisor Curtin, Ronan en
dc.contributor.author O'Flynn, Anne Marie
dc.date.accessioned 2016-11-04T11:23:40Z
dc.date.available 2016-11-04T11:23:40Z
dc.date.issued 2016
dc.date.submitted 2016
dc.identifier.citation O'Flynn, A. M. 2016. Exploring the cardiovascular disease continuum: blood pressure and target organ damage. PhD Thesis, University College Cork. en
dc.identifier.endpage 227 en
dc.identifier.uri http://hdl.handle.net/10468/3244
dc.description.abstract Introduction The objectives of this thesis are to: (1) examine how ambulatory blood pressure monitoring (ABPM) refines office blood pressure (BP) measurement; (2) determine if absolute ambulatory BP or dipping status is better associated with target organ damage (TOD); (3) explore the association of isolated nocturnal hypertension (INH) with TOD; and (4) investigate the association of night-time BP with ultrasound markers of cardiovascular damage. Methods Data from the Mitchelstown Cohort Study was analysed to deliver objectives 1 and 2. Objective 3 was addressed by a systematic review and analysis of data from the Mitchelstown Study. A sample of participants from the Mitchelstown Study underwent an echocardiogram for speckle tracking analysis and carotid ultrasound to achieve objective 4. Results ABPM reclassifies hypertension status in approximately a quarter of individuals, with white coat and masked hypertension prevalence rates of 11% and 13% respectively. Night-time systolic BP is better associated with TOD than daytime systolic BP and dipping level. In multi-variable models the odds ratio (OR) for LVH was 1.4 (95% CI 1.1 -1.8) and for albumin:creatinine ratio ≥ 1.1 mg/mmol was 1.5 (95% CI 1.2 – 1.8) for each 10 mmHg rise in night-time systolic BP. The evidence for the association of INH with TOD is inconclusive. Night-time systolic BP is significantly associated with global longitudinal strain (GLS) (beta coefficient 0.85 for every 10 mmHg rise, 95% CI 0.3 – 1.4) and carotid plaques (OR 1.9 for every 10 mmHg rise, 95% CI 1.1 – 3.2) in univariable analysis. The findings persist for GLS in sex and age adjusted models but not in multivariable models. Discussion Hypertension cannot be effectively managed without using ABPM. Night-time systolic BP is better associated with TOD than daytime systolic BP and dipping level, and therefore, may be a better therapeutic target in future studies. en
dc.description.sponsorship Health Research Board (HPF/2012/14); Irish Heart Foundation (John Feely Research Bursary) en
dc.format.mimetype application/pdf en
dc.language English en
dc.language.iso en en
dc.publisher University College Cork en
dc.rights © 2016, Anne Marie O'Flynn. en
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/ en
dc.subject Hypertension en
dc.subject Target organ damage en
dc.subject Cardiovascular diseases en
dc.subject Blood pressure en
dc.subject Blood pressure monitoring en
dc.subject Ambulatory en
dc.subject Circadian rhythm en
dc.subject Risk factors en
dc.title Exploring the cardiovascular disease continuum: blood pressure and target organ damage en
dc.type Doctoral thesis en
dc.type.qualificationlevel Doctoral en
dc.type.qualificationname Doctor of Medicine en
dc.internal.availability Full text available en
dc.check.info No embargo required en
dc.description.version Accepted Version
dc.contributor.funder Irish Heart Foundation en
dc.contributor.funder Health Research Board en
dc.description.status Not peer reviewed en
dc.internal.school Epidemiology and Public Health en
dc.internal.school Medicine en
dc.check.type No Embargo Required
dc.check.reason No embargo required en
dc.check.opt-out Not applicable en
dc.thesis.opt-out false
dc.check.embargoformat Not applicable en
ucc.workflow.supervisor patricia.kearney@ucc.ie
dc.internal.conferring Autumn 2016 en

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© 2016, Anne Marie O'Flynn. Except where otherwise noted, this item's license is described as © 2016, Anne Marie O'Flynn.
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