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

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dc.check.embargoformatNot applicableen
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dc.contributor.advisorKearney, Patricia M.en
dc.contributor.advisorCurtin, Ronanen
dc.contributor.authorO'Flynn, Anne Marie
dc.contributor.funderIrish Heart Foundationen
dc.contributor.funderHealth Research Boarden
dc.date.accessioned2016-11-04T11:23:40Z
dc.date.available2016-11-04T11:23:40Z
dc.date.issued2016
dc.date.submitted2016
dc.description.abstractIntroduction 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.sponsorshipHealth Research Board (HPF/2012/14); Irish Heart Foundation (John Feely Research Bursary)en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Version
dc.format.mimetypeapplication/pdfen
dc.identifier.citationO'Flynn, A. M. 2016. Exploring the cardiovascular disease continuum: blood pressure and target organ damage. PhD Thesis, University College Cork.en
dc.identifier.endpage227en
dc.identifier.urihttps://hdl.handle.net/10468/3244
dc.languageEnglishen
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2016, Anne Marie O'Flynn.en
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/en
dc.subjectHypertensionen
dc.subjectTarget organ damageen
dc.subjectCardiovascular diseasesen
dc.subjectBlood pressureen
dc.subjectBlood pressure monitoringen
dc.subjectAmbulatoryen
dc.subjectCircadian rhythmen
dc.subjectRisk factorsen
dc.thesis.opt-outfalse
dc.titleExploring the cardiovascular disease continuum: blood pressure and target organ damageen
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnameDoctor of Medicineen
ucc.workflow.supervisorpatricia.kearney@ucc.ie
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