Clinical methods and pathophysiology 145 Pulse pressure and nocturnal fall in blood pressure are predictors of vascular, cardiac and renal target organ damage in hypertensive patients (LOD-RISK study) Luis Garcı ´a-Ortiz a , Manuel A. Go ´ mez-Marcos a , Javier Martı ´n-Moreiras c , Luis J. Gonza ´ lez-Elena a , Jose I. Recio-Rodriguez a , Yolanda Castan ˜ o-Sa ´ nchez a , Gonzalo Grandes d and Carlos Martı ´nez-Salgado b Objectives To analyse the relationship between various parameters derived from ambulatory blood pressure monitoring (ABPM) and vascular, cardiac and renal target organ damage. Methods A cross-sectional, descriptive study. It included 353 patients with short-term or recently diagnosed hypertension. Primary measurements: ABPM, carotid intima–media thickness (IMT), Cornell voltage–duration product (Cornell VDP), glomerular filtration rate and albumin/creatinine ratio to assess vascular, cardiac and renal damage. Results Two hundred and twenty-three patients (63.2%) were males, aged 56.12 ± 11.21 years. The nocturnal fall in blood pressure was 11.33 ± 8.41, with a dipper pattern in 49.0% (173), nondipper in 30.3% (107), extreme dipper in 12.7% (45) and riser in 7.9% (28). The IMT was lower in the extreme dipper (0.716 ± 0.096 mm) and better in the riser pattern (0.794 ± 0.122 mm) (P < 0.05). The Cornell VDP and albumin/creatinine ratio were higher in the riser pattern (1818.94 ± 1798.63 mm/ms and 140.78 ± 366.38 mg/g, respectively) than in the other patterns. In the multivariate analysis after adjusting for age, sex and antihypertensive treatment, with IMT as dependent variable the 24-h pulse pressure (b = 0.003), with Cornell VDP the rest pulse pressure (b = 12.04), and with the albumin/creatinine ratio the percentage of nocturnal fall in systolic blood pressure (b = – 3.59), the rest heart rate (b = 1.83) and the standard deviation of 24-h systolic blood pressure (b = 5.30) remain within the equation. Conclusion The estimated pulse pressure with ABPM is a predictor of vascular and cardiac organ damage. The nocturnal fall and the standard deviation in 24-h systolic blood pressure measured with the ABPM is a predictor of renal damage. Blood Press Monit 14:145–151  c 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins. Blood Pressure Monitoring 2009, 14:145–151 Keywords: ambulatory, blood pressure monitoring, carotid artery injuries, hypertension, kidney disease, left ventricular hypertrophy a Primary Care Research Unit of La Alamedilla Health Centre, b Research Unit, Salamanca University Hospital, and Unit of Renal and Cardiovascular Pathophysiology, Queen Sofia Institute of Nephrological Research, c Cardiology Service, Salamanca University Hospital, Salamanca and d Primary Care Research Unit of Bizkaia, Basque Health Service, Bilbao, Spain Correspondence to Dr Luis Garcia Ortiz, MD, Unidad de investigacio ´n La Alamedilla, Avd, Comuneros No 27-31, Salamanca, CP 37003, Spain Tel: + 34 923124465; fax: + 34 923123644; e-mail: Lgarciao@usal.es Received 3 February 2009 Revised 27 April 2009 Accepted 28 April 2009 Introduction Hypertension is the main risk factor for cardiovascular disease in developed countries. Multiple studies have described that damage in target organs, such as the kidney [1,2], heart [3,4] and carotid [5] is associated with an increased risk of cardiovascular events. Blood pressure measurement at the clinic is still currently the standard of reference, but there is increasing evidence that the values obtained after home blood pressure measurement by the patient and particularly 24-h ambulatory blood pressure monitoring (ABPM) show a better correlation with target organ damage and with cardiovascular events [6–8]. It is also known that the prognostic value of rest blood pressure is greater than daytime blood pressure, particularly when the fall in systolic blood pressure (SBP) during sleep is considered. Therefore, a lower nocturnal fall in blood pressure is associated with a greater prevalence of target organ damage and a less favourable outcome [9,10]. Furthermore, higher blood pressure variability has been described to be asso- ciated with a worse prognosis of the damage in these organs [11,12]. The relationships of other cardiovascular parameters derived from ABPM, including nocturnal fall in SBP and diastolic blood pressure (DBP), exercise, rest and 24-h pulse pressure (PP) and heart rate, with standard deviation, with the results obtained with different techniques evaluating vascular, cardiac and renal damage are not known, and therefore, their value as predictors of target organ damage is not fully defined. 1359-5237  c 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MBP.0b013e32832e062f Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.