Abstract
Abstract
Hypertension management relies heavily on mean blood pressure (BP) targets. However, a "residual hemodynamic gap"—persistent advanced vascular and chronobiological abnormalities despite controlled average BP—remains a clinical challenge. An observational study characterized this gap in 540 subjects (169 normotensives; 371 hypertensives across monotherapy, dual, and triple regimens) using 24-hour Ambulatory Blood Pressure Monitoring (ABPM). Evaluated parameters included pulse pressure (PP), systolic load, variability, and circadian patterns. A Multivariate Analysis of Covariance (MANCOVA) within the hypertensive cohort assessed the impact of sex, diabetes, and smoking, adjusting for age. Hypertensive patients exhibited a profound residual hemodynamic gap compared to controls. Pathological circadian patterns predominated, with non-dipper (32–42%) and riser (19–29%) profiles being highly prevalent (𝑝 = 0.011). Multiple linear regression identified age as an independent predictor of elevated PP (𝛽 = 0.20; 𝑝< 0.001) and arterial stiffness (𝛽 = 0.002; 𝑝 = 0.015). In the MANCOVA model, age emerged as the dominant independent covariate driving the global hemodynamic profile (Pillai’s Trace = 0.107; 𝑝< 0.001). After controlling for age, no significant multivariate main effects were observed for sex (Pillai’s Trace = 0.008; 𝑝 = 0.600), diabetes (Pillai’s Trace = 0.003; 𝑝 = 0.891), or smoking status (Pillai’s Trace = 0.017; 𝑝 = 0.196). This study concludes that a substantial residual hemodynamic gap persists in treated hypertensive patients. Hypertension success metrics must shift from simple average BP control toward assessing and targeting these advanced, residual hemodynamic abnormalities via ABPM, to achieve true cardiovascular protection.