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Ghazi L, Cohen JB, Townsend RR, Drawz PE, Rahman M, Pradhan N, Cohen DL, Weir MR, Rincon-Choles H, Juraschek SP. Orthostatic hypotension, orthostatic hypertension, and ambulatory blood pressure in patients with chronic kidney disease in CRIC. J Hypertens 2024; 42:329-336. [PMID: 37889527 PMCID: PMC10842034 DOI: 10.1097/hjh.0000000000003604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Orthostatic changes in blood pressure (BP), either orthostatic hypotension or orthostatic hypertension (OHTN), are common among patients with chronic kidney disease. Whether they are associated with unique out-of-office BP phenotypes is unknown. METHODS CRIC is a prospective, multicenter, observational cohort study of participants with CKD. BP measured at 2 min after standing and ambulatory BP monitoring (ABPM) were obtained on 1386 participants. Orthostatic hypotension was defined as a 20 mmHg drop in SBP or 10 mmHg drop in DBP when changing from seated to standing positions. Systolic and diastolic night-to-day ratio was also calculated. OHTN was defined as a 20 or 10 mmHg rise in SBP or DBP when changing from a seated to a standing position. White-coat effect (WCE) was defined as seated minus daytime ambulatory BP. RESULTS Of the 1386 participants (age: 58 ± 10 years, 44% female, 39% black), 68 had orthostatic hypotension and 153 had OHTN. Postural reduction in SBP or DBP was positively associated with greater systolic and diastolic WCE and systolic and diastolic night-to-day ratio. Orthostatic hypotension was positively associated with diastolic WCE (β = 3 [0.2, 5.9]). Diastolic OHTN was negatively associated with systolic WCE (β = -4 [-7.2, -0.5]) and diastolic WCE (β = -6 [-8.1, -4.2]). CONCLUSION Postural change in BP was associated with WCE and night-to-day-ratio. Orthostatic hypotension was positively associated with WCE and OHTN was negatively associated with WCE. These findings strengthen observations that postural changes in BP may associate with distinct BP patterns throughout the day. These observations are informative for subsequent research tailoring orthostatic hypotension and OHTN treatment to specific BP phenotypes.
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Affiliation(s)
- Lama Ghazi
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, PA
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Paul E Drawz
- Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Mahboob Rahman
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Nishigandha Pradhan
- Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, OH
| | - Debbie L Cohen
- Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, PA
| | - Matthew R. Weir
- Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD
| | - Hernan Rincon-Choles
- Cleveland Clinic Foundation, Glickman Urological & Kidney Institute, Department of Nephrology, Cleveland, OH
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Mancia G, Facchetti R, Quarti-Trevano F, Dell’Oro R, Cuspidi C, Grassi G. Comparison between visit-to-visit office and 24-h blood pressure variability in treated hypertensive patients. J Hypertens 2024; 42:161-168. [PMID: 37850964 PMCID: PMC10712992 DOI: 10.1097/hjh.0000000000003582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/21/2023] [Accepted: 09/09/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES In any treated hypertensive patient office blood pressure (BP) values may differ between visits and this variability (V) has an adverse prognostic impact. However, little information is available on visit-to-visit 24-h BPV. METHODS In 1114 hypertensives of the ELSA and PHYLLIS trials we compared visit-to-visit office and 24-h mean BPV by coefficient of variation (CV) of the mean systolic (S) and diastolic (D) BP obtained from yearly measurements during a 3-4 year treatment period. Visit-to-visit BPV during daytime and night-time were also compared. RESULTS Twenty-four-hour SBP-CV was about 20% less than office SBP-CV ( P < 0.0001). SBP-CV was considerably greater for the night-time than for the daytime period (20%, P < 0.0001). Results were similar for DBP and in males and females, older and younger patients, patients under different antihypertensive drugs or with different baseline or achieved BP values. In the group as a whole and in subgroups there was significant correlations between office and 24-h BP-CV but the correlation coefficients was weak, indicating that office SBP or DBP CV accounted for only about 1-4% of 24-h SBP or DBP-CV values. CONCLUSION Twenty-four-hour mean BP across visits is more stable than across visit office BP. Visit-to-visit office and 24-h BPV are significantly related to each other, but correlation coefficients are low, making visit-to-visit office BP variations poorly predictive of the concomitant 24-h BP variations and thus of on-treatment ambulatory BP stability.
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Affiliation(s)
| | - Rita Facchetti
- Clinica Medica, Department of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine, University of Milano-Bicocca, Milan, Italy
| | - Raffaella Dell’Oro
- Clinica Medica, Department of Medicine, University of Milano-Bicocca, Milan, Italy
| | | | - Guido Grassi
- Clinica Medica, Department of Medicine, University of Milano-Bicocca, Milan, Italy
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3
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Gonzalez-Garcia J, Mayordomo-Colunga J, Gorostidi M, Gomez-Gonzalez B, Canteli E, Rey C. Non-dipping blood pressure pattern in pediatricians during on-duty. Nefrologia 2023; 43:616-621. [PMID: 36564227 DOI: 10.1016/j.nefroe.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/30/2022] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION People with a reduced nighttime dip in blood pressure have an increased cardiovascular risk. Our objective was to describe the different patterns in blood pressure (BP) among pediatricians who work in long on-duty shifts in relation with sex, medical rank and sleeping time. METHODS Descriptive, cross-sectional, two-center study. On duty pediatric Resident physicians and pediatric Consultants were recruited between January 2018 and December 2021. RESULTS Fifty-one physicians were included in the study (78.4% female, 66.7% Resident physicians). Resident physicians had a higher night/day ratio (0.91 vs 0.85; p<0.001) and a shorter nighttime period (3.87 vs 5.41, p<0.001) than Consultants. Physicians sleeping less than 5h had a higher night/day ratio (0.91 vs 0.87, p=0.014). Being a Resident showed a ∼4.5-fold increased risk of having a non-dipping BP pattern compared to Consultants. CONCLUSION We found a potential link between both being a Resident and, probably, having shorter sleeping time, and the non-dipping BP pattern in physicians during prolonged shifts.
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Affiliation(s)
| | - Juan Mayordomo-Colunga
- Pediatric Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Network Biomedical Research Center, Respiratory Diseases, Institute of Health Carlos III, Madrid, Spain; Health Research Institute of the Principado de Asturias, Oviedo, Spain
| | - Manuel Gorostidi
- Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo, Spain; Department of Nephrology, University of Oviedo, Oviedo, Spain
| | | | - Eva Canteli
- Department of Nephrology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Corsino Rey
- Health Research Institute of the Principado de Asturias, Oviedo, Spain; Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain; Department of Pediatrics, University of Oviedo, Oviedo, Spain; Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), Institute of Health Carlos III, Madrid, Spain
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Buksińska-Lisik M, Kwasiborski PJ, Ryczek R, Lisik W, Mamcarz A. Ambulatory Blood Pressure Monitoring as a Useful Tool in the Cardiological Assessment of Pancreas Transplant Recipients with Type 1 Diabetes. Diagnostics (Basel) 2023; 13:2724. [PMID: 37685261 PMCID: PMC10487007 DOI: 10.3390/diagnostics13172724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
Having the appropriate tools to identify pancreas recipients most susceptible to coronary artery disease (CAD) is crucial for pretransplant cardiological assessment. The aim of this study is to evaluate the association between blood pressure (BP) indices provided by ambulatory blood pressure monitoring (ABPM) and the prevalence of CAD in pancreas transplant candidates with type 1 diabetes (T1D). This prospective cross-sectional study included adult T1D patients referred for pretransplant cardiological assessment in our center. The study population included 86 participants with a median age of 40 (35-46) years. In multivariate logistic regression analyses, after adjusting for potential confounding factors, higher 24 h BP (systolic BP/diastolic BP/pulse pressure) (OR = 1.063, 95% CI 1.023-1.105, p = 0.002/OR = 1.075, 95% CI 1.003-1.153, p = 0.042/OR = 1.091, 95 CI 1.037-1.147, p = 0.001, respectively) and higher daytime BP (systolic BP/diastolic BP/pulse pressure) (OR = 1.069, 95% CI 1.027-1.113, p = 0.001/OR = 1.077, 95% CI 1.002-1.157, p = 0.043/OR = 1.11, 95% CI 1.051-1.172, p = 0.0002, respectively) were independently and significantly associated with the prevalence of CAD. Daytime pulse pressure was the strongest indicator of the prevalence of CAD among all analyzed ABPM parameters. ABPM can be used as a valuable tool to identify pancreas recipients who are most susceptible to CAD. We suggest the inclusion of ABPM in pretransplant cardiac screening in type 1 diabetes patients eligible for pancreas transplantation.
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Affiliation(s)
- Małgorzata Buksińska-Lisik
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 2 Bursztynowa St., 04-749 Warsaw, Poland
- Department of Cardiology and Internal Medicine, Multidisciplinary Hospital Warsaw Miedzylesie, 2 Bursztynowa St., 04-749 Warsaw, Poland
| | - Przemysław Jerzy Kwasiborski
- Department of Cardiology and Internal Medicine, Multidisciplinary Hospital Warsaw Miedzylesie, 2 Bursztynowa St., 04-749 Warsaw, Poland
| | - Robert Ryczek
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, 128 Szaserów St., 04-141 Warsaw, Poland
| | - Wojciech Lisik
- Department of General and Transplantation Surgery, The Medical University of Warsaw, 59 Nowogrodzka St., 02-006 Warsaw, Poland
| | - Artur Mamcarz
- 3rd Department of Internal Medicine and Cardiology, Medical University of Warsaw, 2 Bursztynowa St., 04-749 Warsaw, Poland
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Habas E, Akbar RA, Alfitori G, Farfar KL, Habas E, Errayes N, Habas A, Al Adab A, Rayani A, Geryo N, Elzouki ANY. Effects of Nondipping Blood Pressure Changes: A Nephrologist Prospect. Cureus 2023; 15:e42681. [PMID: 37649932 PMCID: PMC10464654 DOI: 10.7759/cureus.42681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Blood pressure (BP) variations depend on various internal, environmental, and behavioral factors. BP fluctuations occur both in normotensive and hypertensive people. Although it fluctuates over the 24-hr day and night, the morning BP increases after waking up and declines throughout sleep. It is typical for BP to decrease by 10% to 20%, while sleeping, known as dipping BP. However, if there is no decrease in nighttime mean systolic BP or a drop of less than 10 mmHg, it is called nondipping BP. Conversely, reverse dipping BP means an increase in mean systolic BP instead of a drop during the night. Reverse dipping is observed in hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD), and obstructive sleep apnea (OSA) syndrome. The introduction of ambulatory BP monitoring (ABPM) led to the emergence of identifying normal and elevated BP patterns. Non-dipping BP increases the risk of cardiovascular system (CVS) complications such as left ventricular hypertrophy, proteinuria, glomerular filtration rate (GFR) reduction, and CKD progression. A loss or blunting of the normal BP profile is recognized as a deleterious variant, and restoring abnormal BP patterns has been reported to significantly impact end-organ damage, morbidity, and mortality. In this non-systematic clinically-oriented, comprehensive review, we aim to update the BP variables and the pathophysiology of nondipping BP and point out the areas which need more investigation from a nephrology perspective because the nondipping BP increases the risk of proteinuria, GFR reduction, and CKD progression. A literature search of PubMed, Google, EMBASE, and Google Scholar was conducted. Checks of selected papers and relevant reviews complemented the electronic search. With improved BP measurement methods, the physiology of BP profile variations is readily detectable during the day and night. A nondipping BP profile is a distinct BP pattern that may have significant end-organ damage effects and therapeutic importance for nephrologists. The pathophysiology of the nondipping BP variant must be clarified to prevent complications, and further investigations are required. Furthermore, there is debate about the best BP index to utilize: systolic BP, diastolic BP, mean arterial pressure, or a mixture of all. All these areas are important and need new research projects.
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Affiliation(s)
| | - Raza A Akbar
- Internal Medicine, Hamad General Hospital, Doha, QAT
| | | | | | - Eshrak Habas
- Internal Medicine, Tripoli University, Tripoli, LBY
| | - Nada Errayes
- Medical Education, University of Lincoln, Lincoln, GBR
| | - Aml Habas
- Renal and Dialysis, Tripoli Pediatric Hospital, Tripoli, LBY
| | - Aisha Al Adab
- Pulmonary Medicine, Hamad General Hospital, Doha, QAT
| | - Amnna Rayani
- Hemato-Oncology, Tripoli Pediatric Hospital, Tripoli University, Tripoli, LBY
| | - Nagat Geryo
- Internal Medicine, Hamad General Hospital, Doha, QAT
| | - Abdel-Naser Y Elzouki
- Medicine, Hamad General Hospital, Doha, QAT
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
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Proença M, Ambühl J, Bonnier G, Meister TA, Valentin J, Soria R, Ferrario D, Lemay M, Rexhaj E. Method-comparison study between a watch-like sensor and a cuff-based device for 24-h ambulatory blood pressure monitoring. Sci Rep 2023; 13:6149. [PMID: 37061569 PMCID: PMC10105693 DOI: 10.1038/s41598-023-33205-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/09/2023] [Indexed: 04/17/2023] Open
Abstract
The use of 24-h ambulatory blood pressure monitoring (ABPM) has been continuously increasing over the last decades. However, cuff-based devices may cause discomfort, particularly at night, leading to potentially non-representative blood pressure (BP) values. We investigated the feasibility of a cuff-less BP monitoring solution in 67 subjects undergoing conventional 24-h ABPM. A watch-like optical sensor was attached at the upper arm or wrist at the contralateral side of the cuff. Systolic (SBP) and diastolic BP (DBP) values were estimated from the measured optical signals by pulse wave analysis. Average 24-h, daytime and nighttime BP values were compared between the conventional monitor and the cuff-less sensor. The differences between both methods-expressed as mean ± standard deviation (95% limits of agreement)-were of - 1.8 ± 6.2 mmHg (- 13.9, 10.3) on SBP and - 2.3 ± 5.4 mmHg (- 13.0, 8.3) on DBP for 24-h averages, of - 1.5 ± 6.6 mmHg (- 14.4, 11.4) on SBP and - 1.8 ± 5.9 mmHg (- 13.4, 9.9) on DBP for daytime averages, and of 0.4 ± 7.5 mmHg (- 14.4, 15.1) on SBP and - 1.3 ± 6.8 mmHg (- 14.7, 12.0) on DBP for nighttime averages. These results encouragingly suggest that cuff-less 24-h ABPM may soon become a clinical possibility.
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Affiliation(s)
- Martin Proença
- Signal Processing Group, Swiss Center for Electronics and Microtechnology (CSEM), Neuchâtel, Switzerland.
| | - Jeremias Ambühl
- Department of Cardiology and Biomedical Research, University Hospital, Bern, Switzerland
| | - Guillaume Bonnier
- Signal Processing Group, Swiss Center for Electronics and Microtechnology (CSEM), Neuchâtel, Switzerland
| | - Théo A Meister
- Department of Cardiology and Biomedical Research, University Hospital, Bern, Switzerland
| | - Jérémy Valentin
- Department of Cardiology and Biomedical Research, University Hospital, Bern, Switzerland
| | - Rodrigo Soria
- Department of Cardiology and Biomedical Research, University Hospital, Bern, Switzerland
| | - Damien Ferrario
- Signal Processing Group, Swiss Center for Electronics and Microtechnology (CSEM), Neuchâtel, Switzerland
| | - Mathieu Lemay
- Signal Processing Group, Swiss Center for Electronics and Microtechnology (CSEM), Neuchâtel, Switzerland
| | - Emrush Rexhaj
- Department of Cardiology and Biomedical Research, University Hospital, Bern, Switzerland.
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Kim HL, Lee EM, Ahn SY, Kim KI, Kim HC, Kim JH, Lee HY, Lee JH, Park JM, Cho EJ, Park S, Shin J, Kim YK. The 2022 focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. Clin Hypertens 2023; 29:11. [PMID: 36788612 PMCID: PMC9930285 DOI: 10.1186/s40885-023-00234-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
Hypertension is the leading cause of death in human being, which shows high prevalence and associated complications that increase the mortality and morbidity. Controlling blood pressure (BP) is very important because it is well known that lowering high BP effectively improves patients' prognosis. This review aims to provide a focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. The importance of ambulatory BP and home BP monitoring was further emphasized not only for the diagnosis but also for treatment target. By adopting corresponding BPs, the updated guideline recommended out-of-office BP targets for both standard and intensive treatment. Based on the consensus on corresponding BPs and Systolic Blood Pressure Intervention Trial (SPRINT) revisit, the updated guidelines recommended target BP in high-risk patients below 130/80 mmHg and it applies to hypertensive patients with three or more additional cardiovascular risk factors, one or more risk factors with diabetes, or hypertensive patients with subclinical organ damages, coronary or vascular diseases, heart failure, chronic kidney disease with proteinuria, and cerebral lacunar infarction. Cerebral infarction and chronic kidney disease are also high-risk factors for cardiovascular disease. However, due to lack of evidence, the target BP was generally determined at < 140/90 mmHg in patients with those conditions as well as in the elderly. Updated contents regarding the management of hypertension in special situations are also discussed.
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Affiliation(s)
- Hack-Lyoung Kim
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Mi Lee
- grid.410899.d0000 0004 0533 4755Department of Internal Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Republic of Korea
| | - Shin Young Ahn
- grid.411134.20000 0004 0474 0479Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kwang-il Kim
- grid.412480.b0000 0004 0647 3378Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hyeon Chang Kim
- grid.15444.300000 0004 0470 5454Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju Han Kim
- grid.411597.f0000 0004 0647 2471Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hae-Young Lee
- grid.31501.360000 0004 0470 5905Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jang Hoon Lee
- grid.258803.40000 0001 0661 1556Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jong-Moo Park
- grid.255588.70000 0004 1798 4296Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Eun Joo Cho
- grid.488414.50000 0004 0621 6849Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungha Park
- grid.15444.300000 0004 0470 5454Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinho Shin
- grid.49606.3d0000 0001 1364 9317Department of Internal Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young-Kwon Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea.
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Mancia G, Facchetti R, Vanoli J, Dolfini V, Grassi G. Reproducibility of blood pressure phenotypes identified by office and ambulatory blood pressure in treated hypertensive patients. Data from the PHYLLIS study. Hypertens Res 2022; 45:1599-1608. [PMID: 35941356 DOI: 10.1038/s41440-022-00982-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/12/2022] [Accepted: 06/23/2022] [Indexed: 11/09/2022]
Abstract
Previous studies have shown that white-coat and masked uncontrolled hypertension (WUCH and MUCH, respectively) are clinical conditions with very poor reproducibility over time. This is also the case for the different nighttime blood pressure (BP) patterns (dipping, nondipping, reverse dipping or extreme dipping). Whether and to what extent the phenomenon might depend on the type of antihypertensive treatment is unknown. In the present study, we addressed this issue by analyzing the data collected in the Plaque Hypertension Lipid-Lowering Italian Study (PHYLLIS), in which office and ambulatory BP were measured three times during an almost 3-year treatment period. The results showed that a limited number of WUCH or MUCH patients at an initial office measurement and 24-h systolic (S) BP measurement maintained the same status at a second set of measurements one or more years later. This was also the case for all dipping patterns, and only a minimal number of patients exhibited the same phenotype throughout all on-treatment SBP measurements. The results were similar for treatment with a thiazide diuretic or an ACE inhibitor and are in line with those of the European Lacidipine Study on Atherosclerosis (ELSA) trial, i.e., the only other available trial with multiple on-treatment office and ambulatory BP measurements, in which patients were treated with a calcium channel blocker or a beta-blocker. All the BP patterns identified in hypertensive patients treated by joint office and ambulatory BP measurements display poor reproducibility, and this is unrelated to the type of antihypertensive treatment used.
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Affiliation(s)
| | - Rita Facchetti
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Jennifer Vanoli
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Viola Dolfini
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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9
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Non-dipping blood pressure pattern in pediatricians during on-duty. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Verdecchia P, Angeli F, Reboldi G. Chronic Kidney Disease and Left Ventricular Hypertrophy. Potent Modifiers of the Prognostic Impact of Circadian Blood Pressure Changes. Hypertension 2022; 79:1028-1036. [PMID: 35166125 DOI: 10.1161/hypertensionaha.122.18969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unclear whether the prognostic value of blood pressure (BP) changes from day to night is modified by concomitant risk factors and organ damage. METHODS We studied 3247 clinically hypertensive patients who underwent off-therapy 24-hour ambulatory BP monitoring during their initial diagnostic work-up. Over a mean 9.9-year follow-up, 292 patients developed a first primary outcome event (composite of nonfatal myocardial infarction, nonfatal stroke, cardiovascular death, hospitalization for heart failure) and 281 died. The day-night BP changes were analyzed as night-to-day systolic BP ratio and included in semiparametric Cox models. RESULTS After allowance for age, sex, diabetes, cigarette smoking, low-density lipoprotein cholesterol, serum uric acid and average 24-hour systolic BP, the night-to-day systolic BP ratio maintained an independent association with outcome (hazard ratio, 1.17 [1.01-1.35]; P=0.041). When 2 markers of organ damage, chronic kidney disease and left ventricular hypertrophy, were added to the model, the night-to-day systolic BP ratio failed to maintain an independent association with outcome (hazard ratio, 1.19 [0.97-1.31]). The Akaike Information Criterion and the Schwarz-Bayes Information Criterion showed that, after allowance for other covariables, the night-to-day systolic BP ratio: (1) provided less information when compared with chronic kidney disease and left ventricular hypertrophy and (2) did not improve information provided by chronic kidney disease and left ventricular hypertrophy. Results were comparable on all-cause death as well as using categories of the night-day systolic BP ratio (extreme dippers, dippers, nondippers, reverse dippers). CONCLUSIONS Chronic kidney disease and left ventricular hypertrophy are potent modifiers of the prognostic value of the circadian BP changes.
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Affiliation(s)
- Paolo Verdecchia
- Fondazione Umbra Cuore e Ipertensione-ONLUS and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy (P.V.)
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria, Varese (F.A.).,Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Italy (F.A.)
| | - Gianpaolo Reboldi
- Department of Medicine, Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, Italy (G.R.)
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11
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OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1377-1386. [DOI: 10.1093/eurjpc/zwac020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/02/2021] [Accepted: 01/27/2022] [Indexed: 11/14/2022]
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13
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Ingabire PM, Ojji DB, Rayner B, Ogola E, Damasceno A, Jones E, Dzudie A, Ogah OS, Poulter N, Sani MU, Barasa FA, Shedul G, Mukisa J, Mukunya D, Wandera B, Batte C, Kayima J, Pandie S, Mondo CK. High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial. BMC Cardiovasc Disord 2021; 21:254. [PMID: 34022790 PMCID: PMC8141234 DOI: 10.1186/s12872-021-02074-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of antihypertensive therapy, and intensifying salt restriction. OBJECTIVES To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of 6 months of three antihypertensive regimens on the dipping pattern among Black African hypertensive patients. METHODS This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-h ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures. RESULTS The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium > 140 mmol/l (OR = 1.72, 95% CI 1.17-2.51, p-value 0.005), a higher office systolic BP (OR = 1.03, 95% CI 1.01-1.05, p-value 0.003) and a lower office diastolic BP (OR = 0.97, 95% CI 0.95-0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar's Chi2 0.71, p-value 0.40). CONCLUSION There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes. Trial registration ClinicalTrials.gov (NCT02742467).
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Affiliation(s)
- Prossie Merab Ingabire
- St. Francis Hospital, Nsambya, Kampala, Uganda
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
| | - Dike B. Ojji
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
- University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - Brian Rayner
- Division of Nephrology and Hypertension, Cape Town, South Africa
| | - Elijah Ogola
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | | | - Erika Jones
- Division of Nephrology and Hypertension, Cape Town, South Africa
| | | | - Okechukwu S. Ogah
- Cardiology Unit, Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Neil Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Mahmoud U. Sani
- Department of Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Felix Ayub Barasa
- Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Grace Shedul
- Pharmacy, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - John Mukisa
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Mukunya
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Bonnie Wandera
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
| | - Charles Batte
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
| | - James Kayima
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
| | - Shahiemah Pandie
- Hatter Institute of Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - CREOLE Study Investigators
- St. Francis Hospital, Nsambya, Kampala, Uganda
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
- University of Abuja Teaching Hospital, Gwagwalada, Nigeria
- Pharmacy, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Cardiology Unit, Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
- Department of Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
- Division of Nephrology and Hypertension, Cape Town, South Africa
- Hatter Institute of Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
- Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
- Eduardo Mondlane University Hospital, Maputo, Mozambique
- Douala General Hospital, Douala, Cameroon
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14
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Circadian variations in blood pressure and their implications for the administration of antihypertensive drugs: is dosing in the evening better than in the morning? J Hypertens 2021; 38:1396-1406. [PMID: 32618895 DOI: 10.1097/hjh.0000000000002532] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
: Blood pressure (BP) follows a circadian rhythm with a physiological decrease during the night. Studies have demonstrated that nocturnal BP as well as its dipping pattern during night-time have a significant prognostic importance for mortality and the occurrence of cardiovascular events. Therefore, hypertension management guidelines recommend to ascertain that patients treated for hypertension have well controlled BP values around the clock. To improve hypertension control during the night and eventually further reduce cardiovascular events, it has been proposed by some to prescribe at least one antihypertensive medication at bedtime. In this review, we have examined the data which could support the benefits of prescribing BP-lowering drugs at bedtime. Our conclusion is that there is no convincing evidence that the administration of BP-lowering drugs in the evening provides any significant advantage in terms of quality of BP control, prevention of target organ damage or reduction of cardiovascular events. Before changing practice for unproven benefits, it would be wise to wait for the results of the ongoing trials that are addressing this issue.
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15
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Mancia G, Facchetti R, Bombelli M, Quarti-Trevano F, Cuspidi C, Grassi G. Short- and Long-Term Reproducibility of Nighttime Blood Pressure Phenotypes and Nocturnal Blood Pressure Reduction. Hypertension 2021; 77:1745-1755. [PMID: 33745303 DOI: 10.1161/hypertensionaha.120.16827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Giuseppe Mancia
- Policlinico di Monza (G.M.), University of Milano-Bicocca, Italy.,University Milano-Bicocca, Milan (G.M.), University of Milano-Bicocca, Italy
| | - Rita Facchetti
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., F.Q.-T., C.C., G.G.), University of Milano-Bicocca, Italy
| | - Michele Bombelli
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., F.Q.-T., C.C., G.G.), University of Milano-Bicocca, Italy
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., F.Q.-T., C.C., G.G.), University of Milano-Bicocca, Italy
| | - Cesare Cuspidi
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., F.Q.-T., C.C., G.G.), University of Milano-Bicocca, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery (R.F., M.B., F.Q.-T., C.C., G.G.), University of Milano-Bicocca, Italy
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16
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Burgos-Alonso N, Ruiz Arzalluz MV, Garcia-Alvarez A, Fernandez-Fernandez de Quincoces D, Grandes G. Reproducibility study of nocturnal blood pressure dipping in patients with high cardiovascular risk. J Clin Hypertens (Greenwich) 2021; 23:1041-1050. [PMID: 33591600 PMCID: PMC8678773 DOI: 10.1111/jch.14222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/09/2021] [Accepted: 01/25/2021] [Indexed: 12/31/2022]
Abstract
It has been shown that in most people there is a physiological reduction in blood pressure during nighttime sleep, it falling by approximately 10% compared to daytime values (dippers). On the other hand, in some people, there is no nighttime reduction (non‐dippers). Various studies have found an association between being a non‐dipper and a higher risk of cardiovascular disease, but few have assessed whether the nocturnal pattern is maintained over time. From the database of the TAHPS study, data were available on 225 patients, each of whom underwent 24‐hour ambulatory blood pressure monitoring (ABPM) on four occasions over a period of 5 months. We studied the reproducibility of the nocturnal BP dipping pattern with mixed linear analysis and also calculated the concordance in the classification of patients as dippers or non‐dippers. The intraclass correlation coefficients between the different ABPM recordings were 0.482 and 0.467 for systolic and diastolic blood pressure, respectively. Two‐thirds (67%) and 70% of the patients classified, respectively, as dippers or non‐dippers based on systolic and diastolic blood pressure readings in the first ABPM recording were found to have the same classification based on the subsequent recordings. We conclude that the reproducibility of nocturnal dipping patterns and concordance of dipper vs non‐dipper status in individual patients is modest and therefore that we should be cautious about recommending treatments or interventions based on these patterns.
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Affiliation(s)
- Natalia Burgos-Alonso
- Primary Care Research Unit of Bizkaia, BioCruces Bizkaia Health Research Institute, Bilbao, Spain.,Preventive Medicine and Public Health Department, Faculty of Medicine and Nursery. University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Maria Victoria Ruiz Arzalluz
- Primary Care Research Unit of Bizkaia, BioCruces Bizkaia Health Research Institute, Bilbao, Spain.,Tolosaldea Health Region, Basque Health Service (Osakidetza), Bilbao, Spain
| | - Arturo Garcia-Alvarez
- Primary Care Research Unit of Bizkaia, BioCruces Bizkaia Health Research Institute, Bilbao, Spain
| | | | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, BioCruces Bizkaia Health Research Institute, Bilbao, Spain
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17
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Ivy JR, Bailey MA. Nondipping Blood Pressure: Predictive or Reactive Failure of Renal Sodium Handling? Physiology (Bethesda) 2021; 36:21-34. [PMID: 33325814 DOI: 10.1152/physiol.00024.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Blood pressure follows a daily rhythm, dipping during nocturnal sleep in humans. Attenuation of this dip (nondipping) is associated with increased risk of cardiovascular disease. Renal control of sodium homeostasis is essential for long-term blood pressure control. Sodium reabsorption and excretion have rhythms that rely on predictive/circadian as well as reactive adaptations. We explore how these rhythms might contribute to blood pressure rhythm in health and disease.
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Affiliation(s)
- Jessica R Ivy
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Matthew A Bailey
- University/BHF Centre for Cardiovascular Science, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
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18
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Cappuccio FP. The Role of Nocturnal Blood Pressure and Sleep Quality in Hypertension Management. Eur Cardiol 2020; 15:e60. [PMID: 32944089 PMCID: PMC7479543 DOI: 10.15420/ecr.2020.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
The accurate measurement, prediction and treatment of high blood pressure (BP) are essential to the management of hypertension and the prevention of its associated cardiovascular (CV) risks. However, even if BP is optimally controlled during the day, nocturnal high blood pressure may still increase the risk of CV events. The pattern of circadian rhythm of BP can be evaluated by ambulatory BP monitoring (ABPM). Night-time ABPM is more closely associated with fatal and nonfatal CV events than daytime ambulatory BP. However, the use of ABPM is limited by low availability and the fact that it can cause sleep disturbance, therefore may not provide realistic nocturnal measurements. Home blood pressure monitoring (HBPM) offers an inexpensive alternative to ABPM, is preferred by patients and provides a more realistic assessment of BP during an individual’s daily life. However, until recently, HBPM did not offer the possibility to measure nocturnal (sleep time) BP. The development and validation of new BP devices, such as the NightView (OMRON Healthcare, HEM9601T-E3) HBPM device, could overcome these limitations, offering the possibility of daytime and night-time BP measurements with minimal sleep disturbance.
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Affiliation(s)
- Francesco P Cappuccio
- ESH Centre of Excellence in Hypertension and Cardio-metabolic Research, University of Warwick Medical School Coventry, UK.,University Hospitals Coventry and Warwickshire NHS Trust Coventry, UK
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19
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20
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Nocturnal blood pressure measured by home devices: evidence and perspective for clinical application. J Hypertens 2020; 37:905-916. [PMID: 30394982 DOI: 10.1097/hjh.0000000000001987] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Studies using ambulatory blood pressure (BP) monitoring have shown that BP during night-time sleep is a stronger predictor of cardiovascular outcomes than daytime ambulatory or conventional office BP. However, night-time ambulatory BP recordings may interfere with sleep quality because of the device cuff inflation and frequency of measurements. Hence, there is an unmet need for obtaining high quality BP values during sleep. In the last two decades, technological development of home BP devices enabled automated BP measurements during night-time. Preliminary data suggest that nocturnal home BP measurements yield similar BP values and show good agreement in detecting nondippers when compared with ambulatory BP monitoring. Thus, nocturnal home BP measurements might be a reliable and practical alternative to ambulatory BP monitoring to evaluate BP during sleep. As the use of home BP devices is widespread, well accepted by users and has relatively low cost, it may prove to be more feasible and widely available for routine clinical assessment of nocturnal BP. At present, however, data on the prognostic relevance of nocturnal BP measured by home devices, the optimal measurement schedule, and other methodological issues are lacking and await further investigation. This article offers a systematic review of the current evidence on nocturnal home BP, highlights the remaining research questions, and provides preliminary recommendations for application of this novel approach in BP management.
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21
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Hammoudi-Bendib N, Manamani L, Ouabdesselam S, Ouamer DS, Ghemri S, Courouve L, Cherif A, Mahi L, Benkhedda S. Ambulatory Blood Pressure Monitoring in the Diagnosis and Management of Arterial Hypertension in Current Medical Practice in Algeria. Curr Hypertens Rev 2020; 17:75-82. [PMID: 32208121 DOI: 10.2174/1573402116666200324144223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE There are limited data on the management of hypertension (HT) in Algeria. The aim of this study was to assess, in current medical practice, the use and benefits of ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of HT. METHODS A prospective, observational, multicenter study was performed in 2017. Patients aged ≥ 18 years with suspected or treated HT were included. A 24-hour ABPM was performed at baseline in all patients. Therapeutic decision was taken by the physician according to ABPM results and patients were then followed up to 6 weeks. RESULTS The analysis included 1027 patients (mean age, 51.0 years; women, 61.6%) with treated HT (37.3%) or suspected HT (62.7%). Major cardiovascular risk factors were diabetes (15.7%) and lipid disorders (7.2%). ABPM was pathological in 55.1% of patients on antihypertensive treatment and in 60.8% of patients with suspected HT. A therapeutic adjustment or a treatment switch was performed after pathological ABPM in 37.4% of patients already on antihypertensive treatment and an antihypertensive therapy was initiated in 54.9% of patients with initially suspected HT. CONCLUSION This study is the first evaluation of the usefulness of ABPM for the management of HT in Algeria. Our results emphasize that ABPM is a highly valuable method for avoiding the whitecoat effect and for detecting patients who are insufficiently treated with antihypertensive drugs.
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Affiliation(s)
| | | | - Souhila Ouabdesselam
- Cardiology Division, Mustapha Hospital Cardiology Oncology Collaborative Research Group (COCRG), Benyoucef Benkhedda University, Algiers, Algeria
| | - Dalila S Ouamer
- Cardiology Division, Mustapha Hospital Cardiology Oncology Collaborative Research Group (COCRG), Benyoucef Benkhedda University, Algiers, Algeria
| | | | | | | | | | - Salim Benkhedda
- Cardiology Division, Mustapha Hospital Cardiology Oncology Collaborative Research Group (COCRG), Benyoucef Benkhedda University, Algiers, Algeria
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22
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Time to rethink the management of underlying sleep disturbances in nondippers? J Hypertens 2020; 38:403-404. [PMID: 32028514 DOI: 10.1097/hjh.0000000000002340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Klimczak-Tomaniak D, Pilecki T, Żochowska D, Sieńko D, Janiszewski M, Kuch M, Pączek L. Plasma microRNA-126-3p and neutrophil-to-lymphocyte ratio in patients with chronic kidney disease: relationships to ambulatory 24-h blood pressure. J Hum Hypertens 2019; 34:248-257. [PMID: 31853096 DOI: 10.1038/s41371-019-0293-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 10/21/2019] [Accepted: 12/02/2019] [Indexed: 11/09/2022]
Abstract
Pro-inflammatory milieu of chronic kidney disease (CKD) results in endothelial damage and contributes to increased cardiovascular risk. The aim of the study was to evaluate association between neutrophil-to-lymphocyte ratio (NLR) and plasma relative expression of endothelially abundant miR-126-3p with circadian blood pressure (BP) pattern in CKD patients. This single-center observational study involved CKD stage 1-5 patients and healthy age- and sex-matched control subjects. All study participants had 24-h automatic blood pressure measurement (ABPM) performed. Plasma miRNA was quantified by qRT-PCR, in relation to endogenous U6 snRNA. In total, 90 CKD patients (60 ± 14 years, 52% males, 33 renal transplant recipients) and 25 healthy control subjects (55 ± 13 years, 48% males, p > 0.05) were enrolled in the study. We observed a positive correlation between miR-126-3p and average nighttime SBP (rho = 0.27, P = 0.02), average nighttime DBP (rho = 0.32, P = 0.003), night-day SBP ratio (ND-SBP), rho = 0.23, P = 0.03 and night-day DBP ratio (ND-DBP), rho = 0.26, P = 0.02. A positive association was found between NLR and average nighttime SBP (rho = 0.25, P = 0.01), ND-SBP (rho = 0.26, P = 0.006), and ND-DBP (rho = 0.28, P = 0.03). In the multiple regression model, NLR remained an independent predictor of average nighttime SBP (Beta per log change of NLR [95% CI]: 11.2 [1.8-10.6], P = 0.02), whereas miR-126-3p of nighttime DBP (1.88 [0.48; 3.28], p = 0.009), The results of our study point towards a link between both NLR and miR-126-3p and nighttime hypertension in CKD patients.
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Affiliation(s)
- Dominika Klimczak-Tomaniak
- Department of Immunology, Transplantation and Internal Medicine, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.,Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Pilecki
- Department of Immunology, Transplantation and Internal Medicine, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Żochowska
- Department of Immunology, Transplantation and Internal Medicine, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - Damian Sieńko
- Department of Immunology, Transplantation and Internal Medicine, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Janiszewski
- Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Marek Kuch
- Chair and Department of Cardiology, Hypertension and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Pączek
- Department of Immunology, Transplantation and Internal Medicine, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
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24
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Cuspidi C, Caffi G, Dell’Oro R, Tadic M, Sala C, Grassi G, Mancia G. Extreme Dipping: Always Means Nocturnal Hypotension? Am J Hypertens 2019; 32:842-847. [PMID: 31051512 DOI: 10.1093/ajh/hpz074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 12/26/2022] Open
Abstract
AIM Although nocturnal hypotension is considered the key factor responsible for the increased cardiovascular risk associated with the extreme dipping (ED) pattern, no information is available on its prevalence in this setting. Therefore, we have assessed this topic in a cohort of patients referred to a single out-patient hypertension center. METHODS A large database of individual 24-hour ambulatory BP recordings from untreated individuals with a history of hypertension and treated individuals with hypertension was analyzed. RESULTS A total of 339 of 7,074 patients (4.5%) exhibited an ED pattern (207 had a nighttime reduction in both systolic and diastolic BP ≥ 20% compared to daytime values and 132 a nighttime reduction in diastolic BP ≥ 20%). Among patients with ED, the prevalence of nocturnal hypotension varied from 9.1% to 45.0% depending on the criteria used (i.e., mean nighttime BP < 90/50 mm Hg or < 100/60 mm Hg), and the prevalence of nocturnal hypertension (i.e., mean nighttime BP ≥ 120/70 mm Hg) was 19.5%. Compared with untreated patients, those taking antihypertensive drugs were more likely to have nocturnal hypotension and less likely to have nocturnal hypertension. CONCLUSIONS Our findings support the view that ED pattern is a condition not always associated with nocturnal hypotension because a large fraction of ED patients has normal or elevated mean BP nocturnal values.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
- Istituto Auxologico Italiano, IRCCS Milano, Italy
| | - Giovanni Caffi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Raffaella Dell’Oro
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Marijana Tadic
- Department of Cardiology, Charité-University-Medicine Campus Virchow Klinikum, Berlin, Germany
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione IRCCS Policlinico di Milano, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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25
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Kario K, Weber MA, Mahfoud F, Kandzari DE, Schmieder RE, Kirtane AJ, Böhm M, Hettrick DA, Townsend RR, Tsioufis KP. Changes in 24-Hour Patterns of Blood Pressure in Hypertension Following Renal Denervation Therapy. Hypertension 2019; 74:244-249. [PMID: 31256723 PMCID: PMC6635058 DOI: 10.1161/hypertensionaha.119.13081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Kazuomi Kario
- From the Departments of Cardiovascular Medicine and Sleep and Circadian Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | | | - Felix Mahfoud
- Department of Internal Medicine III, University Hospital of Saarland, Saarland University, Homburg/Saar, Germany (F.M., M.B.)
| | | | - Roland E. Schmieder
- Department of Nephrology and HTN, University Hospital of the Friedrich-Alexander University Erlangen-Nürnberg, Germany (R.E.S.)
| | - Ajay J. Kirtane
- Center for Interventional Vascular Therapy, Columbia University Medical Center/New York-Presbyterian Hospital, and the Cardiovascular Research Foundation, New York (A.J.K.)
| | - Michael Böhm
- Department of Internal Medicine III, University Hospital of Saarland, Saarland University, Homburg/Saar, Germany (F.M., M.B.)
| | | | - Raymond R. Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.)
| | - Konstantinos P. Tsioufis
- National and Kapodistrian University of Athens, Hippocration Hospital, Athens Medical Center, Greece (K.P.T.)
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26
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Lopez-Sublet M, Girerd N, Bozec E, Machu JL, Ferreira JP, Zannad F, Mourad JJ, Rossignol P. Nondipping Pattern and Cardiovascular and Renal Damage in a Population-Based Study (The STANISLAS Cohort Study). Am J Hypertens 2019; 32:620-628. [PMID: 30753257 DOI: 10.1093/ajh/hpz020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/25/2019] [Accepted: 02/01/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The attenuation of physiological nocturnal decline of blood pressure (BP)-called nondipper pattern-has previously been reported to be associated with target organ damage in hypertensive subjects. However, this association remains debated and poorly studied in normotensive patients. This study aimed to investigate the association between nondipper pattern and subclinical cardiovascular and renal damage in an initially healthy population-based cohort study. METHODS The STANISLAS Cohort is a single-center, familial longitudinal cohort composed of 1,006 families (4,295 subjects) recruited in 1993-1995 for a 5-year periodic health examination. A total of 1,334 subjects from the 4th visit (2011-2016) of the STANISLAS cohort were included. This 4th examination included estimated glomerular filtration rate, albumin/creatinine ratio, pulse wave velocity, central systolic BP, carotid intima-media thickness and distensibility, left ventricular mass index, left ventricular hypertrophy, diastolic dysfunction, and ambulatory blood pressure monitoring (ABPM). Nondipping status was defined as a mean reduction in systolic BP (SBP) or diastolic BP (DBP) lower than 10% during nighttime. RESULTS Data were obtained from 798 normotensive subjects (45 ± 14 years, 395 [49%] nondippers, SBP/DBP mmHg 24 hours: 116/71 ± 7/5) and 536 hypertensive patients (56 ± 11 years, 257 [48%] nondippers, SBP/DBP mmHg 24 hours: 127/78 ± 10/7). Mean 24-hour and daytime ABPM measurements were within the normal range, even in hypertensive participants (19% treated). The nondipping pattern was not associated with cardiovascular or renal alterations in this population. CONCLUSION In this middle-aged population with an overall 24-hour optimal BP control, the nondipper pattern was not associated with increased cardiovascular or renal damage.
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Affiliation(s)
- Marilucy Lopez-Sublet
- Department of Internal Medicine, ESH Hypertension Excellence Centre, CHU Avicenne, AP-HP, Bobigny, France
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
| | - Nicolas Girerd
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy, France
| | - Erwan Bozec
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy, France
| | - Jean-Loup Machu
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy, France
| | - João Pedro Ferreira
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy, France
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Faiez Zannad
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy, France
| | - Jean-Jacques Mourad
- Department of Internal Medicine, ESH Hypertension Excellence Centre, CHU Avicenne, AP-HP, Bobigny, France
| | - Patrick Rossignol
- French Clinical Research Infrastructure Network Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists (FCRIN INI-CRCT), Nancy, France
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, Nancy, France
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Lempiäinen PA, Vasunta RL, Bloigu R, Kesäniemi YA, Ukkola OH. Non-dipping blood pressure pattern and new-onset diabetes in a 21-year follow-up. Blood Press 2019; 28:300-308. [PMID: 31092019 DOI: 10.1080/08037051.2019.1615369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Non-dipping blood pressure (BP) pattern has been associated with metabolic changes and cardiovascular events. With regard of diabetes, studies are scarce. Our aim was to investigate if there is an association between changes in dipping patterns and incidence of diabetes. Materials and methods: A 24-h ambulatory BP measurement was recorded in addition to other laboratory measurements, and a questionnaire and physical examination were carried out in the baseline study and after 21-year follow-up among a study population (n = 449) consisting of randomly selected middle-aged Finnish females and males without diabetes. Results: 128 (28.5%) developed diabetes during the follow-up. The incidence of new-onset diabetes was the highest, 41.0%, among those subjects who were non-dippers (their systolic BP declined <10% from daytime to nighttime) in the baseline and also in the follow-up study, while the incidence of diabetes was 19.6% in the dipper - dipper (a nighttime decline of systolic BP 10% or more) group (p = 0.003). The difference remained statistically significant after adjustment with age, sex, body mass index, fasting glucose, triglycerides, and insulin levels, smoking status, 24-h mean systolic BP, high-sensitivity C-reactive protein, estimated glomerular filtration and diuretics use. In logistic regression analysis, the non-dipper - non-dippers were at higher risk of diabetes compared with dipper - dipper group (OR = 2.27, 95% CI: 1.13-4.56, p = 0.022). Conclusions: Our prospective study shows that there is an independent association between non-dipping BP pattern and the incidence of diabetes in a 21-year follow-up.
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Affiliation(s)
- Päivi A Lempiäinen
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu , Oulu , Finland
| | - Riitta-Liisa Vasunta
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu , Oulu , Finland
| | - Risto Bloigu
- Medical Informatics and Statistics Research Group, University of Oulu , Oulu , Finland
| | - Y Antero Kesäniemi
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu , Oulu , Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital, University of Oulu , Oulu , Finland
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Melgarejo JD, Lee JH, Maestre GE, De Moraes CG. Reply. Ophthalmology 2019; 126:e12-e13. [PMID: 30683182 DOI: 10.1016/j.ophtha.2018.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/23/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jesus D Melgarejo
- Institute for Biological Research, Neuroscience Laboratory, University of Zulia, Maracaibo, Venezuela
| | - Joseph H Lee
- The Taub Institute for Research in Alzheimer's Disease and the Aging Brain and the G.H. Sergievsky Center, Columbia University, New York, New York; Department of Epidemiology, School of Public Health, Columbia University, New York, New York
| | - Gladys E Maestre
- Institute for Biological Research, Neuroscience Laboratory, University of Zulia, Maracaibo, Venezuela; Departments of Neuroscience and Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, Texas.
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2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36:1953-2041. [PMID: 30234752 DOI: 10.1097/hjh.0000000000001940] [Citation(s) in RCA: 1762] [Impact Index Per Article: 293.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
: Document reviewers: Guy De Backer (ESC Review Co-ordinator) (Belgium), Anthony M. Heagerty (ESH Review Co-ordinator) (UK), Stefan Agewall (Norway), Murielle Bochud (Switzerland), Claudio Borghi (Italy), Pierre Boutouyrie (France), Jana Brguljan (Slovenia), Héctor Bueno (Spain), Enrico G. Caiani (Italy), Bo Carlberg (Sweden), Neil Chapman (UK), Renata Cifkova (Czech Republic), John G. F. Cleland (UK), Jean-Philippe Collet (France), Ioan Mircea Coman (Romania), Peter W. de Leeuw (The Netherlands), Victoria Delgado (The Netherlands), Paul Dendale (Belgium), Hans-Christoph Diener (Germany), Maria Dorobantu (Romania), Robert Fagard (Belgium), Csaba Farsang (Hungary), Marc Ferrini (France), Ian M. Graham (Ireland), Guido Grassi (Italy), Hermann Haller (Germany), F. D. Richard Hobbs (UK), Bojan Jelakovic (Croatia), Catriona Jennings (UK), Hugo A. Katus (Germany), Abraham A. Kroon (The Netherlands), Christophe Leclercq (France), Dragan Lovic (Serbia), Empar Lurbe (Spain), Athanasios J. Manolis (Greece), Theresa A. McDonagh (UK), Franz Messerli (Switzerland), Maria Lorenza Muiesan (Italy), Uwe Nixdorff (Germany), Michael Hecht Olsen (Denmark), Gianfranco Parati (Italy), Joep Perk (Sweden), Massimo Francesco Piepoli (Italy), Jorge Polonia (Portugal), Piotr Ponikowski (Poland), Dimitrios J. Richter (Greece), Stefano F. Rimoldi (Switzerland), Marco Roffi (Switzerland), Naveed Sattar (UK), Petar M. Seferovic (Serbia), Iain A. Simpson (UK), Miguel Sousa-Uva (Portugal), Alice V. Stanton (Ireland), Philippe van de Borne (Belgium), Panos Vardas (Greece), Massimo Volpe (Italy), Sven Wassmann (Germany), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain).The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website www.escardio.org/guidelines.
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Affiliation(s)
- Rosa Maria Bruno
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- PARCC INSERM UMR 970, Paris, France
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39:3021-3104. [PMID: 30165516 DOI: 10.1093/eurheartj/ehy339] [Citation(s) in RCA: 5473] [Impact Index Per Article: 912.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Walczak-Gałęzewska M, Szulińska M, Miller-Kasprzak E, Pupek-Musialik D, Bogdański P. The effect of nebivolol and ramipril on selected biochemical parameters, arterial stiffness, and circadian profile of blood pressure in young men with primary hypertension: A 12-week prospective randomized, open-label study trial. Medicine (Baltimore) 2018; 97:e11717. [PMID: 30045336 PMCID: PMC6078720 DOI: 10.1097/md.0000000000011717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The pleiotropic effects of hypotensive drugs should always be taken into consideration. There is limited data on the effect of such drugs on reducing global cardiovascular risk in young hypertensives. The aim of this study was to evaluate the effect of nebivolol and ramipril on biochemical parameters, arterial stiffness, and circadian profile of blood pressure (BP) in young men undergoing treatment for hypertension (HT). METHODS A total of 80 patients aged 16 to 28 years of age with grade 1 HT were enrolled into the prospective randomized, open-label trial. They were randomized to receive 5 mg of nebivolol or 5 mg of ramipril, daily. Arterial stiffness index (SI), the circadian profile of BP registered in ambulatory blood pressure monitoring (ABPM), and biochemical parameters-including lipid profile, insulinemia, glycemia, and high sensitivity C-reactive protein (hsCRP) levels-were evaluated before and after the twelve-week period. RESULTS After the treatment period, we observed significant decreases in both ABPM systolic blood pressure (SBP) in group of nebivolol (P = .0007) and ramipril (P = .0001) and in ABPM diastolic blood pressure (DBP) in group of nebivolol (P = .0018) and ramipril (P = .0006). Reductions in the nondippers percentage were found in group of nebivolol and ramipril (P = .0077, P = .0001 respectively). Ramipril treatment resulted in a significant plausible modification in high-density lipoprotein (HDL) (P = .0390), glucose (P = .0213), and hsCRP (P = .0053) concentrations, as well as decreased SI (P = .0009) value, while nebivolol treatment showed no such benefits. CONCLUSIONS Despite the similar hypotensive effect of nebivolol and ramipril, ramipril seems to possess better clinical potential in reducing cardiovascular risk in young men with HT.
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Affiliation(s)
- Marta Walczak-Gałęzewska
- Department of Internal Medicine, Metabolic Disorders and Hypertension Department of Education and Obesity Treatment and Metabolic Disorders Department of Physiology, Poznań University of Medical Sciences, Poznań, Poland
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Tosun V, Korucuk N, Kılınç AY, Uygun T, Altekin RE, Güntekin Ü, Ermiş C. Evaluation of atrial electromechanical functions in dipper and nondipper hypertension patients using left atrial strain P-wave dispersion and P terminal force. Echocardiography 2018; 35:1318-1325. [DOI: 10.1111/echo.14041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Veysel Tosun
- Department of Cardiology; Sanliurfa Education and Research Hospital; Sanliurfa Turkey
| | - Necmettin Korucuk
- Department of Cardiology; Private Medical Park Hospital; Antalya Turkey
| | - Ali Yaşar Kılınç
- Department of Cardiology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Turgut Uygun
- Department of Cardiology; Sanliurfa Education and Research Hospital; Sanliurfa Turkey
| | - Refik Emre Altekin
- Department of Cardiology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Ünal Güntekin
- Department of Cardiology; Faculty of Medicine; Akdeniz University; Antalya Turkey
| | - Cengiz Ermiş
- Department of Cardiology; Faculty of Medicine; Akdeniz University; Antalya Turkey
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Asayama K, Satoh M, Kikuya M. Diurnal blood pressure changes. Hypertens Res 2018; 41:669-678. [PMID: 29789641 DOI: 10.1038/s41440-018-0054-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/04/2018] [Accepted: 04/06/2018] [Indexed: 11/09/2022]
Abstract
The definition of diurnal blood pressure changes varies widely, which can be confusing. Short-term blood pressure variability during a 24-h period and the dipping status of diurnal blood pressure can be captured by ambulatory blood pressure monitoring, and these metrics are reported to have prognostic significance for cardiovascular complications. Morning blood pressure surge also indicates this risk, but its effect may be limited to populations with specific conditions. Meanwhile, the combined use of conventional office blood pressure and out-of-office blood pressure allows us to identify people with white-coat and masked hypertension. Current home devices can measure nocturnal blood pressure during sleep more conveniently than ambulatory monitoring; however, we should pay attention to blood pressure measurement conditions regardless of whether they are in a home, ambulatory, or office setting. The relatively poor reproducibility of diurnal blood pressure changes, including the nocturnal fall of blood pressure, is another underestimated issue to be addressed. Although information on diurnal blood pressure changes is expected to be used more effectively in the future, we should also keep in mind that blood pressure levels have remained central to the primary and secondary prevention of blood pressure-related cardiovascular diseases in clinical practice.
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Affiliation(s)
- Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan. .,Tohoku Institute for Management of Blood Pressure, Sendai, Japan.
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Masahiro Kikuya
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
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Araújo S, Rouxinol-Dias A, Mesquita-Bastos J, Silva J, Barbosa L, Polónia J. Ambulatory blood pressure monitoring profiles in a cross-sectional analysis of a large database of normotensive and true or suspected hypertensive patients. Rev Port Cardiol 2018; 37:319-327. [DOI: 10.1016/j.repc.2017.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/26/2017] [Accepted: 07/24/2017] [Indexed: 01/09/2023] Open
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Araújo S, Rouxinol-Dias A, Mesquita-Bastos J, Silva J, Barbosa L, Polónia J. Ambulatory blood pressure monitoring profiles in a cross-sectional analysis of a large database of normotensive and true or suspected hypertensive patients. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Cífková R. Should 24-Hour Ambulatory Blood Pressure Monitoring Become Part of Regular Checkup in Women With Previous Preeclampsia? Hypertension 2017; 71:59-60. [PMID: 29133361 DOI: 10.1161/hypertensionaha.117.09915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Renata Cífková
- From the Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Czech Republic; and Department of Medicine II, Charles University in Prague, First Faculty of Medicine and General University Hospital, Czech Republic.
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Fujiwara T, Hoshide S, Yano Y, Kanegae H, Kario K. Comparison of morning vs bedtime administration of the combination of valsartan/amlodipine on nocturnal brachial and central blood pressure in patients with hypertension. J Clin Hypertens (Greenwich) 2017; 19:1319-1326. [DOI: 10.1111/jch.13128] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/28/2017] [Accepted: 08/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Takeshi Fujiwara
- Jichi Medical University School of Medicine; Shimotsuke Japan
- Higashiagatsuma-machi National Health Insurance Clinic; Gunma Japan
| | - Satoshi Hoshide
- Jichi Medical University School of Medicine; Shimotsuke Japan
| | - Yuichiro Yano
- University of Mississippi Medical Center; Jackson MS USA
| | | | - Kazuomi Kario
- Jichi Medical University School of Medicine; Shimotsuke Japan
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Parati G, Ochoa JE, Bilo G. Moving Beyond Office Blood Pressure to Achieve a Personalized and More Precise Hypertension Management: Which Way to Go? Hypertension 2017; 70:HYPERTENSIONAHA.117.08250. [PMID: 28760937 DOI: 10.1161/hypertensionaha.117.08250] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gianfranco Parati
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., G.B.); and Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.).
| | - Juan Eugenio Ochoa
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., G.B.); and Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.)
| | - Grzegorz Bilo
- From the Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P., G.B.); and Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy (G.P., J.E.O., G.B.)
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Ambulatory versus clinic blood pressure in predicting overall subclinical target organ damage progression in essential hypertensive patients: a 3-year follow-up study. Blood Press Monit 2017; 21:319-326. [PMID: 27579902 DOI: 10.1097/mbp.0000000000000209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ambulatory blood pressure (BP) was shown to predict specific subclinical target organ damage (TOD) progression better than clinic BP, whereas the usefulness of ambulatory and clinic BP measurements to predict overall TOD progression is not well established. METHODS AND RESULTS Clinic and 24-h ambulatory BP values were obtained in 280 patients on baseline. A total of 199 participants (mean age 62.5±9.5, 59.3% men) were followed up for an average of 39 months and overall subclinical TOD were recorded at the end of follow-up period. Patients with increased TOD number had higher baseline clinic, 24-h, day and night systolic blood pressure (SBP), and pulse pressure, but baseline ambulatory and clinic diastolic blood pressure showed no differences. Multiple logistic regression analysis showed that the independent predictors of the overall TOD number increased were clinic [relative ratio (RR)=1.023, P=0.006], 24-h (RR=1.034, P=0.005), day (RR=1.023, P=0.04) and night (RR=1.038, P=0.001) SBP, as well as 24-h (RR=1.050, P=0.005), day (RR=1.037, P=0.02) and night (RR=1.062, P=0.001) ambulatory pulse pressure, and night average diastolic blood pressure with boundary correlation (RR=1.034, P=0.048). The night-time SBP value was more strongly associated with the risk of overall increased TOD number than the daytime (RR=1.049, P=0.003) or clinic SBP (RR=1.026, P=0.02). Similarly, 24-h pulse pressure was superior to clinic (RR=1.045, P=0.02) and night-time was superior to daytime pulse pressure (RR=1.104, P=0.002). CONCLUSION The risk of overall subclinical TOD progression increased more with a given increase in baseline ambulatory night-time BP than baseline clinic or daytime BP in essential hypertension.
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Ott C, Lobo MD, Sobotka PA, Mahfoud F, Stanton A, Cockcroft J, Sulke N, Dolan E, van der Giet M, Hoyer J, Furniss SS, Foran JP, Witkowski A, Januszewicz A, Schoors D, Tsioufis K, Rensing BJ, Saxena M, Scott B, Ng GA, Achenbach S, Schmieder RE. Effect of Arteriovenous Anastomosis on Blood Pressure Reduction in Patients With Isolated Systolic Hypertension Compared With Combined Hypertension. J Am Heart Assoc 2016; 5:JAHA.116.004234. [PMID: 28003251 PMCID: PMC5210451 DOI: 10.1161/jaha.116.004234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Options for interventional therapy to lower blood pressure (BP) in patients with treatment‐resistant hypertension include renal denervation and the creation of an arteriovenous anastomosis using the ROX coupler. It has been shown that BP response after renal denervation is greater in patients with combined hypertension (CH) than in patients with isolated systolic hypertension (ISH). We analyzed the effect of ROX coupler implantation in patients with CH as compared with ISH. Methods and Results The randomized, controlled, prospective ROX Control Hypertension Study included patients with true treatment‐resistant hypertension (office systolic BP ≥140 mm Hg, average daytime ambulatory BP ≥135/85 mm Hg, and treatment with ≥3 antihypertensive drugs including a diuretic). In a post hoc analysis, we stratified patients with CH (n=31) and ISH (n=11). Baseline office systolic BP (177±18 mm Hg versus 169±17 mm Hg, P=0.163) and 24‐hour ambulatory systolic BP (159±16 mm Hg versus 154±11 mm Hg, P=0.463) did not differ between patients with CH and those with ISH. ROX coupler implementation resulted in a significant reduction in office systolic BP (CH: −29±21 mm Hg versus ISH: −22±31 mm Hg, P=0.445) and 24‐hour ambulatory systolic BP (CH: −14±20 mm Hg versus ISH: −13±15 mm Hg, P=0.672), without significant differences between the two groups. The responder rate (office systolic BP reduction ≥10 mm Hg) after 6 months was not different (CH: 81% versus ISH: 82%, P=0.932). Conclusions Our data suggest that creation of an arteriovenous anastomosis using the ROX coupler system leads to a similar reduction of office and 24‐hour ambulatory systolic BP in patients with combined and isolated systolic hypertension. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01642498.
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Affiliation(s)
- Christian Ott
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Melvin D Lobo
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom
| | | | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Alice Stanton
- Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - John Cockcroft
- Cardiolgy Department, Wales Heart Research Institute, Cardiff, United Kingdom
| | - Neil Sulke
- Cardiology Department, Eastbourne District General Hospital, East Sussex, United Kingdom
| | - Eamon Dolan
- Department of Medicine for the Elderly, Connolly Hospital, Dublin, Ireland
| | - Markus van der Giet
- Department of Endocrinology and Nephrology, Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Hoyer
- Department of Internal Medicine and Nephrology, Universitätsklinikum Gießen und Marburg GmbH, Marburg, Germany
| | - Stephen S Furniss
- Department of Cardiology, East Sussex Healthcare NHS Trust, East Sussex, United Kingdom
| | - John P Foran
- Cardiac Department, Royal Brompton Hospital, London, United Kingdom.,Cardiolgy Department, St. Helier Hospital, Surrey, United Kingdom
| | | | | | - Danny Schoors
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Benno J Rensing
- Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Manish Saxena
- William Harvey Research Institute, Barts NIHR Cardiovascular Biomedical Research Unit, Queen Mary University of London, United Kingdom
| | - Benjamin Scott
- Department of Cardiology, ZNA - Cardio Middelheim, Antwerp, Belgium
| | - G André Ng
- Department of Cardiovascular Sciences, University of Leicester Glenfield Hospital/NIHR Leicester Cardiovascular Biomedical Research, Leicester, United Kingdom
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Albert BB, de Bock M, Derraik JG, Brennan CM, Biggs JB, Hofman PL, Cutfield WS. Non-Dipping and Cardiometabolic Profile: A Study on Normotensive Overweight Middle-Aged Men. Heart Lung Circ 2016; 25:1218-1225. [DOI: 10.1016/j.hlc.2016.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/16/2016] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
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B-type natriuretic peptide is a determinant of the nocturnal increase in blood pressure independently of arterial hypertrophy and hypoxia. J Hypertens 2016; 34:2393-2401. [DOI: 10.1097/hjh.0000000000001104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Cicconetti P, Morelli S, De Serra C, Ciotti V, Chiarotti F, de Marle MG, Ottaviani L, Riolo N, Marigliano V. Left Ventricular Mass in Dippers and Nondippers with Newly Diagnosed Hypertension. Angiology 2016; 54:661-9. [PMID: 14666954 DOI: 10.1177/000331970305400605] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertensive subjects can be subdivided into 2 groups, dippers and nondippers, according to the presence or the lack of a nocturnal fall of blood pressure of more than 10%. Several studies have investigated cardiac organ damage in the 2 groups with discordant results, but they included subjects with different onset, severity, and treatment of hypertension. The authors selected 23 dippers and 17 nondippers affected by newly (< 1 year) diagnosed grades 1 and 2 hypertension, never treated, who underwent 24-hour ambulatory blood pressure monitoring and M-mode echocardiography. They did not find significant differences between the 2 groups as regards the echocardiographic left ventricular and atrial dimensions or regarding the left ventricular mass, left ventricular mass index, or relative wall thickness. Also no significant differences were found in the rate of either left ventricular remodeling or left ventricular hyper trophy. These data suggest that nondipping status is not associated with a higher level of cardiac involvement in the early phases of hypertension compared to dipping status.
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Affiliation(s)
- Paolo Cicconetti
- Department of Geriatrics, Ist Institute of Medicine, La Sapienza University, Rome, Italy.
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Wallbach M, Lehnig LY, Schroer C, Lüders S, Böhning E, Müller GA, Wachter R, Koziolek MJ. Effects of Baroreflex Activation Therapy on Ambulatory Blood Pressure in Patients With Resistant Hypertension. Hypertension 2016; 67:701-9. [DOI: 10.1161/hypertensionaha.115.06717] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/19/2016] [Indexed: 11/16/2022]
Abstract
Baroreflex activation therapy (BAT) has been demonstrated to decrease office blood pressure (BP) in the randomized, double-blind Rheos trial. There are limited data on 24-hour BP changes measured by ambulatory BP measurements (ABPMs) using the first generation rheos BAT system suggesting a significant reduction but there are no information about the effect of the currently used, unilateral BAT neo device on ABPM. Patients treated with the BAT neo device for uncontrolled resistant hypertension were prospectively included into this study. ABPM was performed before BAT implantation and 6 months after initiation of BAT. A total of 51 patients were included into this study, 7 dropped out from analysis because of missing or insufficient follow-up. After 6 months, 24-hour ambulatory systolic (from 148±17 mm Hg to 140±23 mm Hg,
P
<0.01), diastolic (from 82±13 mm Hg to 77±15 mm Hg,
P
<0.01), day- and night-time systolic and diastolic BP (all
P
≤0.01) significantly decreased while the number of prescribed antihypertensive classes could be reduced from 6.5±1.5 to 6.0±1.8 (
P
=0.03). Heart rate and pulse pressure remained unchanged. BAT was equally effective in reducing ambulatory BP in all subgroups of patients. This is the first study demonstrating a significant BP reduction in ABPM in patients undergoing chronically stimulation of the carotid sinus using the BAT neo device. About that BAT-reduced office BP and improved relevant aspects of ABPM, BAT might be considered as a new therapeutic option to reduce cardiovascular risk in patients with resistant hypertension. Randomized controlled trials are needed to evaluate BAT effects on ABPM in patients with resistant hypertension accurately.
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Affiliation(s)
- Manuel Wallbach
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Luca-Yves Lehnig
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Charlotte Schroer
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Stephan Lüders
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Enrico Böhning
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Gerhard A. Müller
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Rolf Wachter
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
| | - Michael J. Koziolek
- From the Department of Nephrology and Rheumatology (M.W., L.-Y.L., C.S., E.B., G.A.M., M.J.K.) and Department of Cardiology and Pulmonology (R.W.), Georg-August-University Göttingen, Göttingen, Germany; and St. Josefs Hospital, Cloppenburg, Germany (S.L.)
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Sarafidis PA, Lazaridis AA, Imprialos KP, Georgianos PI, Avranas KA, Protogerou AD, Doumas MN, Athyros VG, Karagiannis AI. A comparison study of brachial blood pressure recorded with Spacelabs 90217A and Mobil-O-Graph NG devices under static and ambulatory conditions. J Hum Hypertens 2016; 30:742-749. [DOI: 10.1038/jhh.2016.11] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/17/2015] [Accepted: 10/14/2015] [Indexed: 11/09/2022]
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Reproducibility of ambulatory blood pressure values and circadian blood pressure patterns in untreated subjects in a 1–11 month interval. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
There has been a dramatic shift in the manner in which blood pressure (BP) is measured to provide far more comprehensive clinical information than that provided by a single set of office BP readings. Extensive clinical and epidemiological research shows an important role of ambulatory BP monitoring (ABPM) in the management of hypertensive patients. A 24-h BP profile helps to determine the absence of nocturnal dipping status and evaluate BP control in patients on antihypertensive therapy. The ability to detect white-coat or masked hypertension is enhanced by ambulatory BP monitoring. In 2001, the Center for Medicare and Medicaid Services approved ABPM for reimbursement for the identification of patients with white-coat hypertension. In 2011, the National Institute for Health and Clinical Excellence (NICE) in the UK published guidelines that recommended the routine use of ABPM in all patients suspected of having hypertension. The European Society of Hypertension (ESH) 2013 guidelines also support greater use of ABPM in clinical practice. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to its cost, the complexity of data evaluation, as well as patient inconvenience. In this review, we evaluate the clinical importance of ABPM, highlighting its role in the current management of hypertension.
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Affiliation(s)
- William B White
- Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06032-3940, USA,
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Monte M, Cambão M, Mesquita Bastos J, Polónia J. Reproducibility of ambulatory blood pressure values and circadian blood pressure patterns in untreated subjects in a 1-11 month interval. Rev Port Cardiol 2015; 34:643-50. [PMID: 26497605 DOI: 10.1016/j.repc.2015.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/18/2015] [Accepted: 05/01/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To evaluate in untreated subjects the reproducibility of mean values and four circadian patterns between two ambulatory blood pressure monitoring (ABPM) recordings separated by 1-11 months. METHODS We performed a retrospective analysis of 481 individuals (59% women) evaluated by ABPM on two occasions, visit 1 (V1) and 2 (V2), separated by 5.5+0.2 months. Four circadian patterns were defined by night/day systolic blood pressure (SBP) ratios: reverse dippers (RD), ratio >1.0; non-dippers (ND), ratio 0.9-1.0; dippers (D), ratio 0.8-<0.9; and extreme dippers (ED), ratio <0.8. Coefficients of correlation and concordance between the ABPM values at V1 and V2 and the reproducibility of the RD, ND, D and ED patterns were calculated by the percentage of the same profile from V1 to V2. RESULTS Mean 24-h blood pressure (BP) at V1 and V2 was 126.8/75.9±0.5/0.5 vs. 126.5/75.7±0.5/0.4 mmHg (NS). Nighttime SBP fall was 9.8±0.4 (V1) and 9.6±0.3% (V2) (NS). The correlation coefficient of ABPM data at V1 vs. at V2 was 0.41-0.69 (p<0.001) and the concordance coefficient was 0.34-0.57 (p<0.01). At V1, 38 subjects were classified as ED (7.9%); D, n=216 (44.9%), 187 as ND (38.9%) and 40 as RD (8.3%). At V2 only 26.3% of ED, 44.9% of D, 54.5% of ND and 40% of RD maintained the same profile as at V1. CONCLUSION In untreated subjects ABPM has high reproducibility for mean values but only modest reproducibility for circadian profiles, thereby challenging the prognostic value of BP dipping patterns.
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Affiliation(s)
- Miguel Monte
- Departamento de Medicina & Cintesis, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Mariana Cambão
- Departamento de Medicina & Cintesis, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - José Mesquita Bastos
- Departamento Medicina, Escola Superior de Saúde da Universidade de Aveiro, Aveiro, Portugal
| | - Jorge Polónia
- Departamento de Medicina & Cintesis, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
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Minamisawa M, Izawa A, Motoki H, Kashima Y, Hioki H, Abe N, Miura T, Ebisawa S, Miyashita Y, Koyama J, Ikeda U. Prognostic Significance of Neuroadrenergic Dysfunction for Cardiovascular Events in Patients With Acute Myocardial Infarction. Circ J 2015; 79:2238-45. [PMID: 26155851 DOI: 10.1253/circj.cj-15-0265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The dysregulation of systemic blood pressure (BP) variation or cardiac neuroadrenergic dysfunction is associated with adverse cardiovascular events. We aimed to clarify the prognostic significance of neuroadrenergic dysfunction for cardiovascular events in patients with acute myocardial infarction (AMI). METHODS AND RESULTS We enrolled 63 AMI patients (mean age, 67±12 years) underwent ambulatory BP monitoring (ABPM) and cardiac iodine-(123)metaiodobenzylguanidine (MIBG) imaging within 4 weeks after AMI onset. We analyzed the circadian BP pattern and heart-to-mediastinum (H/M) MIBG uptake ratio. All the patients were followed for 2 years. The study endpoint was a composite of major adverse cardiovascular events, including all-cause death, MI, coronary revascularization except for the MI culprit lesion, and stroke. Patients with a non-dipper pattern (n=29) or an H/M ratio <1.96 (n=28) had a worse prognosis than those with either a dipper pattern (n=34) or an H/M ratio ≥1.96 (n=35; log-rank, P=0.013 and 0.010, respectively). Patients with both a non-dipper pattern and an H/M ratio <1.96 (n=12) had a significantly worse prognosis than did the other patients (P=0.0020). CONCLUSIONS Dysregulation of BP variation and cardiac MIBG uptake were associated with cardiovascular events following AMI. Examining ABPM with MIBG imaging may potentially improve risk stratification in these patients.
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