Morning blood pressure surge and diastolic dysfunction in patients with masked hypertension

The relationship between morning blood pressure surge and asymptomatic episodes of paroxysmal atrial fibrillation in patients with systemic arterial hypertension

BACKGROUND

Hypertension is a known risk factor for developing atrial fibrillation. However, there is limited data to investigate the association between morning blood pressure surge (MBPS) and paroxysmal atrial fibrillation (PAF). We conducted the present study to determine whether there is a relationship between asymptomatic PAF and MBPS and whether MBPS may be a predictor of asymptomatic PAF episodes.

METHODS

This prospective study comprised 264 adult patients who were newly diagnosed with essential hypertension or were previously diagnosed but not receiving regular antihypertensive therapy. We evaluated the patients in 2 groups according to their 24-h electrocardiography monitoring results: group 1 included patients who exhibited PAF (n = 32, 23 females/9 males; mean age 60.2 ± 7.4 years) and group 2 included patients with no signs of PAF as a control group (n = 232, 134 females/98 males; mean age 56.9 ± 9.4 years). We calculated the MBPS as the difference between mean systolic blood pressure (SBP) in the 2 h after getting up and the minimum nocturnal SBP.

RESULTS

: MBPS values were significantly higher in group 1 than in group 2 (35.3 ± 7.0 vs. 22.0 ± 6.7, p < 0.001). MBPS was positively associated with left atrial diameter (LAD) (r = 0.441, p < 0.001), left ventricle mass index (LVMI) (r = 0.235, p < 0.001), the ratio of early (E) peak of mitral inflow velocity to early (Em) diastolic mitral annular velocity (E / Em) (r = 0.239, p < 0.001), 24-h mean (r = 0.270, p < 0.001) and daytime SBP (r = 0.291, p < 0.001). We determined a cut-off value for MBPS as 28.6 for predicting PAF episodes development and identified LAD and MBPS as independent risk factors for PAF.

DISCUSSION

Patients who had larger MBPS were observed to have higher PAF incidence. MBPS values may be sensitive in predicting asymptomatic episodes of paroxysmal atrial fibrillation.

Clinical usability of morning surge blood pressure for predicting future hypertension in a young population

Objective    Early diagnosis of hypertension (HT) is a critical issue for physicians. This study was conducted to determine if morning surge blood pressure (MSBP) could be used to predict future HT. The study also examined which demographic data in a regression model might help to detect future HT without any invasive procedure.Material and methods    A young population between 18 and 40 yrs of age was included in the study. MSBP and demographic data were used to determine an optimal model for predicting future HT by using Bayesian information criteria and binary logistic regression.Results    1321 patients with 24 hr ambulatory blood pressure monitoring were included in this study. The odds ratio of 10 units of increase in diastolic MSBP was 1.173511 in the model, which indicates that a 10 mmHg increase in diastolic MSBP increases the odds of future HT in the patient by 17.4 %. The odds ratio of age was 1.096365, meaning that at each age above 18 yrs, the patients' odds of future HT rise by 9.6 %. The odds ratios for gender (male) and previous HT were 1.656986 and 3.336759, respectively. The odds of future HT in males were 65 % higher than for females, and a history of HT implies that the odds of future HT were higher by 230 %.Conclusion    Diastolic MSBP can be used to predict HT in young individuals. In addition, age, male gender, and previous HT add more predictive power to diastolic MSBP. This statistically significant, predictive model could be useful in lessening or preventing future HT.

Association of Morning Surge and Postexercise Heart Rate and Blood Pressure Recovery

INTRODUCTION

The autonomic nervous system plays an active role in the regulation of early morning blood pressure (BP) and BP/pulse regulation in the treadmill exercise test (TET).

AIM

We evaluated the relationship between BP/pulse changes during TET and morning blood pressure surge (MS).

METHODS

Patients who underwent ambulatory blood pressure measurement (ABPM) and TET in the same visit between 2017 and 2020 were evaluated retrospectively. Patients with previously diagnosed hypertension and/or using antihypertensives and office BP ≥ 140/90 were excluded from the study.MS values and dipping percentage were calculated from ABPM data. The patients were analyzed by dividing them into two groups according to the MS median, and BP/pulse values during exercise and recovery periods were compared in these groups.

RESULTS

202 patients [median age 45 (39-51), male 134 (66.3%)] were included in the study. MS median was 18.5 (10.75-27) mmHg. TET recovery period 3rd-min systolic blood pressure (RSBP) was higher in the group with high MS (p: 0.017). Systolic and diastolic dipping percentages were higher in the group with higher MS (p: 0.015, p: 0.040, respectively). Peak systolic and diastolic BP, RSBP, and recovery 3rd min diastolic BP were positively correlated with MS (p < 0.05, for all). Additionally, an independent relationship was observed between RSBP and MS (β: 0.205, p: 0.028).

CONCLUSION

We found an independent association between RSBP and MS. Increased RSBP may be associated with target organ damage and cardiovascular events such as MS.

Can Systemic Immune-Inflammation Index Detect the Presence of Exxaggerated Morning Blood Pressure Surge in Newly Diagnosed Treatment-Naive Hypertensive Patients?

Background: The exaggerated morning blood pressure surge (MS) is associated with target organ damage and cardiovascular events. Systemic immune-inflammation index (SII) has been detected as a useful marker in tumors and cardiovascular diseases. The role of inflammation in the pathogenesis of hypertension is a well-known issue. We aimed to investigate whether there is an association between SII and exaggerated MS in newly diagnosed treatment-naive hypertensive patients.Material and Methods: In total, 343 newly diagnosed in clinical and 24-h ambulatory blood pressure (BP) monitoring treatment-naive hypertensive patients were included in this study. Morning surge was defined as the difference between morning BP, which was the mean of BP during 2 h after wake-up, and the lowest BP, which was the mean of three lowest BP during nighttime. A cutoff value of 52.1 mmHg was used to discriminate the high- and low value MS groups. SII was calculated based on neutrophil, platelet, and lymphocyte counts.Results: Neutrophil, platelet, SII, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) were higher, whereas lymphocyte counts were lower in the high-value MS than the low-value MS. These indices were all independently associated with exaggerated MS and SII was superior to all other indices for detecting the presence of exaggerated MS. SII was moderately correlated with morning BP surge (r: 0.489, p < 0.0001).Conclusion: SII was higher in patients with exaggerated MS and was independently associated with exaggerated MS. Furthermore, SII might be a better indicator than platelet, neutrophil, lymphocyte, NLR, and PLR for the presence of exaggerated MS.