1
|
Zhang C, Yao L, Liu M, Zhou Y. Features of cardiovascular magnetic resonance native T1 mapping in maintenance hemodialysis patients and their related factors. Ren Fail 2024; 46:2310078. [PMID: 38293793 PMCID: PMC10833117 DOI: 10.1080/0886022x.2024.2310078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/21/2024] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Increased myocardial T1 values on cardiovascular MRI (CMRI) have been shown to be a surrogate marker for myocardial fibrosis. The use of CMRI in patients on hemodialysis (HD) remains limited. This research aimed to explore the characteristics of native T1 values in HD patients and identify factors related to T1 values. METHODS A total of thirty-two patients on HD and fourteen healthy controls were included in this study. All participants underwent CMRI. Using modified Look-Locker inversion recovery (MOLLI) sequence, native T1 mapping was achieved. Native CMRI T1 values were compared between the two groups. In order to analyze the relationship between T1 values and clinical parameters, correlation analysis was performed in patients on HD. RESULTS Patients on HD exhibited elevated global native T1 values compared to control subjects. In the HD group, the global native T1 value correlated positively with intact parathyroid hormone (iPTH) (r = 0.418, p = 0.017) and negatively with triglycerides (r= -0.366, p = 0.039). Moreover, the global native T1 value exhibited a positive correlation with the left ventricular end-diastolic volume indexed to body surface area (BSA; r = 0.528, p = 0.014), left ventricular end-systolic volume indexed to BSA (r = 0.506, p = 0.019), and left ventricular mass indexed to BSA (r = 0.600, p = 0.005). A negative correlation was observed between the global native T1 value and ejection fraction (r = 0.-0.551, p = 0.010). CONCLUSION The global native T1 value was prolonged in HD patients compared with controls. In the HD group, the global T1 value correlated strongly with iPTH, triglycerides, and cardiac structural and functional parameters.
Collapse
Affiliation(s)
- Changqin Zhang
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lijing Yao
- Department of Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yilun Zhou
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
2
|
Yang S, Zhou Z, Miao H, Zhang H, Zhou Q, Zhai M, Zhang Y. Validation of the Raycome model M2 ambulatory blood pressure monitor in the general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization Universal Standard (ISO 81060-2:2018). Blood Press Monit 2024; 29:161-165. [PMID: 38390625 PMCID: PMC11045396 DOI: 10.1097/mbp.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/15/2023] [Indexed: 02/24/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the accuracy of the Raycome model M2 oscillometric upper-arm blood pressure (BP) monitor developed for ambulatory BP measurement in the general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Universal Standard (ISO 81060-2:2018) at rest and during dynamic exercise. METHOD Subjects were recruited to fulfill the age, gender, BP and cuff distribution criteria of the AAMI/ESH/ISO Universal Standard in the general population using the same arm sequential BP measurement method. Three cuffs of the test device were used for arm circumference 18-22 cm (small), 22-32 cm (medium) and 32-42 cm (large). RESULTS For the general validation study, 106 subjects were recruited and 85 were analyzed. For validation criterion 1, the mean ± SD of the differences between the test device and reference BP readings was 0.5 ± 6.2/-0.2 ± 5.1 mmHg (systolic/diastolic). For criterion 2, the SD of the mean BP differences between the test device and reference BP per subject was 5.23/4.50 mmHg (systolic/diastolic). In the ambulatory validation study ( N = 35), the mean difference was 0.4 ± 5.9/-1.1 ± 5.8 mmHg. The Raycome model M2 performed well against the standard in both the general and ambulatory validations and the Bland-Altman plots did not show any systematic variation in the error. CONCLUSION These data show that the Raycome model M2 monitor meets the requirements of the AAMI/ESH/ISO Universal Standard (ISO 81060-2:2018) and in the ambulatory setting, indicating its suitability for measuring BP in the general population.
Collapse
Affiliation(s)
- Shijie Yang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhanyang Zhou
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanhuan Miao
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongye Zhang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiong Zhou
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mei Zhai
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuqing Zhang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
3
|
Silva MVR, Carvalho AB, Manfredi SR, Cassiolato JL, Canziani MEF. Effect of medium cut-off and high-flux hemodialysis membranes on blood pressure assessed by ambulatory blood pressure monitoring. Artif Organs 2024; 48:433-443. [PMID: 38409907 DOI: 10.1111/aor.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/20/2023] [Accepted: 01/23/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Hypertension is one of the most critical risk factors for cardiovascular disease, which is the leading cause of death in hemodialysis (HD) patients. Medium cut-off (MCO) membrane increases the clearance of medium molecules, which could improve blood pressure (BP) control. This study aimed to compare the effect of MCO and high-flux hemodialysis membranes on BP assessed by ambulatory blood pressure monitoring (ABPM). METHODS This is a pre-established secondary analysis of a 28-week, randomized, open-label crossover clinical trial. Patients were randomized to HD with MCO or high-flux membranes over 12 weeks, followed by a 4-week washout period, and then switched to the alternate membrane treatment for 12 weeks. ABPM was started before the HD session and ended at least 24 h later in weeks 1, 12, 16, and 28. RESULTS 32 patients, 59% male, with a mean age of 52.7 years, and 40% with unknown CKD etiology, were enrolled. The dialysis vintage was 8 years, and more than 70% of the patients had hypertension. Regarding 24-h BP control, morning diastolic BP showed an increase in the high-flux compared to stability in the MCO group (interaction effect, p = 0.039). The adjusted ANOVA models showed no significant difference in the morning BP levels between the groups. Considering only the period of the HD session, patients in the MCO, compared to those in the high-flux membrane group, showed greater BP stability during dialysis, characterized by smaller variation in the pre-post HD systolic and minimum systolic BP (treatment effect, p = 0.039, and p = 0.023, respectively). CONCLUSIONS MCO membrane seems to have a beneficial effect on morning BP and favors better BP stability during HD sessions.
Collapse
|
4
|
Wu S, Li S, Huang J, Yu J, Wei C, Wei L, Zhu S, Chen S, Chen M, Li J. The association between blood pressure variability and renal damage in patients with primary aldosteronism. J Clin Hypertens (Greenwich) 2024. [PMID: 38689511 DOI: 10.1111/jch.14824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 03/15/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024]
Abstract
This research examines the association between blood pressure variability (BPV) and renal damage in a cohort of 129 primary aldosteronism (PA) patients, employing ambulatory blood pressure monitoring (ABPM) for comparative analysis with individuals diagnosed with essential hypertension (EH). The study reveals that PA patients exhibited significantly elevated levels of cystatin C and urine microalbumin/creatinine ratio (UACR). Additionally, a higher prevalence of non-dipping blood pressure patterns in PA patients suggests an increased risk of circadian blood pressure regulation disturbances. Notably, while most BPV indices were comparable between the two groups, the standard deviation of 24-h weighted diastolic blood pressure was markedly lower in the PA cohort, distinguishing it as a unique variable. Through multiple linear regression analysis, the duration of hypertension, angiotensin II concentrations, and daytime systolic blood pressure standard deviation emerged as significant determinants of estimated glomerular filtration rate (eGFR) in PA patients. Furthermore, UACR was significantly influenced by variables including the 24-h weighted standard deviation (wSD) of systolic BP, glycosylated hemoglobin levels, nocturnal systolic BP peaks, aldosterone-renin ratio (ARR), and total cholesterol, with the most pronounced association observed with the 24-h wSD of systolic BP (β = 0.383).The study also found significant correlations between the 24-h wSD of systolic BP, ARR, HbA1c, serum potassium levels, and 24-h urinary microalbumin, underscoring the critical role of the 24-h wSD of systolic BP (β = 0.267). These findings underscore the imperative of an integrated management strategy for PA, addressing the intricate interconnections among metabolic abnormalities, blood pressure variability, and renal health outcomes.
Collapse
Affiliation(s)
- Siying Wu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Sen Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jing Huang
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jie Yu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chaoping Wei
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Lixia Wei
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Shuangbei Zhu
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Shanshan Chen
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Meilan Chen
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jianling Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| |
Collapse
|
5
|
Melgarejo JD, Patil D, Mena LJ, Vatcheva KP, Garcia JA, Satizabal CL, Chavez CA, Pirela RV, Silva E, Calmon G, Lee JH, Terwilliger JD, Seshadri S, Maestre GE. Association of Variability and Hypertensive Loads in 24-h Blood Pressure With Mortality and Cardiovascular Risk. Am J Hypertens 2024; 37:323-333. [PMID: 38294177 PMCID: PMC11016833 DOI: 10.1093/ajh/hpae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Evidence shows that high 24-h blood pressure (BP) variability increases cardiovascular risk. We investigated whether 24-h BP variability relates to mortality and cardiovascular risk due to inherent variability and/or hypertensive loads in 24-h BP. METHODS A total of 1,050 participants from the Maracaibo Aging Study (mean age, 66 years; women, 67.2%) underwent 24-h ambulatory BP monitoring and were followed between 2001 and 2016. To evaluate inherent BP variability, we used average real variability (ARV) as it captures variability among consecutive BP readings. 24-h systolic BP load was the proportion (%) of systolic BP readings ≥130 mm Hg during the daytime and ≥110 during the nighttime. Our primary endpoint was total mortality and major adverse cardiovascular endpoints (MACE). Statistics included Cox proportional models. RESULTS During a median follow-up of 8.3 years, 299 participants died and 210 experienced MACE. Each +2 mm Hg (corresponding to 1-standard deviation) higher 24-h systolic ARV (mean value, 9.0 ± 2.0 mm Hg) was associated with higher hazard ratios (HRs) for mortality by 1.28-fold (95% confidence interval [CI], 1.14-1.43) and for MACE by 1.24-fold (95% CI, 1.08-1.42). Each 30% higher 24-h systolic BP load (median value, 63%) was associated with mortality and MACE with HRs of 1.29 (95% CI, 1.15-1.46) and 1.28 (95% CI, 1.10-1.48); respectively. After models were additionally adjusted by BP level, only ARV was associated with mortality (HR, 1.17; 95% CI, 1.04-1.33) and MACE (HR, 1.16; 95% CI, 1.00-1.34). CONCLUSIONS High ARV and hypertensive loads in 24-h systolic BP were associated with mortality and cardiovascular risk, however, only ARV is associated independently of the BP level.
Collapse
Affiliation(s)
- Jesus D Melgarejo
- Institute of Neuroscience, Neuro and Behavioral Health INtegrated Service Unit, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Rio Grande Valley Alzheimer’s Center (AD-RCMAR), Institute of Neuroscience, Neuro and Behavioral Health Integrated Service Unit, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Zulia, Venezuela
- South Texas Alzheimer’s Disease Center, Institute of Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Texas, USA
| | - Dhrumil Patil
- Department of General Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, Massachusetts, USA
| | - Luis J Mena
- Department of Computer Sciences, Polytechnic University of Sinaloa, Mazatlán, Sinaloa, Mexico
| | - Kristina P Vatcheva
- Institute of Neuroscience, Neuro and Behavioral Health INtegrated Service Unit, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- School of Mathematical and Statistical Science, College of Science, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Jose A Garcia
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville, Texas, USA
| | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- South Texas Alzheimer’s Disease Center, Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas, USA
| | - Carlos A Chavez
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Zulia, Venezuela
| | - Rosa V Pirela
- Institute of Neuroscience, Neuro and Behavioral Health INtegrated Service Unit, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Rio Grande Valley Alzheimer’s Center (AD-RCMAR), Institute of Neuroscience, Neuro and Behavioral Health Integrated Service Unit, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Zulia, Venezuela
- South Texas Alzheimer’s Disease Center, Institute of Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Texas, USA
| | - Egle Silva
- Laboratory of Ambulatory Recordings, Cardiovascular Institute (IECLUZ), University of Zulia, Maracaibo, Venezuela
| | - Gustavo Calmon
- Laboratory of Ambulatory Recordings, Cardiovascular Institute (IECLUZ), University of Zulia, Maracaibo, Venezuela
| | - Joseph H Lee
- Department of Psychiatry, Columbia University, New York, New York, USA
- Department of Genetics and Development, Columbia University, New York, New York, USA
- Sergievsky Center and Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, New York, USA
| | - Joseph D Terwilliger
- Department of Psychiatry, Columbia University, New York, New York, USA
- Department of Genetics and Development, Columbia University, New York, New York, USA
- Sergievsky Center and Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
- Division of Public Health Genomics, National Institute for Health and Welfare, Helsinki, Finland
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- South Texas Alzheimer’s Disease Center, Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, UT Health San Antonio, San Antonio, Texas, USA
| | - Gladys E Maestre
- Institute of Neuroscience, Neuro and Behavioral Health INtegrated Service Unit, School of Medicine, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Rio Grande Valley Alzheimer’s Center (AD-RCMAR), Institute of Neuroscience, Neuro and Behavioral Health Integrated Service Unit, University of Texas Rio Grande Valley, Harlingen, Texas, USA
- Laboratory of Neuroscience, University of Zulia, Maracaibo, Zulia, Venezuela
- South Texas Alzheimer’s Disease Center, Institute of Neuroscience, School of Medicine, University of Texas Rio Grande Valley, Texas, USA
| |
Collapse
|
6
|
Du Y, Zhu B, Liu Y, Zhou W, Du Z, Yang W, Gao C. Association between nocturnal blood pressure phenotype and adverse cardiovascular prognosis in patients with coronary heart disease and hypertension. J Clin Hypertens (Greenwich) 2024; 26:405-415. [PMID: 38450952 PMCID: PMC11007788 DOI: 10.1111/jch.14790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/16/2024] [Accepted: 02/03/2024] [Indexed: 03/08/2024]
Abstract
Nocturnal blood pressure and nighttime dipping patterns are associated with the occurrence of cardiovascular events. However, there is few research on whether riser pattern is associated with the poor prognosis of patients with coronary heart disease (CHD) and hypertension independent of nighttime systolic blood pressure (SBP). This prospective and observational clinical study included 568 hospitalized patients with CHD and hypertension. All patients underwent 24-h ambulatory blood pressure (BP) monitoring during their hospitalization. Multivariate adjusted Cox proportional hazard models were utilized to examine the associations of nocturnal blood pressure and dipping status with primary endpoint events. Additionally, Harrell's C-statistics were employed to compare the discriminative ability of each model. During the 1-year follow-up period, 64 (11.3%) primary endpoint events were recorded, including 55 (9.7%) atherosclerotic cardiovascular disease (ASCVD) events. After adjusting for demographic and clinical risk variables, nighttime SBP was significantly related to the risk of incident primary endpoint events [per 20 mm Hg increase: hazard ratio (HR) = 1.775, 95% confidence interval (CI) 1.256-2.507]. The riser pattern group exhibited a significantly higher risk for primary endpoint events compared to the dipper pattern group, even after adjusting for office SBP (HR: 2.687, 95% CI: 1.015-7.110, p = .047). Furthermore, the addition of nighttime SBP or dipping status to the base model yielded statistically significant increments in C-statistic values (p = .036 and p = .007). However, adding both nighttime SBP and dipping status did not significantly enhance the model's performance in predicting the risk of primary endpoint events and ASCVD events according to the C-index (p = .053 and p = .054), which meant that the riser pattern group did not exhibit a significantly higher risk for primary endpoint events compared to the dipper pattern group after adjusting for nighttime SBP. In conclusion, nocturnal SBP and riser pattern demonstrated an association with adverse prognosis in patients with CHD and hypertension. Notably, nocturnal SBP proved to be a more reliable predictor than dipping status.
Collapse
Affiliation(s)
- Yao Du
- Department of CardiologyZhengzhou University Central China Fuwai HospitalZhengzhouHenanChina
| | - Binbin Zhu
- Department of CardiologyZhengzhou University Central China Fuwai HospitalZhengzhouHenanChina
| | - Yahui Liu
- Department of CardiologyZhengzhou University Central China Fuwai HospitalZhengzhouHenanChina
| | - Weicen Zhou
- Department of CardiologyZhengzhou University Central China Fuwai HospitalZhengzhouHenanChina
| | - Zhou Du
- Department of CardiologyZhengzhou University Central China Fuwai HospitalZhengzhouHenanChina
| | - Wei Yang
- Department of CardiologyZhengzhou University Central China Fuwai HospitalZhengzhouHenanChina
| | - Chuanyu Gao
- Department of CardiologyZhengzhou University Central China Fuwai HospitalZhengzhouHenanChina
| |
Collapse
|
7
|
Cömerter D, Baysal T, Doğan S, Erdem A, Çınar T. Comparison of choroidal thickness and choroidal vascular index in normotensive dippers and nondippers. Rev Assoc Med Bras (1992) 2024; 70:e20230950. [PMID: 38511753 PMCID: PMC10941874 DOI: 10.1590/1806-9282.20230950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/27/2023] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the choroidal thickness and choroidal vascular index in normotensive individuals with dipping and nondipping patterns. METHODS Patients who applied to the cardiology clinic for routine checkups and underwent 24-h blood pressure monitoring were included in our study. They were divided into two groups based on their dipper status. The patients in whom systolic blood pressure decreased during the nocturnal time by 10% or more of the daily blood pressure were defined as dippers. On the contrary, patients whose nocturnal systolic blood pressure decreased by less than 10% were defined as nondippers. Choroidal thickness and choroidal vascular index were measured by spectral-domain optical coherence tomography. Central macular thickness, retinal nerve fiber layer, and ganglion cell layer (GCL) analyses were also recorded. RESULTS In total, 35 patients with dipper pattern and 34 patients with nondipper pattern were recruited. The mean subfoveal choroidal thickness was 349.72±90 μm in the dipper group and 358.54±132.5 μm in the nondipper group. The groups had no significant difference in choroidal thickness, central macular thickness, retinal nerve fiber layer, and ganglion cell layer analyses. However, the choroidal vascular index was statistically significantly lower in the nondipper group when compared to the dipper group (0.61±0.02 vs. 0.64±0.02; p<0.001). Also, the choroidal vascular index was negatively correlated with subfoveal choroidal thickness in the nondipper group (Spearman; r=-0.419; p=0.033). CONCLUSION Our study showed that the choroidal vascular index was significantly lower in nondippers than in dippers. Nondipper individuals may be affected by vascular dysregulation, leading to alterations in the choroidal circulation.
Collapse
Affiliation(s)
- Doğukan Cömerter
- University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, Department of Ophthalmology – Istanbul, Turkey
| | - Taha Baysal
- University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, Department of Ophthalmology – Istanbul, Turkey
| | - Selami Doğan
- University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, Department of Cardiology – Istanbul, Turkey
| | - Almina Erdem
- University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, Department of Cardiology – Istanbul, Turkey
| | - Tufan Çınar
- University of Health Sciences, Sultan Abdülhamid Han Training and Research Hospital, Department of Cardiology – Istanbul, Turkey
| |
Collapse
|
8
|
Gaillard-Groleas C, Ormezzano O, Pollet-Villard F, Vignal C, Gohier P, Thuret G, Rougier MB, Pepin JL, Chiquet C. Study of nycthemeral variations in blood pressure in patients with non-arteritic anterior ischemic optic neuropathy. Eur J Ophthalmol 2024:11206721241232027. [PMID: 38470323 DOI: 10.1177/11206721241232027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
PURPOSE The objective of this study was to analyze the nycthemeral variations in blood pressure (BP) in individuals who presented with non-arteritic anterior ischemic optic neuropathy (NAION). METHODS BP was recorded for 24 h (ambulatory blood pressure monitoring, ABPM) in 65 patients with acute NAION. Three definitions of nighttime periods were used: definition 1, 1 a.m.-6 a.m.; definition 2, 10 p.m.-7 a.m.; and definition 3, 10 p.m.-8 a.m. For each of these definitions, patients were classified according to the value of nocturnal reduction in BP into dippers (10-20%), mild dippers (0-10%), reverse dippers (< 0%), and extreme dippers (> 20%). RESULTS The proportions of dippers, mild dippers, reverse dippers, and extreme dippers varied significantly depending on the definition chosen. We found the highest number of patients with extreme dipping (23%) when using the strictest definition of nighttime period (definition 1, 1 a.m.-6 a.m.), as compared with 6.2% and 1.5% for the other definitions, respectively. Overall, 13 of 33 patients without known systemic hypertension (39%) were diagnosed with hypertension after ABPM. No risk factor for NAION was associated with the extreme-dipping profile. Finally, the prevalence of systemic hypertension was high (69%). CONCLUSION In our population of patients who had an episode of NAION, the proportion of extreme dippers was higher than that usually found in the literature. However, extreme dipping is not a frequent feature of patients with NAION as compared to patients with systemic hypertension. ABPM is recommended for all patients with NAION and unknown history of systemic hypertension.
Collapse
Affiliation(s)
- Claire Gaillard-Groleas
- Department of Ophthalmology, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000 Grenoble, France
| | - Olivier Ormezzano
- Department of Cardiology, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000 Grenoble, France
| | | | - Catherine Vignal
- Department of Ophthalmology, Urgences et neuro-ophtalmologie, Fondation Rothschild, 75940, Paris Cedex 19, France
- Department of Ophthalmology, Centre Hospitalier National d'Ophtalmologie, service des urgences ophtalmologiques, 75940, Paris Cedex 19, France
| | - Philippe Gohier
- Department of Ophthalmology, CHU de Angers, 21079 Dijon Cedex, France
| | - Gilles Thuret
- Department of Ophthalmology, CHU de Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France
| | - Marie-Bénédicte Rougier
- Department of Ophthalmology, CHU de Bordeaux, Hôpital Pellegrin, CHU de Bordeaux, 33000 Bordeaux, France
| | - Jean-Louis Pepin
- Univ. Grenoble Alpes, INSERM U1300, CHU Grenoble Alpes, HP2 Laboratory, 38000 Grenoble, France
- Pôle Thorax et Vaisseaux, CHU Grenoble, Université Grenoble Alpes, Grenoble, France
| | - Christophe Chiquet
- Department of Ophthalmology, CHU Grenoble Alpes, Univ. Grenoble Alpes, 38000 Grenoble, France
- Univ. Grenoble Alpes, INSERM U1300, CHU Grenoble Alpes, HP2 Laboratory, 38000 Grenoble, France
| |
Collapse
|
9
|
Khan MTF, Smith DF, Schuler CL, Witter AM, DiFrancesco MW, Armoni Domany K, Amin RS, Hossain MM. Circadian blood pressure dysregulation in children with obstructive sleep apnea. Sleep 2024; 47:zsad254. [PMID: 38092705 PMCID: PMC10851857 DOI: 10.1093/sleep/zsad254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/14/2023] [Indexed: 02/09/2024] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) adversely affects normal blood pressure (BP) and may disrupt circadian BP patterns. We sought to examine 24-hour circadian BP rhythms in children with OSA and healthy controls. METHODS Children 5-14 years with OSA and healthy controls underwent 24-hour BP monitoring and actigraphy to quantify sleep. Shape invariant statistical models compared circadian BP patterns (e.g. times of BP peaks, time arrived at peak BP velocity [TAPV]) in the OSA and control groups. RESULTS The analytic sample included 219 children (mild OSA: n = 52; moderate-to-severe OSA (MS-OSA): n = 50; controls: n = 117). In the morning, the MS-OSA group had earlier TAPV for DBP than controls (51 minutes, p < 0.001). TAPV in the evening was earlier for the MS-OSA group than controls (SBP: 95 minutes, p < 0.001; DBP: 28 minutes, p = 0.028). At mid-day, SBP and DBP velocity nadirs were earlier for the MS-OSA group than controls (SBP: 57 minutes, p < 0.001; DBP: 38 minutes, p < 0.01). The MS-OSA group reached most BP values significantly earlier than controls; the largest differences were 118 minutes (SBP) and 43 minutes (DBP) (p < 0.001). SBP and DBP were elevated in the MS-OSA group (hours 18-21 and 7--12, respectively, p < 0.01) compared to controls. The MS-OSA group was prone to "non-dipping" compared to controls (SBP: odds ratio [OR] = 2.16, 95% CI: 1.09, 4.29; DBP: OR = 3.45, 95% CI: 1.21, 10.23). CONCLUSIONS Children with MS-OSA had changes in circadian BP patterns, namely earlier TAPV and BP peaks and nadirs than controls. Circadian disturbances in BP rhythms may be key to mapping the natural history of BP dysregulation in children with OSA.
Collapse
Affiliation(s)
- Md Tareq Ferdous Khan
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Department of Mathematics and Statistics, Cleveland State University, Cleveland, OH, USA
| | - David F Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- The Center for Circadian Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Christine L Schuler
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abigail M Witter
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mark W DiFrancesco
- The Imaging Research Center, Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Keren Armoni Domany
- Pediatric Pulmonology Unit, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raouf S Amin
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Md Monir Hossain
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
10
|
Vallelonga F, Valente M, Tangari MM, Covolo A, Milazzo V, Di Stefano C, Sobrero G, Giudici M, Milan A, Veglio F, Lopiano L, Maule S, Romagnolo A. Hypotensive episodes at 24-h Ambulatory Blood Pressure Monitoring predict adverse outcomes in Parkinson's Disease. Res Sq 2024:rs.3.rs-3904996. [PMID: 38405860 PMCID: PMC10889044 DOI: 10.21203/rs.3.rs-3904996/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Purpose Neurogenic orthostatic hypotension (nOH) is a frequent non-motor feature of Parkinson's disease (PD), associated with adverse outcomes. Recently, 24-hour ambulatory BP monitoring (ABPM) has been shown to diagnose nOH with good accuracy (in the presence of at least 2 episodes of systolic BP drop ≥ 15 mmHg compared to the average 24-h). This study aims at evaluating the prognostic role of ABPM-hypotensive episodes in predicting PD disability milestones and mortality and comparing it to well-defined prognostic role of nOH. Methods PD patients who underwent ABPM from January 2012 to December 2014 were retrospectively enrolled and assessed for the development of falls, fractures, dementia, bed/wheelchair confinement, hospitalization, mortality, during an up-to-10-year follow-up. Results Ninety-nine patients (male 74%; age: 64.0 ± 10.1 years; PD duration: 6.4 ± 4.0 years) were enrolled. At baseline, 38.4% of patients had ABPM-hypotensive episodes and 46.5% had bedside nOH.At Kaplan-Meier analysis patients with ABPM-hypotensive episodes had an earlier onset of falls (p = 0.001), fractures (p = 0.004), hospitalizations (p = 0.009), bed/wheelchair confinement (p = 0.032), dementia (p = 0.001), and showed a shorter survival (8.0vs9.5 years; p = 0.009). At Cox regression analysis (adjusted for age, disease duration, Charlson Comorbidity Index, and H&Y stage at baseline) a significant association was confirmed between ABPM-hypotensive episodes and falls (OR:3.626; p = 0.001), hospitalizations (OR:2.016; p = 0.038), and dementia (OR:2.926; p = 0.008), while bedside nOH was only associated with falls (OR 2.022; p = 0.039) and dementia (OR:1.908; p = 0.048). Conclusion The presence of at least two ABPM-hypotensive episodes independently predicted the development of falls, dementia, and hospitalization, showing a stronger prognostic value than the simple bedside assessment.
Collapse
Affiliation(s)
| | - Matteo Valente
- Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Marta Maria Tangari
- Università degli Studi di Torino Dipartimento di Neuroscienze 'Rita Levi Montalcini': Universita degli Studi di Torino Dipartimento di Neuroscienze Rita Levi Montalcini
| | - Anna Covolo
- Universita degli Studi di Torino Dipartimento di Neuroscienze Rita Levi Montalcini
| | - Valeria Milazzo
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Cristina Di Stefano
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Gabriele Sobrero
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Marta Giudici
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Alberto Milan
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Franco Veglio
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Leonardo Lopiano
- University of Turin Department of Neurosciences Rita Levi Montalcini: Universita degli Studi di Torino Dipartimento di Neuroscienze Rita Levi Montalcini
| | - Simona Maule
- Università degli Studi di Torino Dipartimento di Scienze Mediche: Universita degli Studi di Torino Dipartimento di Scienze Mediche
| | - Alberto Romagnolo
- University of Turin Department of Neurosciences Rita Levi Montalcini: Universita degli Studi di Torino Dipartimento di Neuroscienze Rita Levi Montalcini
| |
Collapse
|
11
|
Hornstrup BG, Rosenbæk JB, Hoffmann-Petersen N, Bech JN. Screening for hypertension in adults - the use of tonometric blood pressure monitoring. Blood Press Monit 2024; 29:15-22. [PMID: 37678188 PMCID: PMC10766095 DOI: 10.1097/mbp.0000000000000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 08/26/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Arterial hypertension increases the risk of developing cardiovascular disease. Reliable screening tools for diagnosing hypertension are important to ensure correct risk stratification of subjects. In this study, we aimed to analyse if a wrist-worn device using a tonometric technique for measuring of 24-hour blood pressure could be used to diagnose hypertension and non-dipping. A conventional device using oscillometric measurements was used as golden standard. Secondary aim was to compare the degree of discomfort related to monitoring with the two devices. METHODS In 89 subjects with a history of normal blood pressure and naive to ambulatory BP monitoring (ABPM), 24-hour ABPM was measured simultaneously with A&D TM2430 (oscillometric technique) and BPro (tonometric technique). RESULTS When comparing measurements from the two devices, we found that the tonometric device misclassified 46% of hypertensive subjects and 69% of non-dippers. The tonometric device measured significantly lower systolic 24-hour and daytime blood pressure. The subjects reported less discomfort related to the tonometric than the oscillometric device. CONCLUSION Despite less discomfort related to usage of the tonometric device for 24-hour blood pressure monitoring compared to an oscillometric device, misclassification of hypertension and non-dipping makes the tonometric device inappropriate as a screening instrument.
Collapse
Affiliation(s)
- Bodil G. Hornstrup
- Department of Medicine, Gødstrup Hospital, University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark
| | - Jeppe B. Rosenbæk
- Department of Medicine, Gødstrup Hospital, University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark
| | - Nikolai Hoffmann-Petersen
- Department of Medicine, Gødstrup Hospital, University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark
| | - Jesper N. Bech
- Department of Medicine, Gødstrup Hospital, University Clinic in Nephrology and Hypertension, Gødstrup Hospital and Aarhus University, Herning, Denmark
| |
Collapse
|
12
|
Zanuzzi MG, López SM, Cattaneo MJ, Pérez-Maure MA, Lahiri CD, Romero CA. Isolated Nocturnal Hypertension in People Living With Human Immunodeficiency Virus: A Cross-Sectional Study. Am J Hypertens 2024; 37:127-133. [PMID: 37777195 DOI: 10.1093/ajh/hpad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/04/2023] [Accepted: 09/20/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Nocturnal hypertension (NH) is a potent cardiovascular risk factor described frequently in people with HIV (PWH). Isolated NH (INH) is less well reported in PWH because of the need for ambulatory blood pressure monitoring (ABPM) in office normotensive patients. We aim to document the prevalence of NH and INH and the clinical factors associated with these phenotypes. METHODS Cross-sectional study from an HIV program in Argentina. Office and ABPM measurements, as well as clinical and laboratory exploration, were performed. We defined INH as NH with daytime normotension in patients with office normotension. RESULTS We obtained ABPM in 66 PWH, 60% male, aged 44.7 (IQR 27-69) years; 87% receiving antiretroviral therapy, and 86.2% virologically suppressed. ABPM-based hypertension prevalence was 54.7% (95% CI: 42.5-66.3). The prevalence of NH was 48.5% (32/66), while the INH prevalence was 19.7% (95% CI: 11.7-30.9). No differences were found regarding sex, HIV viral load, CD4+ T lymphocytes count, or years of infection between normotensive and INH patients. Multiple linear regression model adjusted for sex and age determined that body mass index (β = 0.93, P < 0.01), plasma uric acid (β = 0.25, P = 0.04), plasma potassium (β = -10.1, P = 0.01), and high-sensitivity C-reactive protein (hs-CRP) (β = 0.78, P = 0.02) independently predicted nocturnal systolic blood pressure (BP) in PWH. In a multiple logistic regression model adjusted for age and sex, the presence of sedentariness, plasma potassium <4 mEq/L, BMI, and hs-CRP levels were predictors of INH. CONCLUSION INH is highly prevalent in PWH. Metabolic and inflammatory markers predict nocturnal SBP in PWH.
Collapse
Affiliation(s)
- Matias G Zanuzzi
- Servicio de Clínica Médica, Hospital Privado de Córdoba, Córdoba, Argentina
| | - Silvina M López
- Servicio de Clínica Médica, Hospital Rawson de Córdoba, Córdoba, Argentina
| | - Máximo J Cattaneo
- Servicio de Clínica Médica, Hospital Rawson de Córdoba, Córdoba, Argentina
| | | | - Cecile D Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Cesar A Romero
- Renal Division, Department of Medicine, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
13
|
Lipski D, Marzyńska D, Sytek P, Rzesoś P, Rabiza A, Żurek S, Radziemski A, Stryczyński Ł, Tykarski A, Uruski P. Obesity in Hypertensive Patients Is Characterized by a Dawn Phenomenon in Systolic Blood Pressure Values and Variability. J Clin Med 2024; 13:371. [PMID: 38256505 PMCID: PMC10816240 DOI: 10.3390/jcm13020371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/31/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
One of the causes of hypertension is excess weight gain, which can also affect the course of this disease. Both the diagnosis and management of hypertension commonly use ambulatory blood pressure monitoring; the results of which correlate more strongly with cardiovascular diseases and cardiovascular death than office blood pressure monitoring. We evaluated blood pressure values and their variability from hour to hour to see if and when they differed between hypertensive patients with and without obesity. The study included 1345 patients who underwent 24 h ambulatory blood pressure monitoring and then were divided into groups according to body mass index and waist circumference. The obtained data were analyzed according to the subjects' wake-up time, and short-term blood pressure variability parameters were calculated as the mean of the absolute values of the differences between consecutive measurements. The systolic blood pressure in obese subjects was significantly higher between 1 and 5 h before waking than in normal-weighted individuals. In turn, the variability in systolic and diastolic blood pressure was higher with increasing body mass index. The difference in systolic blood pressure values and blood pressure variability was most prominent in the last 5 h of sleep in obese patients.
Collapse
Affiliation(s)
- Dawid Lipski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
| | - Dorota Marzyńska
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
| | - Paulina Sytek
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
| | - Patrycja Rzesoś
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
| | - Agnieszka Rabiza
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
| | - Sebastian Żurek
- Institute of Physics, University of Zielona Gora, 65-516 Zielona Gora, Poland
| | - Artur Radziemski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
| | - Łukasz Stryczyński
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
| | - Andrzej Tykarski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
| | - Paweł Uruski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznan University of Medical Sciences, 61-848 Poznan, Poland
| |
Collapse
|
14
|
Kasap Demir B, Başaran C, Demircan T, Erfidan G, Özdemir Şimşek Ö, Arslansoyu Çamlar S, Alaygut D, Mutlubaş F, Karadeniz C. The Effect of "Unclassified" Blood Pressure Phenotypes on Left Ventricular Hypertrophy. Turk Arch Pediatr 2024; 59:43-48. [PMID: 38454259 PMCID: PMC10837538 DOI: 10.5152/turkarchpediatr.2024.23109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/17/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVE We aimed to evaluate the clinical significance of the "unclassified" blood pressure phenotypes on left ventricular hypertrophy in children. MATERIALS AND METHODS All children evaluated with ambulatory blood pressure monitoring in the pediatric nephrology department between October 2018 and January 2021 were included in the study. Prehypertension, normotensive, white coat hypertension, masked hypertension, ambulatory hypertension groups and 2 other groups including increased blood pressure load, normal ambulatory blood pressure measurements, but normal (unclassified group 1) or high (unclassified group 2) office blood pressure measurements were defined according to the American Heart Association 2014 statement. Left ventricular mass index, left ventricular mass index/95 percentile values, and left ventricular hypertrophy ratios were compared between the groups separately to establish the influence of the unclassified cases. RESULTS A total of 497 children were included. There were 52 cases in normotensive, 47 cases in unclassified group 1, 50 cases in masked hypertension, 79 cases in white coat hypertension, 104 cases in unclassified group 2, and 165 cases in the ambulatory hypertension group. Left ventricular mass index/95 percentile and left ventricular hypertrophy in masked hypertension were significantly higher than normotensive but similar between normotensive and unclassified group 1 groups. Left ventricular hypertrophy was significantly higher in the ambulatory hypertension group compared to white coat hypertension, and similar between white coat hypertension and unclassified group 2 groups. CONCLUSION Independent of age, we have found that interpretation of blood pressure load not only has a limited predictable effect on left ventricular hypertrophy but also causes a large group of patients to be unclassified. Cite this article as: Kasap-Demir B, Başaran C, Demircan T, et al. The effect of "unclassified" blood pressure phenotypes on left ventricular hypertrophy. Turk Arch Pediatr. 2024;59(1):43-48.
Collapse
Affiliation(s)
- Belde Kasap Demir
- Division of Pediatric Nephrology and Rheumatology, Department of Pediatrics, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Turkey
| | - Cemaliye Başaran
- Division of Nephrology, Department of Pediatrics, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Tülay Demircan
- Division of Cardiology, Department of Pediatrics, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Gökçen Erfidan
- Department of Pediatric Nephrology, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Özgür Özdemir Şimşek
- Department of Pediatric Nephrology, University of Health Sciences, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Seçil Arslansoyu Çamlar
- Department of Pediatric Nephrology, University of Health Sciences School of Medicine, İzmir, Turkey
| | - Demet Alaygut
- Department of Pediatric Nephrology, University of Health Sciences School of Medicine, İzmir, Turkey
| | - Fatma Mutlubaş
- Department of Pediatric Nephrology, University of Health Sciences School of Medicine, İzmir, Turkey
| | - Cem Karadeniz
- Division of Cardiology, Department of Pediatrics, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Turkey
| |
Collapse
|
15
|
Abstract
AIMS To explore the relationship between diurnal blood pressure (BP) pattern and season. METHODS A total of 6765 eligible patients (average age 57.35 ± 15.53 years; male 51.8%; hypertensives 68.8%) from 1 October 2016 to 6 April 2022 were enrolled, who were divided into four dipper groups, dipper, non-dipper, riser, and extreme-dipper, according to the diurnal BP pattern calculated using their ambulatory BP monitoring data. The season which the patient was in was determined by the time of ambulatory BP monitoring examination. RESULTS Among the 6765 patients, 2042 (31.18%) were grouped into dipper, 380 (5.6%) into extreme-dipper, 1498 (22.1%) into riser and 2845 (42.1%) into non-dipper. Only the dipper subjects showed age difference among seasons, with the average age significantly lower in winter. There was no seasonal difference in age for the other types. No seasonal difference was revealed in gender, BMI, hypertension or not. Diurnal BP patterns significantly differed among seasons (P < .001). Post hoc tests with Bonferroni correction indicated the significantly different diurnal BP pattern between any two seasons (P < .001), but not between spring and autumn (P = .257), and the significance of the P value was assessed at 0.008 (0.05/6) after Bonferroni correction. Multinomial logistic regression suggested season as an independent contributor to diurnal BP pattern. CONCLUSION Diurnal BP pattern is influenced by season.
Collapse
Affiliation(s)
- Xinyue Du
- Cardiovascular Medicine Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingli Wang
- Cardiovascular Medicine Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenyi He
- Cardiovascular Medicine Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Fu
- Cardiovascular Medicine Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingjiao Zhang
- Cardiovascular Medicine Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Zhou
- Cardiovascular Medicine Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuying Han
- Cardiovascular Medicine Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guolan Deng
- Cardiovascular Medicine Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
16
|
Jiang X, Li X, Peng H, Li M, Wang C. Prognostic Value of Nighttime Double Product in Nondialysis Chronic Kidney Disease With Hypertension. J Am Heart Assoc 2023; 12:e031627. [PMID: 38108241 PMCID: PMC10863753 DOI: 10.1161/jaha.123.031627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Both nighttime systolic blood pressure and pulse rate are associated with adverse outcomes in patients with chronic kidney disease (CKD). However, nighttime double product (DP), which is the product of nighttime systolic blood pressure and pulse rate, has not yet been investigated in this context. The present study aimed to explore the prognostic value of nighttime DP for adverse outcomes in patients with CKD and hypertension. METHODS AND RESULTS This retrospective cohort study included a total of 1434 patients with nondialysis CKD complicated by hypertension. The patients were enrolled in Zhuhai and Guangzhou, China, with a median follow-up of 23.8 months. Patient enrollment for the high or low nighttime DP group was performed on the basis of the cutoff value determined by time-dependent receiver operator characteristic curve analysis. The primary end point was a composite of major cardiovascular and cerebrovascular events, and the secondary end point was all-cause death and composite renal end point. The 24-hour circadian DP rhythm was established via multiple-component cosinor analysis. Cox regression was used to explore the association between nighttime DP and adverse outcomes. The DP of nondialysis patients with CKD and hypertension showed a diurnal rhythm, which varied with renal function. After adjustment, high nighttime DP was associated with a higher risk for major cardiovascular and cerebrovascular events (hazard ratio [HR], 5.823 [95% CI, 2.382-14.233]), all-cause death (HR, 4.978 [95% CI, 2.205-11.240]), and composite renal event (HR, 1.661 [95% CI, 1.128-2.447]), compared with low nighttime DP. These associations were independent of nighttime systolic blood pressure and PR. CONCLUSIONS The present cohort study demonstrated that DP had diurnal fluctuations and nighttime DP was an important prognostic factor in nondialysis patients with CKD and hypertension, outperforming traditional risk factors, including systolic blood pressure and pulse rate.
Collapse
Affiliation(s)
- Xinying Jiang
- Division of Nephrology, Department of MedicineThe Fifth Affiliated Hospital Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Xuehong Li
- Division of Nephrology, Department of MedicineThe Fifth Affiliated Hospital Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Hui Peng
- Division of Nephrology, Department of MedicineThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouGuangdongChina
| | - Man Li
- Guangdong Provincial Key Laboratory of Biomedical ImagingThe Fifth Affiliated Hospital Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Cheng Wang
- Division of Nephrology, Department of MedicineThe Fifth Affiliated Hospital Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| |
Collapse
|
17
|
Mizuno H, Choi E, Kario K, Muntner P, Fang CL, Liu J, Sangapalaarachchi DN, Lam M, Yano Y, Schwartz JE, Shimbo D. Diagnostic Accuracy of Office Blood Pressure Measurement and Home Blood Pressure Monitoring for Hypertension Screening Among Adults: Results From the IDH Study. J Am Heart Assoc 2023; 12:e030150. [PMID: 38084733 PMCID: PMC10863761 DOI: 10.1161/jaha.123.030150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Using high awake blood pressure (BP; ≥130/80 mm Hg) on ambulatory BP monitoring (ABPM) as a reference, the purpose of this study was to determine the accuracy of high office BP (≥130/80 mm Hg) at an initial visit and high confirmatory office BP (≥130/80 mm Hg), and separately, high home BP (≥130/80 mm Hg) among participants with high office BP (≥130/80 mm Hg) at an initial office visit. METHODS AND RESULTS The accuracy of office BP measurements using the oscillometric method for detecting high BP on ABPM was determined among 379 participants with complete office BP and ABPM data in the IDH (Improving the Detection of Hypertension) study. For detecting high BP on ABPM, the accuracy of high confirmatory office BP using the oscillometric method and, separately, high home BP was also determined among the subgroup of 122 participants with high office BP at an initial visit and complete home BP monitoring data. High office BP had moderate sensitivity (0.61 [95% CI, 0.53-0.68]) and high specificity (0.85 [95% CI, 0.80-0.90]) for high awake BP. High confirmatory office BP and high home BP had moderate sensitivity (0.69 [95% CI, 0.59-0.79] and 0.79 [95% CI, 0.71-0.87], respectively) and low and moderate specificity (0.44 [95% CI, 0.27-0.61] and 0.72 [95% CI, 0.56-0.88], respectively). CONCLUSIONS Many individuals with high BP on ABPM do not have high office BP. Confirmatory office BP and home blood pressure monitoring also had limited ability to identify individuals with high BP on ABPM.
Collapse
Affiliation(s)
- Hiroyuki Mizuno
- The Columbia Hypertension Center and LabColumbia University Irving Medical CenterNew YorkNY
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Eunhee Choi
- The Columbia Hypertension Center and LabColumbia University Irving Medical CenterNew YorkNY
| | - Kazuomi Kario
- Division of Cardiovascular MedicineJichi Medical University School of MedicineTochigiJapan
| | - Paul Muntner
- Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamAL
| | - Chloe L. Fang
- The Columbia Hypertension Center and LabColumbia University Irving Medical CenterNew YorkNY
| | - Justin Liu
- The Columbia Hypertension Center and LabColumbia University Irving Medical CenterNew YorkNY
| | | | - Michael Lam
- The Columbia Hypertension Center and LabColumbia University Irving Medical CenterNew YorkNY
| | - Yuichiro Yano
- Noncommunicable Disease (NCD) Epidemiology Research CenterShiga University of Medical ScienceShigaJapan
- Department of Family Medicine and Community HealthDuke UniversityDurhamNC
| | - Joseph E. Schwartz
- Center for Behavioral Cardiovascular HealthColumbia University Irving Medical CenterNew YorkNY
- Department of Psychiatry and Behavioral SciencesStony Brook UniversityStony BrookNY
| | - Daichi Shimbo
- The Columbia Hypertension Center and LabColumbia University Irving Medical CenterNew YorkNY
| |
Collapse
|
18
|
Hsu CN, Liao WT, Chen WL, Chang-Chien GP, Lin S, Tain YL. Plasma and Urinary Platelet Factor 4 as Biomarkers for Cardiovascular Risk in Children with Chronic Kidney Disease. Biomedicines 2023; 11:3318. [PMID: 38137539 PMCID: PMC10741387 DOI: 10.3390/biomedicines11123318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/02/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
Children suffering from chronic kidney disease (CKD) have a high risk of cardiovascular disease (CVD). The early detection and diagnosis of subclinical CVD in pediatric CKD can reduce mortality later in life. Plasma factor 4 (PF4) is a chemokine released by activated platelets. We examined whether or not PF4 in the plasma and urine, its kidney function normalized ratio, and fractional excretion have differential associations with CVD risk markers in 139 youths aged 3 to 18 years old with CKD stages G1-G4. Significant negative correlations were observed between plasma PF4 and cardiovascular surrogate markers, such as the left ventricular mass index (LVMI), carotid intima-media thickness (cIMT), and pulse wave velocity (PWV). The plasma PF4/creatinine (Cr) ratio was lower in CKD children with a high daytime BP and 24 h BP, high BP load, and nocturnal non-dipping status. After adjusting for confounders, the plasma PF4 and plasma PF4/Cr ratio still independently predicted an abnormal ABPM profile. In addition, both the plasma PF4 and plasma PF4/Cr ratio presented a negative correlation with the L-arginine and asymmetric dimethylarginine ratio. These findings provide convincing evidence supporting the link between PF4 and CVD markers in pediatric CKD. Our study highlights the importance of further research to assess the performance of PF4-related biomarkers in predicting CVD events and CKD progression in children with CKD.
Collapse
Affiliation(s)
- Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan;
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Wei-Ting Liao
- Division of Pediatric Nephrology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (W.-T.L.); (W.-L.C.)
| | - Wei-Ling Chen
- Division of Pediatric Nephrology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (W.-T.L.); (W.-L.C.)
| | - Guo-Ping Chang-Chien
- Institute of Environmental Toxin and Emerging-Contaminant, Cheng Shiu University, Kaohsiung 833, Taiwan; (G.-P.C.-C.); (S.L.)
- Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833, Taiwan
- Super Micro Mass Research and Technology Center, Cheng Shiu University, Kaohsiung 833, Taiwan
| | - Sufan Lin
- Institute of Environmental Toxin and Emerging-Contaminant, Cheng Shiu University, Kaohsiung 833, Taiwan; (G.-P.C.-C.); (S.L.)
- Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833, Taiwan
- Super Micro Mass Research and Technology Center, Cheng Shiu University, Kaohsiung 833, Taiwan
| | - You-Lin Tain
- Division of Pediatric Nephrology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (W.-T.L.); (W.-L.C.)
- College of Medicine, Chang Gung University, Taoyuan 330, Taiwan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| |
Collapse
|
19
|
de Souza ÂMN, Griep RH, Hermsdorff HHM, da Fonseca MDJM, Juvanhol LL. Are ambulatory blood pressure parameters associated more with central adiposity than with total adiposity? Results of the ELSA-Brasil study. Front Cardiovasc Med 2023; 10:1286726. [PMID: 38155992 PMCID: PMC10752922 DOI: 10.3389/fcvm.2023.1286726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Background Worldwide obesity has a high prevalence, as well as carries a high risk of several chronic diseases, including hypertension. Studies of the association between obesity and ambulatory blood pressure (BP) are scarce and most use only body mass index (BMI) as indicator of adiposity. Thus, we aimed to examine for associations between total and central adiposity and ambulatory BP parameters (BP means and variability, nocturnal dipping and morning surge) among participants in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Methods This cross-sectional study (2012-2014) used a subsample of participants (n = 812) of ELSA-Brasil who underwent 24-hour ambulatory BP monitoring to assess systolic and diastolic BP (SBP and DBP, respectively) over 24-hour periods and sub-periods. Indicators for total adiposity were BMI and body fat (BF) and, for central adiposity, waist circumference (WC) and waist-to-height ratio (WHR). Associations were tested using crude and adjusted gamma and logistic regression. Results Overweight (BMI) and abdominal obesity (WC and WHR) associated positively with mean 24-hour (Coef = 2.71, 3.09 and 4.00, respectively), waking (Coef = 2.87, 3.26 and 4.16, respectively), and sleeping (Coef = 2.30, 2.74 and 3.50, respectively) SBP; mean DBP associated with high WHR in these three periods (Coef = 2.00, 2.10 and 1.68, respectively) and with WC in the waking period (Coef = 1.44). Overweight and abdominal obesity (WC and WHR) were positively associated with SBP variability over 24 h (Coef = 0.53, 0.45 and 0.49, respectively) and in sleep (Coef = 0.80, 0.74 and 0.59, respectively), and with DBP variability in 24 h (Coef = 0.64, 0.73 and 0.58, respectively), wakefulness (Coef = 0.50, 0.52 and 0.52, respectively) and sleep (Coef = 0.53, 0.45 and 0.49); excess BF associated positively with DBP variability over 24 h (Coef = 0.43) and in wakefulness (Coef = 0.38). Lastly, high WHR and excess BF were associated with higher odds of extreme dipping (OR = 1.03 for both), while high WC and WHR associated with higher odds of exacerbated diastolic morning surge (OR = 3.18 and 3.66, respectively). Conclusion Indicators of adiposity were associated with the BP means and variability, nocturnal dipping and morning surge, with more substantial results for indicators of central adiposity that the others.
Collapse
Affiliation(s)
| | - Rosane Harter Griep
- Environment and Health Education Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | | |
Collapse
|
20
|
Ogungbe O, Rose E, Juraschek SP. Mean-ing Beyond Office Blood Pressure. J Am Heart Assoc 2023; 12:e032576. [PMID: 38038183 PMCID: PMC10727330 DOI: 10.1161/jaha.123.032576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Oluwabunmi Ogungbe
- Johns Hopkins School of NursingBaltimoreMDUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Emily Rose
- Department of MedicineBeth Israel Deaconess Medical CenterBostonMAUSA
| | - Stephen P. Juraschek
- Department of MedicineBeth Israel Deaconess Medical CenterBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| |
Collapse
|
21
|
Friščić T, Vidović D, Alfirević I, Galić E. Impact of CPAP Therapy on the Autonomic Nervous System. Biomedicines 2023; 11:3210. [PMID: 38137432 PMCID: PMC10740859 DOI: 10.3390/biomedicines11123210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/25/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a significant risk factor for cardiovascular disease (CVD) with increasing prevalence. An important mechanism of CVD development is a dysregulation of the autonomic nervous system (ANS). This prospective and controlled cohort study aimed to investigate ANS function in OSA including the response to long-term continuous positive airway pressure (CPAP) therapy by analyzing 24 h Holter electrocardiogram and 24 h Holter ambulatory blood pressure recording parameters. The study enrolled 57 patients who were newly diagnosed with severe OSA. After 6 months of CPAP therapy, 37 patients had a good therapy adherence (usage of CPAP device >4 h per night), and their data were analyzed. The difference in nocturnal diastolic blood pressure values before and after CPAP therapy reached statistical significance (76 (68-84) vs. 74 (63-80) mmHg, p = 0.0439). Lower nocturnal values after CPAP therapy of SDNN (101.5 vs. 95 ms, p = 0.0492) and RMSSD (29.5 vs. 26 ms, p = 0.0193) were found. An increase in diurnal spectral power (1742 vs. 2112 ms2, p = 0.0282) and a decrease in nocturnal spectral power (3256 vs. 2124 ms2, p = 0.0097), nocturnal VLF band (2493 vs. 1485.4 ms2, p = 0.0176), nocturnal LF band (638.7 vs. 473 ms2, p = 0.0097), and nocturnal HF band (234.9 vs. 135.7 ms2, p = 0.0319) was found. The results showed an imbalance of the ANS with a sympathetic predominance, especially during the night hours and in those with arterial hypertension. The impact of CPAP therapy on the improvement in ANS parameters was more pronounced at night, in men, and those with arterial hypertension.
Collapse
Affiliation(s)
- Tea Friščić
- Department of Cardiovascular Diseases, Clinical Hospital Sveti Duh, 10000 Zagreb, Croatia; (I.A.); (E.G.)
| | - Domagoj Vidović
- University Psychiatric Hospital Vrapče, 10000 Zagreb, Croatia;
- Faculty of Croatian Studies, University of Zagreb, 10000 Zagreb, Croatia
- Libertas international University, 10000 Zagreb, Croatia
| | - Igor Alfirević
- Department of Cardiovascular Diseases, Clinical Hospital Sveti Duh, 10000 Zagreb, Croatia; (I.A.); (E.G.)
| | - Edvard Galić
- Department of Cardiovascular Diseases, Clinical Hospital Sveti Duh, 10000 Zagreb, Croatia; (I.A.); (E.G.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| |
Collapse
|
22
|
Jorge da Silva Franco R, Antonio Vieira Filho J, Inomata Cardoso da Silva D, Cuadrado Martin L, Alves Silva B, Garcia Zanati Bazan S, Barretti P, Regina Nogueira C. Non-dipping circadian pattern as a predictor of incipient nephropathy in normotensive normoalbuminuric type 1 diabetics. Chronobiol Int 2023; 40:1523-1528. [PMID: 37985469 DOI: 10.1080/07420528.2023.2282471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
The objective of this study was to assess the value of the abnormal circadian blood pressure pattern by ambulatory blood pressure monitoring (ABPM) to predict the onset of abnormal albuminuria in normotensive and normoalbuminuric DM1 patients. The participators were submitted to ABPM and followed prospectively until the onset of albuminuria or the end of follow-up. The patients with normal circadian blood pressure pattern were compared with the non-dippers in regard of the time interval free of albuminuria. The survival curves were evaluated by the Kaplan-Meier method. Of 34 patients screened, 10 patients matched the exclusion criteria. Therefore, 24 patients were submitted to ABPM, aged 24 ± 8.3 y, 18 men, and all Caucasian. Elevated levels of albuminuria did not occurin any individual with normal systolic blood pressure dip (>10%) at 54 months of follow-up. Only 22% of patients among non-dippers were free of albuminuria (<30 mg/g maintained for 3 months) at the same time (p = 0.049). Patients that reached the outcome were homogeneous in regard to other clinical and ABPM data evaluated. Abnormal systolic blood pressure circadian pattern predicts the evolution to incipient nephropathy in normotensive normoalbuminuric DM1 patients.
Collapse
Affiliation(s)
- Roberto Jorge da Silva Franco
- Nephrology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - José Antonio Vieira Filho
- Nephrology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - Douglas Inomata Cardoso da Silva
- Nephrology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - Luis Cuadrado Martin
- Nephrology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - Bruno Alves Silva
- Nephrology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - Silméia Garcia Zanati Bazan
- Cardiology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - Pasqual Barretti
- Nephrology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School, São Paulo, Brazil
| | - Célia Regina Nogueira
- Endocrinology Discipline, Department of Internal Medicine, São Paulo State University (Unesp), Botucatu Medical School,São Paulo, Brazil
| |
Collapse
|
23
|
Tulkki L, Martinez-Majander N, Haapalahti P, Tolppanen H, Sinisalo J, Repo O, Sarkanen T, Numminen H, Ryödi E, Ylikotila P, Roine RO, Lautamäki R, Saraste A, Miettinen T, Autere J, Jäkälä P, Hedman M, Huhtakangas J, Junttola U, Putaala J, Pirinen J. 24-hour ambulatory blood pressure and cryptogenic ischemic stroke in young adults. Ann Med 2023; 55:2203513. [PMID: 37086083 PMCID: PMC10124975 DOI: 10.1080/07853890.2023.2203513] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND In young patients, up to 40% of ischemic strokes remain cryptogenic despite modern-day diagnostic work-up. There are limited data on blood pressure (BP) behavior in these patients. Thus, we aimed to compare ambulatory blood pressure (ABP) profiles between young patients with a recent cryptogenic ischemic stroke (CIS) and stroke-free controls. PATIENTS AND METHODS In this substudy of the international multicenter case-control study SECRETO (NCT01934725), 24-hour ambulatory blood pressure monitoring (ABPM) was performed in consecutive 18-49-year-old CIS patients and stroke-free controls. The inclusion criteria were met by 132 patients (median age, 41.9 years; 56.1% males) and 106 controls (41.9 years; 56.6% males). We assessed not only 24-hour, daytime, and nighttime ABP but also hypertension phenotypes and nocturnal dipping status. RESULTS 24-hour and daytime ABP were higher among controls. After adjusting for relevant confounders, a non-dipping pattern of diastolic blood pressure (DBP) was associated with CIS in the entire sample (odds ratio, 3.85; 95% confidence interval, 1.20-12.42), in participants without antihypertensives (4.86; 1.07-22.02), and in participants without a patent foramen ovale (PFO) (7.37; 1.47-36.81). After excluding patients in the first tertile of the delay between the stroke and ABPM, a non-dipping pattern of DBP was not associated with CIS, but a non-dipping pattern of both systolic BP and DBP was (4.85; 1.37-17.10). In participants with a PFO and in those without hypertension by any definition, no associations between non-dipping patterns of BP and CIS emerged. CONCLUSIONS Non-dipping patterns of BP were associated with CIS in the absence of a PFO but not in the absence of hypertension. This may reflect differing pathophysiology underlying CIS in patients with versus without a PFO. Due to limitations of the study, results regarding absolute ABP levels should be interpreted with caution.Key MessagesNocturnal non-dipping patterns of blood pressure were associated with cryptogenic ischemic stroke except in participants with a patent foramen ovale and in those without hypertension by any definition, which may indicate differing pathophysiology underlying cryptogenic ischemic stroke in patients with and without a patent foramen ovale.It might be reasonable to include ambulatory blood pressure monitoring in the diagnostic work-up for young patients with ischemic stroke to detect not only the absolute ambulatory blood pressure levels but also their blood pressure behavior.
Collapse
Affiliation(s)
- Lauri Tulkki
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Nicolas Martinez-Majander
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Petri Haapalahti
- HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - Heli Tolppanen
- University of Helsinki, Helsinki, Finland
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Juha Sinisalo
- University of Helsinki, Helsinki, Finland
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Olli Repo
- Tampere University, Tampere, Finland
| | - Tomi Sarkanen
- Tampere University, Tampere, Finland
- Department of Neuroscience and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Heikki Numminen
- Tampere University, Tampere, Finland
- Department of Neuroscience and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Essi Ryödi
- Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Pauli Ylikotila
- Neurocenter, Turku University Hospital, Turku, Finland
- University of Turku, Turku, Finland
| | - Risto O Roine
- Neurocenter, Turku University Hospital, Turku, Finland
- University of Turku, Turku, Finland
| | - Riikka Lautamäki
- University of Turku, Turku, Finland
- Heart Centre, Turku University Hospital, Turku, Finland
| | - Antti Saraste
- University of Turku, Turku, Finland
- Heart Centre, Turku University Hospital, Turku, Finland
| | - Tuuli Miettinen
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Jaana Autere
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Jäkälä
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Huhtakangas
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Ulla Junttola
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Jani Pirinen
- University of Helsinki, Helsinki, Finland
- HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
24
|
Xagas E, Sarafidis P, Iatridi F, Theodorakopoulou MP, Pella E, Korogiannou M, Argyris A, Protogerou A, Boletis IN, Marinaki S. Kidney transplantation and kidney donation do not affect short-term blood pressure variability. Blood Press 2023; 32:2181640. [PMID: 36814377 DOI: 10.1080/08037051.2023.2181640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE Blood pressure variability (BPV) is an independent cardiovascular risk factor in CKD. Kidney transplantation (KTx) is associated with improved BP levels for kidney transplant recipient (KTRs), without evoking significant changes in donors. The aim of this study was to assess the short- and mid-time effects of KTx and donation on short-term BPV in KTRs and their respective living kidney donors. MATERIALS AND METHODS Forty KTRs and their respective donors were evaluated with 24-h ABPM (Mobil-O-Graph-NG) at baseline (1 month before), 3-months and 12-months after KTx. Standard-deviation (SD), weighted-SD (wSD), coefficient-of-variation (CV), average-real-variability (ARV) and variability independent of mean (VIM) for SBP/DBP were calculated with validated formulas. RESULTS All 24-h systolic and diastolic BPV indexes studied did not change significantly from baseline to 3-month (SBP-wSD: 12.8 ± 3.0 vs 13.2 ± 3.4 mmHg, p = 0.608; SBP-ARV: 10.3 ± 2.4 vs 10.8 ± 2.6 mmHg, p = 0.463) and 12-month evaluation (SBP-wSD 12.8 ± 3.0 vs 12.1 ± 2.8; p = 0.424 and SBP-ARV: 10.3 ± 2.4 vs 10.2 ± 2.5; p = 0.615) after kidney transplantation in the KTRs.In kidney donors, all 24-h systolic BPV indices displayed a trend towards higher values at 3 months compared to baseline, but without reaching statistical significance (SBP-wSD: 12.2 ± 2.8 vs 13.6 ± 4.2 mmHg, p = 0.107 and SBP-ARV: 10.1 ± 2.1 vs 11.2 ± 3.1 mmHg, p = 0.099), the levels of 24-h systolic SBP indices at 12-months were almost identical to baseline values. 24-h diastolic BPV indices at 3-month and 12-month evaluation were similar to baseline. CONCLUSION Short-term BPV did not change significantly 3 and 12 months after kidney transplantation/donation neither in KTRs nor in living kidney donors. Longitudinal studies examining associations of BPV with adverse outcomes in these individuals are needed.
Collapse
Affiliation(s)
- Efstathios Xagas
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotini Iatridi
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eva Pella
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Korogiannou
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Argyris
- Cardiovascular Prevention & Research Unit, Clinic & Laboratory of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanase Protogerou
- Cardiovascular Prevention & Research Unit, Clinic & Laboratory of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis N Boletis
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
25
|
Wojciechowska W, Rajzer M, Weber T, Prejbisz A, Dobrowolski P, Ostrowska A, Bilo G, Mancia G, Kreutz R, Januszewicz A. Ambulatory blood pressure monitoring in treated patients with hypertension in the COVID-19 pandemic - The study of European society of hypertension (ESH ABPM COVID-19 study). Blood Press 2023; 32:2161998. [PMID: 36694963 DOI: 10.1080/08037051.2022.2161998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown profoundly affected almost all aspects of daily life including health services worldwide. The established risk factors for increased blood pressure (BP) and hypertension may also demonstrate significant changes during the pandemic. This study aims to determine the impact of the COVID-19 pandemic on BP control and BP phenotypes as assessed with 24-hour ambulatory BP monitoring (ABPM). MATERIALS AND METHODS This is a multi-centre, observational, retrospective and comparative study involving Excellence Centres of the European Society of Hypertension across Europe. Along with clinical data and office BP, ABPM recordings will be collected in adult patients with treated arterial hypertension. There will be two groups in the study: Group 1 will consist of participants who have undergone two ABPM recordings - the second one occurring during the COVID-19 pandemic, i.e. after March 2020, and the first one 9-15 months prior to the second. Participants in Group 2 will have two repeated ABPM recordings - both performed before the pandemic within a similar 9-15 month interval between the recordings. Within each group, we will analyse and compare BP variables and phenotypes (including averaged daytime and night-time BP, BP variability, dipper and non-dipper status, white-coat and masked hypertension) between the two respective ABPM recordings and compare these changes between the two groups. The target sample size will amount to least 590 participants in each of the study groups, which means a total of at least 2360 ABPM recordings overall. EXPECTED OUTCOMES As a result, we expect to identify the impact of a COVID-19 pandemic on blood pressure control and the quality of medical care in order to develop the strategy to control cardiovascular risk factors during unpredictable global events.
Collapse
Affiliation(s)
- Wiktoria Wojciechowska
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Rajzer
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Thomas Weber
- Cardiology Department Klinikum Wels-Grieskirchen, Wels, Austria
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Dobrowolski
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Aleksandra Ostrowska
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Bilo
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, Università Milano-Bicocca, Milano, Italy
| | - Giuseppe Mancia
- Department of Medicine and Surgery, Università Milano-Bicocca, Milano, Italy
| | - Reinhold Kreutz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| |
Collapse
|
26
|
Jing Z, Wang G, Li Z, Wu S, Qiu X, Huang R. Association of blood pressure variability with target organ damage in older patients with essential hypertension. Chronic Dis Transl Med 2023; 9:320-328. [PMID: 37915384 PMCID: PMC10617365 DOI: 10.1002/cdt3.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 11/03/2023] Open
Abstract
Background Although multiple measures of blood pressure variability (BPV) have been proposed, whether they are better than mean blood pressure in predicting target organs is unclear. We aimed to determine the relationship between short term BPV and target organ injury. Methods This study was a retrospective study, and 635 inpatients in the Department of Cardiology from 2015 to 2020 were selected. We divided participants into four groups on the basis of the quartiles of BPV. One-way analysis of variance was used to compare the differences between the groups, and linear regression was used to analyze the relationship between BPV and target organ damage. Results The average age of 635 patients was 74.36 ± 6.50 years old. Among them, 354 of 627 patients had diminished renal function (56.5%), 221of 604 patients had associated left ventricular hypertrophy (36.6%), and 227 of 231 patients had carotid plaque formation (98.3%). The baseline data indicated significant differences in fasting glucose, total cholesterol, low-density lipoprotein, creatinine, glomerular filtration rate, sex, calcium channel blocker use, and the rate of diminished renal function. Multiple linear regression analysis showed that BPV was negatively correlated with renal injury (creatinine: r = 0.306, p < 0.01; estimated glomerular filtration rate: r = 0.058, p < 0.01), and BPV is positively correlated with cardiac injury (r = 0.083, p < 0.01). Elevated BPV was not found to be associated with vascular injury. Conclusion Renal function decreases with increasing BPV and left ventricular mass increases with increasing BPV.
Collapse
Affiliation(s)
- Zhiquan Jing
- Department of Cardiology, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Gang Wang
- Department of Cardiology, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Zeya Li
- Department of Cardiology, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Shanshan Wu
- Department of Clinical Epidemiology and EBM, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| | - Xiang Qiu
- Department of CardiologyBeijing Fangshan First HospitalBeijingChina
| | - Rongchong Huang
- Department of Cardiology, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
| |
Collapse
|
27
|
Xiao Y, Yang T, Zhang L, Wei Q, Ou R, Hou Y, Liu K, Lin J, Jiang Q, Shang H. Association between the blood pressure variability and cognitive decline in Parkinson's disease. Brain Behav 2023; 13:e3319. [PMID: 37969048 PMCID: PMC10726805 DOI: 10.1002/brb3.3319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVES High visit-to-visit blood pressure variability (BPV) was found to be associated with cognitive decline in the elderly. This study aimed to investigate the impact of visit-to-visit BPV on cognition in patients with early-stage Parkinson's disease (PD). DESIGN This is a retrospective analysis of a prospective cohort. SETTING AND PARTICIPANTS A total of 297 patients with early-stage PD (103 mild cognitive impairments [PD-MCI] and 194 normal cognitions [PD-NC] at baseline) were included from the Parkinson's Progression Markers Initiative study. METHODS Variation independent of mean (VIM) of the first year was used as the indicator of BPV. The Montreal Cognitive Assessment (MoCA) was used to assess global cognition. Patients were divided into PD-MCI and PD-NC according to the MoCA score at baseline. Longitudinal cerebrospinal fluid (Aβ-42, Aβ, α-synuclein, neurofilament light protein, tau phosphorylated at the threonine 181 position, total tau, glial fibrillary acidic protein) and serum (neurofilament light protein) biomarkers were assessed. The Bayesian linear growth model was used to evaluate the relationship between baseline BPV and the rate of change in cognition and biomarkers. RESULTS Higher systolic VIM of the first year was related to a greater rate of decline in MoCA score in the following years in PD-MCI (β = -.15 [95% CI -.29, -.01]). No association was found between BPV and biomarkers. CONCLUSION AND IMPLICATIONS Higher systolic VIM predicted a steeper decline in cognitive tests in PD-MCI independently from the mean value of blood pressure, orthostatic hypotension, and supine hypertension.
Collapse
Affiliation(s)
- Yi Xiao
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Tianmi Yang
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Lingyu Zhang
- Health Management CenterWest China Hospital of Sichuan UniversityChengduChina
| | - Qianqian Wei
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Ruwei Ou
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Yanbing Hou
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Kuncheng Liu
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Junyu Lin
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Qirui Jiang
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| | - Huifang Shang
- Department of NeurologyRare Disease Center, Laboratory of Neurodegenerative Disorders, National Clinical Research Center for GeriatricWest China Hospital of Sichuan UniversityChengduSichuanChina
| |
Collapse
|
28
|
Yaneva-Sirakova T, Petrov I, Traykov L, Coca A, Cunha PG, Gasecki D, Farukh B, Kotsis V, Vicario A, Manios E, Sierra C, Hering D. Twenty-four-hour ambulatory blood pressure monitoring-from silent to whispering brain damage. Blood Press 2023; 32:2208228. [PMID: 37209040 DOI: 10.1080/08037051.2023.2208228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/22/2023]
Affiliation(s)
| | - Ivo Petrov
- Acibadem City Clinic UMHAT Cardiovascular Center, Sofia, Bulgaria
| | - Latchezar Traykov
- Department of Neurology, UMHAT "Alexandrovska", Neurology clinic, Medical University Sofia, Bulgaria
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Pedro G Cunha
- Center for the Research and Treatment of Arterial Hypertension and Cardiovascular Risk; Hospital Senhora da Oilveira, Life and Health Research Institute, Minho University, Guimarães, Portugal
| | - Dariusz Gasecki
- Department of Adult Neurology, Medical University of Gdansk, Gdansk, Poland
| | - Bushra Farukh
- School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London, United Kingdom
| | - Vasilios Kotsis
- Third Dept. of Int. Medicine, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | - Augusto Vicario
- Heart-Brain Unit, Cardiovascular Institute of Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Efstathis Manios
- Dept. of Clinical Therapeutics National, and Kapodistrian University of Athens, Alexandra Hospital, Greece
| | - Cristina Sierra
- Department of Internal Medicine, University of Barcelona, Hospital Clinic, Barcelona, Spain
| | - Dagmara Hering
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| |
Collapse
|
29
|
Sada K, Yoshida Y, Shibuta K, Kimoto K, Miyamoto S, Ozeki Y, Okamoto M, Gotoh K, Masaki T, Yokoyama K, Kubota T, Shibata H. Associations of Diabetic Retinopathy Severity With High Ambulatory Blood Pressure and Suppressed Serum Renin Levels. J Clin Endocrinol Metab 2023; 108:e1624-e1632. [PMID: 37319371 DOI: 10.1210/clinem/dgad358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
CONTEXT The relationships between serum renin levels, severity of diabetic retinopathy (DR), and 24-hour blood pressure (BP) have not been previously reported. OBJECTIVE To explore causes for DR and the relationships of 24-hour ambulatory BP, and hormone levels with the severity of DR. METHODS The diabetic patients were classified as having no DR, simple DR, or severe DR (preproliferative DR plus proliferative DR) based on funduscopic examination, and we measured 24-hour BP, serum active renin (ARC), aldosterone (SAC), adrenocorticotropic hormone, and cortisol levels in each group. RESULTS Compared to those with no DR or simple DR, patients with severe DR showed significantly higher 24-hour BPs, including daytime and nighttime systolic and diastolic BP levels, independent of diabetic duration and HbA1c levels. The variability of nighttime systolic BP was greater in patients with severe DR than in those with nonsevere DR, although nocturnal BP reduction was similar between the groups. The ambulatory BPs were significantly inversely associated with ARC. The ARC was significantly lower in severe DR patients than in those with no DR or simple DR (3.2 [1.5-13.6] vs 9.8 [4.6-18.0] pg/mL, P < .05), but there were no differences in SAC in patients taking calcium channel blockers and/or α-blockers. No associations were found between DR severity and other hormone levels. CONCLUSION Severe DR was associated with higher 24-hour BPs and suppressed ARC. These findings suggest that mineralocorticoid receptor overactivation may play a role in higher BP levels and severe DR in diabetic patients.
Collapse
Affiliation(s)
- Kentaro Sada
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Yuichi Yoshida
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Kanako Shibuta
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Kenichi Kimoto
- Department of Ophthalmology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Shotaro Miyamoto
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Yoshinori Ozeki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Mitsuhiro Okamoto
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Koro Gotoh
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Takayuki Masaki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Katsuhiko Yokoyama
- Department of Ophthalmology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Toshiaki Kubota
- Department of Ophthalmology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan
| |
Collapse
|
30
|
Chung J, Robinson C, Sheffield L, Paramanathan P, Yu A, Ewusie J, Sanger S, Mitsnefes M, Parekh RS, Sinha MD, Rodrigues M, Thabane L, Dionne J, Chanchlani R. Prevalence of Pediatric Masked Hypertension and Risk of Subclinical Cardiovascular Outcomes: A Systematic Review and Meta-Analysis. Hypertension 2023; 80:2280-2292. [PMID: 37737026 DOI: 10.1161/hypertensionaha.123.20967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Masked hypertension (MH) occurs when office blood pressure is normal, but hypertension is confirmed using out-of-office blood pressure measures. Hypertension is a risk factor for subclinical cardiovascular outcomes, including left ventricular hypertrophy, increased left ventricular mass index, carotid intima media thickness, and pulse wave velocity. However, the risk factors for ambulatory blood pressure monitoring defined MH and its association with subclinical cardiovascular outcomes are unclear. A systematic literature search on 9 databases included English publications from 1974 to 2023. Pediatric MH prevalence was stratified by disease comorbidities and compared with the general pediatric population. We also compared the prevalence of left ventricular hypertrophy, and mean differences in left ventricular mass index, carotid intima media thickness, and pulse wave velocity between MH versus normotensive pediatric patients. Of 2199 screened studies, 136 studies (n=28 612; ages 4-25 years) were included. The prevalence of MH in the general pediatric population was 10.4% (95% CI, 8.00-12.80). Compared with the general pediatric population, the risk ratio (RR) of MH was significantly greater in children with coarctation of the aorta (RR, 1.91), solid-organ or stem-cell transplant (RR, 2.34), chronic kidney disease (RR, 2.44), and sickle cell disease (RR, 1.33). MH patients had increased risk of subclinical cardiovascular outcomes compared with normotensive patients, including higher left ventricular mass index (mean difference, 3.86 g/m2.7 [95% CI, 2.51-5.22]), left ventricular hypertrophy (odds ratio, 2.44 [95% CI, 1.50-3.96]), and higher pulse wave velocity (mean difference, 0.30 m/s [95% CI, 0.14-0.45]). The prevalence of MH is significantly elevated among children with various comorbidities. Children with MH have evidence of subclinical cardiovascular outcomes, which increases their risk of long-term cardiovascular disease.
Collapse
Affiliation(s)
- Jason Chung
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada (J.C.)
| | - Cal Robinson
- Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada (C.R.)
| | - Lauren Sheffield
- Faculty of Sciences, McMaster University, Hamilton, Ontario, Canada (L.S.)
| | - Prathayini Paramanathan
- All Saints University College of Medicine, Kingstown, Saint Vincent and the Grenadines (P.P.)
| | - Andrew Yu
- Faculty of Science, University of Alberta, Edmonton, Canada (A.Y.)
| | - Joycelyne Ewusie
- Department of Health Research Methods, Evidence, and Impact, Research Institute - St Joseph's Healthcare Hamilton, McMaster University, Ontario, Canada (J.E., L.T.)
| | - Stephanie Sanger
- Department of Health Sciences: Health Science Library, McMaster University, Hamilton, Ontario, Canada (S.S.)
| | - Mark Mitsnefes
- Department of Pediatrics, Division of Nephrology, Cincinnati Children's Hospital Medical Center, OH (M.M.)
| | - Rulan S Parekh
- Department of Pediatrics and Medicine, Division of Nephrology, The Hospital for Sick Children, University Health Network and University of Toronto, Ontario, Canada (R.S.P.)
| | - Manish D Sinha
- Department of Paediatric Nephrology, King's College London, Evelina London Childrens Hospital, United Kingdom (M.D.S.)
| | - Myanca Rodrigues
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (M.R.)
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, Research Institute - St Joseph's Healthcare Hamilton, McMaster University, Ontario, Canada (J.E., L.T.)
- University of Johannesburg Faculty of Health Sciences, South Africa (L.T.)
| | - Janis Dionne
- Department of Pediatrics, Division of Nephrology, University of British Columbia, Vancouver, Canada (J.D.)
| | - Rahul Chanchlani
- Department of Pediatrics, Division of Pediatric Nephrology, McMaster Children's Hospital, McMaster University, Hamilton, Canada (R.C.)
| |
Collapse
|
31
|
Kario K, Tomitani N, Hoshide S, Nishizawa M, Yoshida T, Kabutoya T, Fujiwara T, Mizuno H, Okawara Y, Kanegae H. Different Home Blood Pressure Thresholds to Predict Perfect 24-Hour Ambulatory Blood Pressure Control in Treated Hypertension Based on an "All-in-One" Device. Hypertension 2023; 80:2464-2472. [PMID: 37671575 DOI: 10.1161/hypertensionaha.123.21578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/11/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Home blood pressure (BP) is an important component of digital strategies for hypertension management. However, no studies have used the same device to investigate 24-hour BP control status in relation to different home BP control thresholds. METHODS Participants in the general practitioner-based, multicenter HI-JAMP study (Home-Activity Information and Communication Technology-Based Japan Ambulatory Blood Pressure Monitoring Prospective) underwent office BP measurement, then 24-hour ambulatory BP monitoring, then home BP monitoring for 5 days. A validated all-in-one BP monitoring device was used to measure office, home, and ambulatory BP. Baseline data were used to investigate ambulatory BP control status in individuals with well-controlled home BP based on the different guideline thresholds (125/75 mm Hg, 130/80 mm Hg, and 135/85 mm Hg). RESULTS Data from 2269 patients were analyzed. For individuals with well-controlled home BP <135/85 mm Hg (59.5% of the total population), the prevalence of uncontrolled 24-hour (≥130/80 mm Hg), daytime (≥135/85 mm Hg), and nighttime ambulatory BP (≥120/70 mm Hg) was 19.9%, 18.5%, and 33.6%, respectively. Corresponding prevalence rates in the 42.7% of participants with well-controlled home BP <130/80 mm Hg were 13.4%, 12.9%, and 26.0%, and when well-controlled home BP was strictly defined as <125/75 mm Hg (23.9% of the population), prevalence of rates of uncontrolled 24-hour, daytime, and nighttime ambulatory BP were 7.0%, 9.0%, and 15.3%, respectively. CONCLUSIONS Home BP control status defined using different thresholds could predict 24-hour ambulatory BP control status in treated hypertension. One-third of individuals still had uncontrolled nocturnal hypertension when home BP was controlled to <135/85 mm Hg, but ambulatory BP was quite well controlled when home BP was <125/75 mm Hg.
Collapse
Affiliation(s)
- Kazuomi Kario
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Naoko Tomitani
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Satoshi Hoshide
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | | | - Tetsuro Yoshida
- Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.)
| | - Tomoyuki Kabutoya
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Takeshi Fujiwara
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Hiroyuki Mizuno
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Yukie Okawara
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Hiroshi Kanegae
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| |
Collapse
|
32
|
Alp A, Saruhan E, Doğan E, Genek DG, Huddam B. Time to Change Our Viewpoints to Assess Renal Risks in Patients with Solitary Kidneys beyond Traditional Approaches? J Clin Med 2023; 12:6885. [PMID: 37959350 PMCID: PMC10649944 DOI: 10.3390/jcm12216885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Solitary functioning kidney (SFK) can be defined as the absence or hypofunction of a kidney due to acquired or congenital reasons. A congenital solitary functioning kidney (cSFK) is more common than is an acquired one (aSFK) and is characterized by the anatomical absence (agenesis) or hypofunction (hypoplasia; hypodysplasia) of one kidney from birth. Among the acquired causes, the most important is nephrectomy (Nx) (due to the donor, trauma or mass resection). Patients with SFK are at risk for the development of chronic kidney disease (CKD) in the long term. This risk potential is also significantly affected by hypertension. The relationship between hypertension and subclinical chronic inflammation is a connection that has not yet been fully clarified pathogenetically, but there are many studies highlighting this association. In recent years, studies examining different fibrosis and inflammation biomarkers in terms of the evaluation and prediction of renal risks have become increasingly popular in the literature. Oxidative stress is known to play an important role in homocysteine-induced endothelial dysfunction and has been associated with hypertension. In our study, we aimed to investigate the relationship between ambulatory blood pressure monitoring (ABPM) and urinary/serum fibrosis and inflammatory markers in patients with SFK. We prospectively investigated the relationship between ABPM results and soluble urokinase plasminogen activator receptor (suPAR), procollagen type III N-terminal peptide (PIIINP), homocysteine and other variables in 85 patients with SFK and compared them between cSFK and aSFK groups. In the etiology of SFK, a congenital or acquired origin may differ in terms of the significance of biomarkers. In particular, the serum homocysteine level may be associated with different clinical outcomes in patients with cSFK and aSFK.
Collapse
Affiliation(s)
- Alper Alp
- Department of Nephrology, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey; (D.G.G.); (B.H.)
| | - Ercan Saruhan
- Department of Medical Biochemistry, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey;
| | - Emrah Doğan
- Department of Radiology, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey;
| | - Dilek Gibyeli Genek
- Department of Nephrology, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey; (D.G.G.); (B.H.)
| | - Bülent Huddam
- Department of Nephrology, Faculty of Medicine, Mugla Sıtkı Koçman University, 48000 Mugla, Turkey; (D.G.G.); (B.H.)
| |
Collapse
|
33
|
Brito LCD, Bowles NP, McHill AW, Rice SPM, Butler MP, Emens JS, Shea SA, Thosar SS. Chronological distribution of readings in ambulatory blood pressure monitoring exams affects the nighttime average and the magnitude of blood pressure dipping. Am J Physiol Heart Circ Physiol 2023; 325:H1394-H1399. [PMID: 37861648 PMCID: PMC10908404 DOI: 10.1152/ajpheart.00542.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/21/2023]
Abstract
STUDY OBJECTIVES Averaged nighttime blood pressure (BP) is superior to daytime BP for cardiovascular risk stratification, and the relative change between daytime/nighttime BP (dipping%) significantly predicts cardiovascular risk. Newer reports suggest that 4 measurements at night may be enough for cardiovascular risk stratification. Since BP oscillates across the night, the temporal distribution of measurements across the night may impact nighttime BP and dipping%. Therefore, we compared average nighttime BP and dipping% when using measurements in the first half (1st-half), second (2nd-half), and a combination of both (combined). METHODS Forty-three (17 females and twenty-six males) midlife adults aged 50±10 years old wore an ambulatory BP monitor for 24 hours at home, programmed to measure BP every 20 minutes when scheduled for daytime and every 30 minutes during a self-selected 8-hour nighttime for time-in-bed. We compared the nighttime BP averages and dipping% when using either the first four measurements from the 1st-half or 2nd-half of the nighttime and combined. RESULTS Nighttime Systolic BP was significantly different across 1st-half, 2nd-half, and combined (111±9 vs.107±11 vs. 109±9 mmHg, p<0.01), respectively, with significant pairwise differences across all categories (p<0.01 for each). Systolic BP dipping% was significantly different across 1st-half, 2nd-half, and combined (9.9±5.5 vs.13.5±6.4 vs. 11.7±5.0 %, p<0.01), respectively, with significant pairwise differences across all categories (p<0.01 for each. Diastolic BP and diastolic dipping% were similar across the three different bins. CONCLUSION In midlife adults, systolic nighttime BP and dipping% may depend upon when BP measurements are taken during the night.
Collapse
Affiliation(s)
- Leandro Campos de Brito
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | | | - Andrew W McHill
- Oregon Health and Science University, Portland, Oregon, United States
| | - Sean P M Rice
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, United States
| | - Matthew P Butler
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | | | - Steven A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | - Saurabh S Thosar
- Oregon Institute of Occupational Health Sciences, Oregon Health and Science University Hospital, Portland, Oregon, United States
| |
Collapse
|
34
|
de la Sierra A. Blood Pressure Variability as a Risk Factor for Cardiovascular Disease: Which Antihypertensive Agents Are More Effective? J Clin Med 2023; 12:6167. [PMID: 37834811 PMCID: PMC10573370 DOI: 10.3390/jcm12196167] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Blood pressure oscillations during different time scales, known as blood pressure variability (BPV), have become a focus of growing scientific interest. BPV can be measured at long-term (seasonal variability or visit-to-visit), at mid-term (differences in consecutive days or weeks) or at short-term (day-night differences or changes induced by other daily activities and conditions). An increased BPV, either at long, mid or short-term is associated with a poor cardiovascular prognosis independently of the amount of blood pressure elevation. There is scarce evidence on the effect of different antihypertensive treatments on BPV, but some observational and interventional studies suggest that calcium channel blockers in general, and particularly amlodipine, either in monotherapy or combined with renin-angiotensin system blockers, can reduce BPV more efficiently than other antihypertensive drugs or combinations. Nevertheless, there are several aspects of the relationship between BPV, antihypertensive treatment, and clinical outcomes that are still unknown, and more work should be performed before considering BPV as a therapeutical target in clinical practice.
Collapse
|
35
|
Chen WL, Liao WT, Hsu CN, Tain YL. Pregnancy Zone Protein as an Emerging Biomarker for Cardiovascular Risk in Pediatric Chronic Kidney Disease. J Clin Med 2023; 12:5894. [PMID: 37762835 PMCID: PMC10531502 DOI: 10.3390/jcm12185894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/22/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Cardiovascular disease (CVD) is a significant cause of mortality and morbidity among children with chronic kidney disease (CKD). The causes of pediatric CKD differ from those in adults, as congenital anomalies in the kidney and urinary tract (CAKUT) are the leading causes in childhood. Identifying ideal markers of CVD risk early is crucial for CKD children to improve their care. Previously, we screened differentially expressed proteins in CKD children with or without blood pressure (BP) abnormalities and identified pregnancy zone protein (PZP). In 106 children and adolescents with CKD stages G1-G4, we analyzed plasma PZP concentration. The associations between PZP and ambulatory BP monitoring (ABPM) profile, parameters of cardiac and carotid ultrasounds, indices of arterial stiffness, and nitric oxide (NO) parameters were determined. We observed that PZP positively correlated with arterial stiffness indices, beta index, and pulse wave velocity in CAKUT. CKD children with abnormalities in ABPM and night dipping displayed a higher PZP concentration than those without. Additionally, the PZP level was positively correlated with NO bioavailability. In conclusion, our results suggest PZP has differential influences on cardiovascular risk in CAKUT and non-CAKUT children. Identification of this relationship is novel in the pediatric CKD literature.
Collapse
Affiliation(s)
- Wei-Ling Chen
- Division of Pediatric Nephrology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (W.-L.C.); (W.-T.L.)
| | - Wei-Ting Liao
- Division of Pediatric Nephrology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (W.-L.C.); (W.-T.L.)
| | - Chien-Ning Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - You-Lin Tain
- Division of Pediatric Nephrology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan; (W.-L.C.); (W.-T.L.)
- College of Medicine, Chang Gung University, Taoyuan 330, Taiwan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| |
Collapse
|
36
|
Barone Gibbs B, Muldoon MF, Conroy MB, Paley JL, Shimbo D, Perera S. Influence of Recent Standing, Moving, or Sitting on Daytime Ambulatory Blood Pressure. J Am Heart Assoc 2023; 12:e029999. [PMID: 37589152 PMCID: PMC10547321 DOI: 10.1161/jaha.123.029999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023]
Abstract
Background There are no recommendations for being seated versus nonseated during ambulatory blood pressure (BP) monitoring (ABPM). The authors examined how recent standing or moving versus sitting affect average daytime BP on ABPM. Methods and Results This analysis used baseline assessments from a clinical trial in desk workers with office systolic BP (SBP) 120 to 159 mm Hg or diastolic BP (DBP) 80 to 99 mm Hg. ABPM was measured every 30 minutes with a SunTech Medical Oscar 2 monitor. Concurrent posture (standing or seated) and moving (steps) were measured via a thigh-worn accelerometer. Linear regression determined within-person BP variability explained (R2) by standing and steps before ABPM readings. Mean daytime BP and the prevalence of mean daytime BP >135/85 mm Hg from readings after sitting (seated) or after recent standing or moving (nonseated) were compared with all readings. Participants (n=266, 59% women; age, 45.2±11.6 years) provided 32.5±3.9 daytime BP readings. Time standing and steps before readings explained variability up to 17% for daytime SBP and 14% for daytime DBP. Using the 5-minute prior interval, seated SBP/DBP was lower (130.8/79.7 mm Hg, P<0.001) and nonseated SBP/DBP was higher (137.8/84.3 mm Hg, P<0.001) than mean daytime SBP/DBP from all readings (133.9/81.6 mm Hg). The prevalence of mean daytime SBP/DBP ≥135/85 mm Hg also differed: 38.7% from seated readings, 70.3% from nonseated readings, and 52.6% from all readings (P<0.05). Conclusions Daytime BP was systematically higher after standing and moving compared with being seated. Individual variation in activity patterns could influence the diagnosis of high BP using daytime BP readings on ABPM.
Collapse
Affiliation(s)
- Bethany Barone Gibbs
- Department of Epidemiology and Biostatistics, School of Public HealthWest Virginia UniversityMorgantownWVUSA
- Departments of Health and Human Development, School of EducationUniversity of PittsburghPAUSA
| | - Matthew F. Muldoon
- Division of Cardiology, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Molly B. Conroy
- Division of General Internal Medicine, Department of Internal MedicineUniversity of UtahSalt Lake CityUTUSA
| | - Joshua L. Paley
- Departments of Health and Human Development, School of EducationUniversity of PittsburghPAUSA
| | - Daichi Shimbo
- Division of Cardiology, Department of MedicineColumbia University Irving Medical CenterNew YorkNYUSA
| | - Subashan Perera
- Division of Geriatric Medicine and Department of BiostatisticsUniversity of PittsburghPittsburghPAUSA
| |
Collapse
|
37
|
Al-Anazi AF, Gul R, Al-Harbi FT, Al-Radhi SA, Al-Harbi H, Altaher A, Al-Harbi MM, Al-Rashidi FO, Al-Haweeri OS, Al-Mutairi FM, Al-Riyaee AA, Al-Hotan FM, Al-Radhi AA, Al Shehri HM, Alharbi MS, ALGhasab NS. Home versus Clinic Blood Pressure Monitoring: Evaluating Applicability in Hypertension Management via Telemedicine. Diagnostics (Basel) 2023; 13:2686. [PMID: 37627945 PMCID: PMC10453092 DOI: 10.3390/diagnostics13162686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Hypertension is a significant public health concern in Saudi Arabia, affecting 28.6% of the population. Despite the availability of effective treatments, optimal blood pressure control is not always achieved, highlighting the need for effective management strategies. This study aimed to evaluate the applicability of home, compared to clinic, blood pressure measurements for managing hypertension in the Qassim region of Saudi Arabia. The study included 85 adults undergoing antihypertensive treatment. Home blood pressure measurements were obtained during the day and the evening using automated oscillometric sphygmomanometers, whereas clinic measurements were taken during clinic hours. Home blood pressure readings were significantly lower than clinic blood pressure readings, with mean differences of 20.4 mmHg and 4.1 mmHg for systolic and diastolic blood pressures, respectively. There was a positive correlation between the clinic systolic and diastolic blood pressures (r = 0.549, p < 0.001) and a weak correlation between the daytime home and clinic systolic blood pressures (r = 0.218, p < 0.05). This study provides insight into the applicability of home blood pressure monitoring, which may aid in the development of more effective hypertension management strategies, particularly the use of morning home blood pressure monitoring to aid treatment decisions through telehealth medicine.
Collapse
Affiliation(s)
- Ali F. Al-Anazi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Rahim Gul
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Fahad T. Al-Harbi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Sulaiman A. Al-Radhi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Hamood Al-Harbi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Altigani Altaher
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Mohammed M. Al-Harbi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Fahad O. Al-Rashidi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Omer S. Al-Haweeri
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Buraydah 52366, Qassim, Saudi Arabia
| | - Fakhri M. Al-Mutairi
- Department of Internal Medicine, Al-Rass General Hospital, Al-Rass 58883, Qassim, Saudi Arabia
| | - Afyaa A. Al-Riyaee
- College of Medicine, Qassim University, Buraydah 51482, Qassim, Saudi Arabia
| | - Fai M. Al-Hotan
- College of Medicine, Qassim University, Buraydah 51482, Qassim, Saudi Arabia
| | - Alulu A. Al-Radhi
- Department of Pharmacy, Qassim University Medical City, Buraidah 52571, Qassim, Saudi Arabia
| | - Hamdan M. Al Shehri
- Department of Internal Medicine, Medical College, Najarn University, Najran 55461, Najran, Saudi Arabia
| | - Mohammed S. Alharbi
- Department of Internal Medicine, Medical College, Ha’il University, Ha’il 55476, Hail, Saudi Arabia
| | - Naif Saad ALGhasab
- Department of Internal Medicine, Medical College, Ha’il University, Ha’il 55476, Hail, Saudi Arabia
| |
Collapse
|
38
|
Cai P, Lin Q, Lv D, Zhang J, Wang Y, Wang X. Establishment of a scoring model for the differential diagnosis of white coat hypertension and sustained hypertension. Blood Press Monit 2023; 28:185-192. [PMID: 37115849 PMCID: PMC10309104 DOI: 10.1097/mbp.0000000000000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/19/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES This study aimed to establish a scoring model for the differential diagnosis of white coat hypertension (WCH) and sustained hypertension (SHT). METHODS This study comprised 553 adults with elevated office blood pressure, normal renal function, and no antihypertensive medications. Through questionnaire investigation and biochemical detection, 17 parameters, such as gender and age, were acquired. WCH and SHT were distinguished by 24 h ambulatory blood pressure monitoring. The participants were randomly divided into a training set (445 cases) and a validation set (108 cases). The above parameters were screened using least absolute shrinkage and selection operator regression and univariate logistic regression analysis in the training set. Afterward, a scoring model was constructed through multivariate logistic regression analysis. RESULTS Finally, six parameters were selected, including isolated systolic hypertension, office systolic blood pressure, office diastolic blood pressure, triglyceride, serum creatinine, and cardiovascular and cerebrovascular diseases. Multivariate logistic regression was used to establish a scoring model. The R2 and area under the ROC curve (AUC) of the scoring model in the training set were 0.163 and 0.705, respectively. In the validation set, the R2 of the scoring model was 0.206, and AUC was 0.718. The calibration test results revealed that the scoring model had good stability in both the training and validation sets (mean square error = 0.001, mean absolute error = 0.014; mean square error = 0.001, mean absolute error = 0.025). CONCLUSION A stable scoring model for distinguishing WCH was established, which can assist clinicians in identifying WCH at the first diagnosis.
Collapse
Affiliation(s)
- Peng Cai
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing
- Department of Intensive Care Medicine, PLA 80th Group Army Hospital, Weifang
| | - Qingshu Lin
- Department of Intensive Care Medicine, PLA 80th Group Army Hospital, Weifang
| | - Dan Lv
- Department of Intensive Care Medicine, PLA 80th Group Army Hospital, Weifang
| | - Jing Zhang
- Department of Intensive Care Medicine, PLA 80th Group Army Hospital, Weifang
| | - Yan Wang
- Department of Pharmacy, Key Laboratory of Basic Pharmacology of Ministry of Education Joint International Research Laboratory of Ministry Education, Zunyi Medical University, Zunyi
| | - Xukai Wang
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing
- Department of Cardiology, Chongqing Hygeia Hospital, Chongqing, China
| |
Collapse
|
39
|
Dahle N, Ärnlöv J, Leppert J, Hedberg P. Nondipping blood pressure pattern predicts cardiovascular events and mortality in patients with atherosclerotic peripheral vascular disease. Vasc Med 2023; 28:274-281. [PMID: 37036102 PMCID: PMC10408241 DOI: 10.1177/1358863x231161655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Patients with peripheral vascular disease (PVD) are often underdiagnosed and undertreated. Nocturnal nondipping blood pressure (BP) pattern, as diagnosed by ambulatory BP monitoring (ABPM), is associated with increased cardiovascular risk, but has not been studied in patients with PVD. We aimed to investigate if a nondipping BP pattern predicts cardiovascular events or all-cause death in outpatients with PVD. METHODS Consecutive outpatients with carotid or lower-extremity PVD were examined with 24-hour ABPM (n = 396). Nondipping was defined as a < 10% fall in systolic BP level during night-time. We used Cox regression models adjusting for potential confounders. We also evaluated the incremental prognostic value of dipping status in the COPART risk score. Our primary composite outcome was cardiovascular events or all-cause death. RESULTS In the cohort (mean age 70; 40% women), 137 events occurred during a 5.1-year median follow-up; incident rate of 7.35 events per 100 person-years. Nondipping was significantly associated with outcome (hazard ratio 1.55, 95% CI 1.07-2.26, p = 0.021) in a fully adjusted model. When adding nondipping to the risk markers in the COPART risk score, the model fit significantly improved (χ2 7.91, p < 0.005) and the C-statistic increased from 0.65 to 0.67. CONCLUSION In a cohort of outpatients with PVD, nondipping was an independent risk factor for future cardiovascular events or mortality and seemed to be a strong predictor in patients with carotid artery disease but not in lower-extremity PVD. Additional studies are needed to evaluate the clinical utility of ABPM for improved prevention in these high-risk patients. (ClinicalTrials.gov Identifier: NCT01452165).
Collapse
Affiliation(s)
- Nina Dahle
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- Primary Health Care Center Britsarvet-Grycksbo, County of Dalarna, Falun, Sweden
| | - Johan Ärnlöv
- Department of Neurobiology, Division of Family Medicine and Primary Care, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Jerzy Leppert
- Center for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Pär Hedberg
- Center for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
- Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden
| |
Collapse
|
40
|
Karakayali M, Omar T, Artac I, Rencuzogullari İ, Karabag Y, Demir O. The relationship between the systemic immune-inflammation index and reverse-dipper circadian pattern in newly diagnosed hypertensive patients. J Clin Hypertens (Greenwich) 2023; 25:700-707. [PMID: 37464585 PMCID: PMC10423764 DOI: 10.1111/jch.14688] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/20/2023]
Abstract
Although hypertension is considered high intravascular pressure, impairing circadian blood pressure (BP) has been shown to potentially contribute to poor clinical outcomes. Systemic immune-inflammation index (SII), based on platelet, neutrophil, and lymphocyte counts, has been established as a strong prognostic marker in cardiovascular disease. The role of inflammation in the pathogenesis of hypertension is a well-known issue and inflammatory markers are associated with BP variability. We aimed to investigate whether there is a relationship between circadian BP changes and SII in newly diagnosed hypertensive patients. The study population consisted of 196 newly diagnosed hypertensive patients without LVH. In total, 76 (38%) patients had a dipper BP pattern, 60 (31%) patients had a non-dipper BP pattern, and 60 (31%) patients had a reverse-dipper BP pattern. SII was calculated according to Multivariate logistic regression analysis revealed SII and HDL-C as an independent predictors of reverse-dipper circadian pattern in newly diagnosed hypertensive patients. The cut-off value of the SII for reverse-dipper hypertension in a ROC curve analysis was >639.73 with 63.3% sensitivity and 84.2% specificity. Our study showed that the SII level was higher in the reverse-dipper hypertension patient group than in the dipper and non-dipper hypertension groups. Furthermore, SII was an independent predictor of newly diagnosed reverse-dipper hypertensive patients. The high SII value in newly diagnosed hypertensive patients can be used as an early warning parameter to identify reverse-dipper hypertension patients.
Collapse
Affiliation(s)
| | - Timor Omar
- Department of CardiologyKafkas University School of MedicineKarsTurkey
| | - Inanç Artac
- Department of CardiologyKafkas University School of MedicineKarsTurkey
| | | | - Yavuz Karabag
- Department of CardiologyKafkas University School of MedicineKarsTurkey
| | - Ozturk Demir
- Department of CardiologyKafkas University School of MedicineKarsTurkey
| |
Collapse
|
41
|
Juraschek SP, Bello NA, Chang AR, Cluett JL, Griffin K, Hinderliter A, Mukamal K, Ngo L, Turkson-Ocran RAN, Voora R, Vongpatanasin W. Trends in Ambulatory Blood Pressure Monitoring in Five High-Volume Medical Centers. Hypertension 2023; 80:e131-e133. [PMID: 37226835 PMCID: PMC10449367 DOI: 10.1161/hypertensionaha.123.21412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Stephen P Juraschek
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Natalie A. Bello
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Jennifer L Cluett
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Alan Hinderliter
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kenneth Mukamal
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Long Ngo
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Raven Voora
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | |
Collapse
|
42
|
Yang H, Fan X, Shen X, Liang L, Hu D, Zhang Y, Liu L, Qian H. Correlation of blood pressure levels at different time periods throughout the day with total CSVD burden and MRI imaging markers. Front Neurol 2023; 14:1200846. [PMID: 37576008 PMCID: PMC10415676 DOI: 10.3389/fneur.2023.1200846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Purpose Hypertension is an important risk factor for atherosclerotic cerebral small vessel disease (CSVD). Higher blood pressure is associated with a higher CSVD burden and the presence of relevant magnetic resonance imaging (MRI) markers. However, the effect of blood pressure level on CSVD burden and imaging markers including white matter hyperintensity (WHM), lacune, enlarged perivascular spaces (EPVS), and cerebral microbleed (CMB) remains unknown. The purpose of this study was to investigate the correlation between blood pressure level and CSVD burden at different time periods throughout the day. Methods In total, 144 in-patients with CSVD (66.4 ± 9.8 years, 50% male) were enrolled and underwent brain MRI, and 24-h ambulatory blood pressure was assessed. Patients were categorized into five groups according to their MRI-evaluated total CSVD burden scores (0-4). Spearman's correlation analysis was performed to examine the correlation between blood pressure levels at different time periods and the total CSVD score or the markers of periventricular WMH, deep WMH, lacune, EPVS, and CMB. Results Of the 144 patients, 83.3% (120/144) harbored one or more CSVD markers of interest. The systolic blood pressure (SBP) of 24-h, daytime, nighttime, and morning differed significantly among the five groups. The SBP levels increased significantly with the total CSVD scores during 24 h (P = 0.018), daytime (P = 0.018), and nighttime (P = 0.035). Spearman's correlation analysis demonstrated that the SBP of 24 h, daytime, nighttime, and morning and the diastolic blood pressure (DBP) of 24 h and morning positively and significantly correlated with the total CSVD score (P < 0.05). A logistic regression analysis indicated that both morning SBP and DBP were independent risk factors for total CSVD burden (OR = 1.13, 95% CI: 1.02-1.23, P = 0.015; OR = 1.19, 95% CI: 1.06-1.33, P = 0.005). Spearman's correlation analysis indicated a significant positive correlation between morning SBP and higher deep WMH Fazekas score (r = 0.296, P < 0.001), EPVS grade in the basal ganglia (r = 0.247, P = 0.003), and the presence of lacune (r = 0.173, P = 0.038) and CMB (r = 0.326, P < 0.001). Morning DBP only correlated positively with the presence of CMB (r = 0.292, P < 0.001). Conclusion Higher SBP signficantly correlated with total CSVD burden in patients with atherosclerotic CSVD. Early morning blood pressure level is an important indicator to reflect the severity of CSVD patients.
Collapse
Affiliation(s)
- Hua Yang
- Department of Neurology, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Xueyi Fan
- Department of Neurology, The Sixth Medical Center of PLA General Hospital, Beijing, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Xiangyi Shen
- School of Medicine, Tsinghua University, Beijing, China
| | - Li Liang
- Department of Neurology, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Dongyang Hu
- Department of Neurology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Yimo Zhang
- Department of Neurology, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Li Liu
- Department of General Practice, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Hairong Qian
- Department of Neurology, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
43
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
44
|
Omboni S, Khan NA, Kunadian V, Olszanecka A, Schutte AE, Mihailidou AS. Sex Differences in Ambulatory Blood Pressure Levels and Subtypes in a Large Italian Community Cohort. Hypertension 2023; 80:1417-1426. [PMID: 37315119 DOI: 10.1161/hypertensionaha.122.20589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/11/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Sex differences in blood pressure control are recognized. We systematically investigated sex differences in specific components of ambulatory blood pressure (ABP), including variability, day-night changes, morning surge, and hypertension types. METHODS We analyzed ABPs of 52 911 participants (45.6% male, 54.4% female, 37.0% treated for hypertension) visiting 860 Italian community pharmacies. Sex differences in ABP levels and patterns were evaluated in the whole group and 4 risk groups (antihypertensive-treated patients, patients with diabetes, dyslipidemia, or cardiovascular disease). RESULTS Average 24-hour, day-time, and night-time blood pressure values were consistently higher in males than females (P<0.001). Variability in ABP was higher in females, except during the night. Nondippers and an abnormal morning surge were more common among males (odds ratio and 95% CI, 1.282 [1.230-1.335] and 1.244 [1.159-1.335]; P<0.001). The prevalence of 24-hour and masked hypertension was higher in males (odds ratio and 95% CI, 2.093 [2.019-2.170] and 1.347 [1.283-1.415]; P<0.001) and that of white-coat hypertension in females (0.719 [0.684-0.755]; P<0.001). Ambulatory heart rate mean values were higher (P<0.001) in females. Day-time HR variability was higher and night-time heart rate variability lower in females (P<0.001). Sex differences in ABP levels and patterns detected in the whole population were replicated in all risk groups, except for the prevalence of abnormal morning surge (between sexes difference in antihypertensive-treated participants only). CONCLUSIONS Females show better ABP control than males, but with an increased blood pressure variability and a greater prevalence of white-coat hypertension. These findings support tailored management of hypertension. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03781401.
Collapse
Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy (S.O.)
- Department of Cardiology, Sechenov First Moscow State Medical University, Russian Federation (S.O.)
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada (N.A.K.)
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University (V.K.), Newcastle upon Tyne, United Kingdom
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust (V.K.), Newcastle upon Tyne, United Kingdom
| | - Agnieszka Olszanecka
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland (A.O.)
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, Australia (A.E.S.)
- Hypertension in Africa Research Team, South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital (A.S.M.), Sydney, New South Wales, Australia
- Macquarie University (A.S.M.), Sydney, New South Wales, Australia
| |
Collapse
|
45
|
Kakaletsis N, Ntaios G, Milionis H, Karagiannaki A, Chouvarda I, Dourliou V, Chytas A, Hatzitolios AI, Savopoulos C. Prognostic significance of 24-h blood pressure and variability indices in the outcome of acute ischaemic stroke. Intern Med J 2023; 53:1137-1146. [PMID: 35666577 DOI: 10.1111/imj.15834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association between blood pressure (BP) levels and BP variability (BPV) following acute ischaemic stroke (AIS) and outcome remains controversial. AIMS To investigate the predictive value of systolic BP (SBP) and diastolic BP (DBP) and BPV measured using 24-h ambulatory blood pressure monitoring (ABPM) methods during AIS regarding outcome. METHODS A total of 228 AIS patients (175 without prior disability) underwent ABPM every 20 min within 48 h from onset using an automated oscillometric device (TM 2430, A&D Company Ltd) during day time (7:00-22:59) and night time (23:00-6:59). Risk factors, stroke subtypes, clinical and laboratory findings were recorded. Mean BP parameters and several BPV indices were calculated. End-points were death and unfavourable functional outcome (disability/death) at 3 months. RESULTS A total of 61 (26.7%) patients eventually died. Multivariate logistic regression analysis revealed that only mean night-time DBP (hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.00-1.07) was an independent prognostic factor of death. Of the 175 patients without prior disability, 79 (45.1%) finally met the end-point of unfavourable functional outcome. Mean 24-h SBP (HR: 1.03; 95% CI: 1.00-1.05), day-time SBP (HR: 1.02; 95% CI: 1.00-1.05) and night-time SBP (HR: 1.03; 95% CI: 1.01-1.05), SBP nocturnal decline (HR: 0.93; 95% CI: 0.88-0.99), mean 24-h DBP (HR: 1.08; 95% CI: 1.03-1.13), day-time DBP (HR: 1.07; 95% CI: 1.03-1.12) and night-time DBP (HR: 1.06; 95% CI: 1.02-1.10) were independent prognostic factors of an unfavourable functional outcome. CONCLUSIONS In contrast with BPV indices, ABPM-derived BP levels and lower or absence of BP nocturnal decline in the acute phase are prognostic factors of outcome in AIS patients.
Collapse
Affiliation(s)
- Nikolaos Kakaletsis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, Medical School, University of Ioannina, University Hospital of Ioannina, Ioannina, Greece
| | - Anastasia Karagiannaki
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ioanna Chouvarda
- Laboratory of Medical Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Dourliou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Achileas Chytas
- Laboratory of Medical Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| |
Collapse
|
46
|
Agarwal R. Should we CLICK on chlorthalidone for treatment-resistant hypertension in chronic kidney disease? Clin Kidney J 2023; 16:793-796. [PMID: 37151421 PMCID: PMC10157782 DOI: 10.1093/ckj/sfac272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 12/24/2022] Open
Abstract
Treatment-resistant hypertension is common among patients with advanced chronic kidney disease (CKD). In people with preserved kidney function, spironolactone is an evidence-based treatment. However, the risk for hyperkalemia limits its use in people with more advanced CKD. In the Chlorthalidone in Chronic Kidney Disease (CLICK) trial, 160 patients with stage 4 CKD and poorly controlled hypertension as confirmed by 24-hour ambulatory blood pressure (ABP) monitoring were randomly assigned to either placebo or chlorthalidone 12.5 mg daily in a 1:1 ratio stratified by prior loop diuretic use. The primary endpoint was the change in 24-hour systolic ABP from baseline to 12 weeks. The trial showed a treatment-induced reduction of 24-hour systolic ABP by 10.5 mmHg. Of the 160 patients randomized, 113 (71%) had resistant hypertension, of which 90 (80%) were on loop diuretics and the mean number of antihypertensive medications prescribed was 4.1 (standard deviation 1.1). In this subgroup of patients with treatment-resistant hypertension, the adjusted change from baseline to 12 weeks in the between-group difference in 24-hour systolic ABP was -13.9 mmHg (95% CI -19.4 to -8.4; P < .0001). Furthermore, compared with placebo, the urine albumin:creatinine ratio in the chlorthalidone group at 12 weeks was 54% lower (95% CI -65 to -40). Following randomization, hypokalemia, reversible increases in serum creatinine, hyperglycemia, dizziness, orthostatic hypotension and hyperuricemia occurred more frequently in the chlorthalidone group. Chlorthalidone has the potential to improve BP control among patients with advanced CKD and treatment-resistant hypertension. However, caution is advised when treating patients, especially when they are on loop diuretics.
Collapse
Affiliation(s)
- Rajiv Agarwal
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
| |
Collapse
|
47
|
Angeli F, Reboldi G, Solano FG, Prosciutto A, Paolini A, Zappa M, Bartolini C, Santucci A, Coiro S, Verdecchia P. Interpretation of Ambulatory Blood Pressure Monitoring for Risk Stratification in Hypertensive Patients: The 'Ambulatory Does Prediction Valid (ADPV)' Approach. Diagnostics (Basel) 2023; 13:diagnostics13091601. [PMID: 37174992 PMCID: PMC10178200 DOI: 10.3390/diagnostics13091601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Several outcome-based prospective investigations have provided solid data which support the prognostic value of 24 h ambulatory blood pressure over and beyond cardiovascular traditional risk factors. Average 24 h, daytime, and nighttime blood pressures are the principal components of the ambulatory blood pressure profile that have improved cardiovascular risk stratification beyond traditional risk factors. Furthermore, several additional ambulatory blood pressure measures have been investigated. The correct interpretation in clinical practice of ambulatory blood pressure monitoring needs a standardization of methods. Several algorithms for its clinical use have been proposed. Implementation of the results of ambulatory blood pressure monitoring in the management of individual subjects with the aim of improving risk stratification is challenging. We suggest that clinicians should focus attention on ambulatory blood pressure components which have been proven to act as the main independent predictors of outcome (average 24 h, daytime, and nighttime blood pressure, pulse pressure, dipping status, BP variability).
Collapse
Affiliation(s)
- Fabio Angeli
- Department of Medicine and Technological Innovation (DiMIT), University of Insubria, 21100 Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, 21049 Tradate, Italy
| | - Gianpaolo Reboldi
- Department of Medicine, and Centro di Ricerca Clinica e Traslazionale (CERICLET), University of Perugia, 06100 Perugia, Italy
- Division of Nephrology, Hospital S. Maria della Misericordia, 33100 Perugia, Italy
| | | | | | | | - Martina Zappa
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Claudia Bartolini
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
| | - Andrea Santucci
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
| | - Stefano Coiro
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
| | - Paolo Verdecchia
- Division of Cardiology, Hospital S. Maria della Misericordia, 06100 Perugia, Italy
- Fondazione Umbra Cuore e Ipertensione-ONLUS, 06100 Perugia, Italy
| |
Collapse
|
48
|
Espeche WG, Salazar MR. Ambulatory Blood Pressure Monitoring for Diagnosis and Management of Hypertension in Pregnant Women. Diagnostics (Basel) 2023; 13:diagnostics13081457. [PMID: 37189558 DOI: 10.3390/diagnostics13081457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
Hypertension disorders during pregnancy has a wide range of severities, from a mild clinical condition to a life-threatening one. Currently, office BP is still the main method for the diagnosis of hypertension during pregnancy. Despite of the limitation these measurements, in clinical practice office BP of 140/90 mmHg cut point is used to simplify diagnosis and treatment decisions. The out-of-office BP evaluations are it comes to discarding white-coat hypertension with little utility in practice to rule out masked hypertension and nocturnal hypertension. In this revision, we analyzed the current evidence of the role of ABPM in diagnosing and managing pregnant women. ABPM has a defined role in the evaluation of BP levels in pregnant women, being appropriate performing an ABPM to classification of HDP before 20 weeks of gestation and second ABMP performed between 20-30 weeks of gestation to detected of women with a high risk of development of PE. Furthermore, we propose to, discarding white-coat hypertension and detecting masked chronic hypertension in pregnant women with office BP > 125/75 mmHg. Finally, in women who had PE, a third ABPM in the post-partum period could identify those with higher long-term cardiovascular risk related with masked hypertension.
Collapse
Affiliation(s)
- Walter G Espeche
- Unidad de Enfermedades Cardiometabólicas, Hospital General San Martín, La Plata 1900, Argentina
| | - Martin R Salazar
- Docencia e Investigación, Hospital San Martin de La Plata, La Plata 1900, Argentina
| |
Collapse
|
49
|
Szypenbejl J, Hoffmann M, Chwojnicki K, Czyż-Szypenbejl K, Kowalke A, Węgłowska Z, Siemiński M. The importance of blood pressure measurements at the emergency department in detection of arterial hypertension. Cardiol J 2023:VM/OJS/J/91386. [PMID: 37067335 DOI: 10.5603/cj.a2023.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/30/2022] [Accepted: 03/24/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Arterial hypertension (AH) is the most important modifiable risk factor for cardiovascular diseases in Poland and around the world. Unfortunately, despite its potentially catastrophic consequences, more than 30% of hypertensive patients in Poland remain undiagnosed. Therefore, emergency department (ED) triage may play a role in screening of a significant proportion of the population. The present study aimed to assess the prevalence of hypertension in patients reporting to the ED by verifying ad hoc measurements with ambulatory blood pressure monitoring (ABPM). METHODS The study included 78,274 patients admitted to the ED of the University Clinical Center in Gdansk from 01.01.2019 to 31.12.2020, with elevated blood pressure values (systolic blood pressure [SBP] > 140 mmHg and/or diastolic blood pressure [DBP] > 90 mmHg) during triage according to the inclusion and exclusion criteria. RESULTS Out of 34,597 patients with SBP > 140 mmHg and/or DBP > 90 mmHg, 27,896 patients (80.6% of patients) had previously been diagnosed with AH. Finally, a group of 6701 patients with elevated values of arterial blood pressure in triage, who had not yet been diagnosed with AH, was identified. This accounted for 8.6% of patients admitted to the ED. Ultimately, 58 patients (26 women and 36 men) agreed to undergo ABPM. Based on the analysis, AH 32 patients were diagnosed with AH (55.2%). CONCLUSIONS The ED plays an essential role in diagnosing hypertension among people reporting to the ED for various reasons. There is a high probability of a diagnosis of AH in a group of patients who have elevated blood pressure values during triage and have not yet been diagnosed with hypertension.
Collapse
Affiliation(s)
- Jacek Szypenbejl
- Department of Emergency Medicine, Medical University of Gdansk, Poland.
| | - Michał Hoffmann
- Department of Hypertension and Diabetology, Medical University of Gdansk, Poland
| | - Kamil Chwojnicki
- Department of Anesthesiology and Intensive Care, Medical University of Gdansk, Poland
| | | | - Adrianna Kowalke
- Department of Emergency Medicine, Medical University of Gdansk, Poland
| | - Zuzanna Węgłowska
- Department of Emergency Medicine, Medical University of Gdansk, Poland
| | - Mariusz Siemiński
- Department of Emergency Medicine, Medical University of Gdansk, Poland
| |
Collapse
|
50
|
Barochiner J, Díaz RR, Martínez R. Prevalence and Characteristics of Isolated Nocturnal Hypertension and Masked Nocturnal Hypertension in a Tertiary Hospital in the City of Buenos Aires. Diagnostics (Basel) 2023; 13:1419. [PMID: 37189519 PMCID: PMC10138072 DOI: 10.3390/diagnostics13081419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Isolated nocturnal hypertension (INH) and masked nocturnal hypertension (MNH) increase cardiovascular risk. Their prevalence and characteristics are not clearly established and seem to differ among populations. We aimed to determine the prevalence and associated characteristics of INH and MNH in a tertiary hospital in the city of Buenos Aires. We included 958 hypertensive patients ≥ 18 years who underwent an ambulatory blood pressure monitoring (ABPM) between October and November 2022, as prescribed by their treating physician to diagnose or to assess hypertension control. INH was defined as nighttime BP ≥ 120 mmHg systolic or ≥70 diastolic in the presence of normal daytime BP (<135/85 mmHg regardless of office BP; MNH was defined as the presence of INH with office BP < 140/90 mmHg). Variables associated with INH and MNH were analyzed. The prevalences of INH and MNH were 15.7% (95% CI 13.5-18.2%) and 9.7 (95% CI 7.9-11.8%), respectively. Age, male sex, and ambulatory heart rate were positively associated with INH, whereas office BP, total cholesterol, and smoking habits showed a negative association. In turn, diabetes and nighttime heart rate were positively associated with MNH. In conclusion, INH and MNH are frequent entities, and determination of clinical characteristics such as those detected in this study is critical since this might contribute to a more appropriate use of resources.
Collapse
Affiliation(s)
- Jessica Barochiner
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina; (R.R.D.); (R.M.)
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de Triple Dependencia CONICET-Instituto Universitario del Hospital Italiano (IUHI)-Hospital Italiano (HIBA), Buenos Aires C1199, Argentina
| | - Romina R. Díaz
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina; (R.R.D.); (R.M.)
| | - Rocío Martínez
- Hypertension Section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina; (R.R.D.); (R.M.)
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), UE de Triple Dependencia CONICET-Instituto Universitario del Hospital Italiano (IUHI)-Hospital Italiano (HIBA), Buenos Aires C1199, Argentina
| |
Collapse
|