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Kim Y, Esquivel JH, Mattos MK, Davis EM, Logan J. Psychological distress, forced awakening, and morning blood pressure surge. Blood Press Monit 2024:00126097-990000000-00119. [PMID: 39087911 DOI: 10.1097/mbp.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
BACKGROUND Morning blood pressure surge (MBPS) has been recognized as an independent predictor of cardiovascular disease events. Psychological distress, including anxiety, depression, and perceived stress, and behavioral risk factors, such as poor sleep quality, have been associated with increased MBPS. Elevations in sympathetic activity induced by forced awakening may also contribute to further increases in MBPS. Yet, no examination of the interrelationships among psychological distress, sleep quality, awakening mode (natural vs. forced awakenings), and MBPS has been undertaken. OBJECTIVE This pilot study aimed: (1) to examine if MBPS differs by awakening mode and (2) to investigate whether psychological distress is associated with MBPS difference between natural and forced awakenings, independent of sleep quality. METHODS Thirty-two healthy adults were included in this cross-sectional study. Blood pressure was measured using a beat-to-beat blood pressure monitor over two nights, consisting of one night of natural awakening and one night of forced awakening. Psychological distress and sleep quality were assessed using questionnaires. We conducted paired t-tests (aim 1) and multiple linear regressions (aim 2). RESULTS MBPS was significantly greater during forced awakening compared with natural awakening. In addition, the MBPS difference between natural and forced awakenings was significantly greater in participants with higher anxiety levels, independent of sleep quality. CONCLUSION We found that augmentation of MBPS by forced awakening was significantly greater in individuals who reported higher anxiety levels. Additional research is needed to examine the potential impacts of forced awakening and anxiety on MBPS in a larger sample of individuals at risk for cardiovascular disease.
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Affiliation(s)
- Yeonsu Kim
- School of Nursing, University of Virginia, Charlottesville, Virginia
| | - Jill Howie Esquivel
- School of Nursing, University of California San Francisco, San Francisco, California and
| | | | - Eric M Davis
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Jeongok Logan
- School of Nursing, University of Virginia, Charlottesville, Virginia
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Baek MS, Song WK, Kim KE, Lee A, Lee JY, Shin JW, Kook MS. Morning Blood Pressure Surge and Glaucomatous Visual Field Progression in Normal-Tension Glaucoma Patients With Systemic Hypertension. Am J Ophthalmol 2023; 254:161-176. [PMID: 37352910 DOI: 10.1016/j.ajo.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE To investigate the impact of a morning blood pressure surge (MBPS) at baseline on subsequent visual field (VF) progression in hypertensive, normal-tension glaucoma (NTG) patients receiving oral anti-hypertensive treatment. DESIGN Retrospective cohort study. METHODS A total of 127 eyes from 127 newly diagnosed NTG patients treated for systemic hypertension and followed up for at least 2 years were analyzed. All patients underwent baseline 24-hour ambulatory blood pressure monitoring (ABPM) and at least 5 serial VF examinations during the follow-up period. VF progression was defined according to the Early Manifest Glaucoma Trial criteria. The associations of VF progression with 24-hour ABPM-based blood pressure (BP) parameters (including MBPS) and other clinical variables were analyzed using Cox regression analyses. Kaplan-Meier survival analysis was used to compare VF survival estimates in patients with and without MBPS. RESULTS VF progression was detected in 38 eyes (29.9%) over a 5.2-year mean follow-up. In the multivariate Cox regression model, a greater MBPS (hazard ratio [HR] = 1.033; P = .024) and lower nighttime mean arterial pressure (MAP) trough (HR = 0.965; P = .031) at baseline were significant independent predictors of subsequent VF progression. The likelihood of VF progression was significantly greater in patients with higher MBPS (P = .021) at baseline according to Kaplan-Meier survival analysis. CONCLUSIONS An increased MBPS at baseline is a significant independent predictor of subsequent VF progression in NTG patients with systemic hypertension. This may be another relevant BP parameter associated with VF progression in hypertensive NTG patients receiving oral anti-hypertensive treatment.
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Affiliation(s)
- Min Su Baek
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Woo Keun Song
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ko Eun Kim
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Anna Lee
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Yeong Lee
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joong Won Shin
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Michael S Kook
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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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] [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).
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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
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Morning blood pressure surge in the early stage of hypertensive patients impacts three-dimensional left ventricular speckle tracking echocardiography. Clin Hypertens 2021; 27:16. [PMID: 34391469 PMCID: PMC8364689 DOI: 10.1186/s40885-021-00173-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to examine left ventricular (LV) function in untreated, newly diagnosed hypertensive patients with morning blood pressure surge (MBPS) status using three-dimensional (3D) speckle tracking echocardiography (STE). METHODS In this study, 163 newly diagnosed hypertensive patients were included, and all patients underwent 24-h ambulatory blood pressure monitoring (ABPM). According to ABPM, participants were divided into a MBPS group and a non-MBPS group. The entire study population was examined by complete two-dimensional (2D) transthoracic echocardiography (TTE) and 3D STE. RESULT The results of this study showed that 3D LV longitudinal strain was significantly decreased in the MBPS group compared with the non-MBPS group (- 30.1 ± 2.0 vs. -31.1 ± 2.7, p = 0.045). Similar trends were observed for 3D twist (9.6 ± 6.1 vs. 12.1 ± 4.8, p = 0.011) as well as for 3D torsion (1.23 ± 0.78 vs. 1.49 ± 0.62, p = 0.042). The LV principal strain was decreased in the MBPS group (- 33.9 ± 1.7 vs. -35.5 ± 2.8, p < 0.001). The 3D LV global longitudinal strain (GLS) and principal strain were significantly associated with quartile of MBPS as measured by systolic blood pressure (SBP). CONCLUSION The 3D STE revealed that LV mechanics were more impaired in the MBPS group than in the non-surge newly diagnosed, untreated hypertensive patients; even the 2D TTE parameters showed no difference.
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The Association of Morning Surge and Night-Time Dipping Blood Pressure with Significant and Complex Coronary Artery Lesions. High Blood Press Cardiovasc Prev 2021; 28:467-474. [PMID: 34057691 DOI: 10.1007/s40292-021-00463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Hypertension responsible for more than 10 million deaths annually worldwide and abnormal diurnal blood pressure (BP) variation is associated with cardiovascular events. AIM This study aimed to investigate the association between the 24-h ambulatory night BP dipping and morning BP surge (MS) with characteristic of coronary artery lesions that may contribute cardiovascular events and mortality burden. METHODS A cross sectional study over 1-year, collected 263 cases of hypertensive (80%) and non-hypertensive patients, aged 61 ± 10 years, who undergoing invasive coronary angiography (CAG) and 24-h ambulatory BP monitoring admitted to cardiology department complain of chest pain. The night-time/day-time dip and sleep-trough MS were calculated. Non-dipper status was considered when night-time/day-time dip < 10%, and significant coronary lesion (SCL) when ≥ 50 % stenosis in 1.5 mm vessels. The SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score was used to quantify the complexity of SCL. RESULT The mean morning systolic BP (SBP) surge was higher in the high SYNTAX Score subgroup than low and intermediate subgroups (25 ± 11 vs 17 ± 13 and 10 ± 10 mmHg, p < 0.010). Non-dipper SBP status was more frequently in patients with SCL than non-SCL (p < 0.019). In ordinal regression, hypertension was independent predictor of SCL (odd ratio: 0.40, p < 0.003), the night-time/day-time BP dip was independent predictor of being in a higher SYNTAX score subgroup (systolic odd ratio: 0.88, diastolic odd ratio: 1.14 p < 0.05). CONCLUSION Hypertension is associated with SCL and the night-time/day-time BP dip as a continuous variable is associated with complex coronary lesion. Non-dipping as categorical variable and morning BP surge were not independent predictors of significant or complex coronary lesions.
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Roy SK, Das P, Mondal A, Mandal A, Kuotsu K. Design, formulation and evaluation of multiparticulate time programmed system of ramipril for pulsed release: An approach in the management of early morning surge in blood pressure. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Mancia G, Facchetti R, Seravalle G, Cuspidi C, Corrao G, Grassi G. Adding Home and/or Ambulatory Blood Pressure to Office Blood Pressure for Cardiovascular Risk Prediction. Hypertension 2021; 77:640-649. [PMID: 33390055 DOI: 10.1161/hypertensionaha.120.16303] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Home and 24-hour blood pressure (BPHome and BP24h) are believed to improve the prognostic value of office BP (BPOffice) alone, but the evidence has limitations such as that (1) these 3 BPs are characterized by multicollinearity and (2) the procedures adopted do not allow quantification of the prognostic advantage. One thousand eight hundred thirty-three individuals belonging to the PAMELA (Pressioni Arteriose Monitorate e Loro Associazioni) were followed for 16 years. Prediction of cardiovascular and all-cause mortality was determined via the goodness of fit of individual data (Cox model), the area underlying the receiving operator curves and the net reclassification improvement of cardiovascular and all-cause mortality risk. Calculations were made for BPOffice alone and after addition of BPHome, BP24h, or both, limited to their residual portion which was found to be unexplained by, and thus independent on, BPOffice. With all methods addition of residual out-of-office systolic or diastolic BP to BPOffice significantly improved cardiovascular and all-cause mortality prediction. The improvement was more consistent when BPHome rather than BP24h was added to BPOffice and, compared with BPOffice plus BPHome, no better prediction was found when addition was extended to BP24h. With all additions, however, the improvement was quantitatively modest, which was the case also when data were separately analyzed in younger and older individuals or in dippers and nondippers. Thus, addition of out-of-office to BPOffice improves prediction of cardiovascular risk, even when data analysis avoids previous limitations. The improvement appears to be limited, however, which raises the question of the advantage to recommend their extended use in clinical practice.
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Affiliation(s)
- Giuseppe Mancia
- From the Policlinico di Monza (G.M.), University Milano-Bicocca, Milan, Italy
| | - Rita Facchetti
- Clinica Medica, Department of Medicine and Surgery (R.F., G.S., C.C., G.G.), University Milano-Bicocca, Milan, Italy
| | - Gino Seravalle
- Clinica Medica, Department of Medicine and Surgery (R.F., G.S., C.C., G.G.), University Milano-Bicocca, Milan, Italy
| | - Cesare Cuspidi
- Clinica Medica, Department of Medicine and Surgery (R.F., G.S., C.C., G.G.), University Milano-Bicocca, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods (G.C.), University Milano-Bicocca, Milan, Italy
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery (R.F., G.S., C.C., G.G.), University Milano-Bicocca, Milan, Italy
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Kario K, Hasebe N, Okumura K, Yamashita T, Akao M, Atarashi H, Ikeda T, Koretsune Y, Shimizu W, Tsutsui H, Toyoda K, Hirayama A, Yasaka M, Yamaguchi T, Teramukai S, Kimura T, Kaburagi J, Takita A, Inoue H. High prevalence of masked uncontrolled morning hypertension in elderly non-valvular atrial fibrillation patients: Home blood pressure substudy of the ANAFIE Registry. J Clin Hypertens (Greenwich) 2021; 23:73-82. [PMID: 33190415 PMCID: PMC8029869 DOI: 10.1111/jch.14095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/15/2020] [Accepted: 10/02/2020] [Indexed: 12/28/2022]
Abstract
In the ANAFIE Registry home blood pressure subcohort, we evaluated 5204 patients aged ≥75 years with non-valvular atrial fibrillation (NVAF) to assess blood pressure (BP) control, prevalence of masked hypertension, and anticoagulant use. Mean clinic (C) and home (H) systolic/diastolic BP(SBP/DBP) was 128.5/71.3 and 127.7/72.6 mm Hg, respectively. Overall, 77.5% of patients had hypertension; of these, 27.7%, 13.4%, 23.4%, and 35.6% had well-controlled, white coat, masked, and sustained hypertension, respectively. Masked hypertension prevalence increased with diabetes, decreased renal function, age ≥80 years, current smoker status, and chronic obstructive pulmonary disease. By morning/evening average, 59.0% of patients had mean H-SBP ≥ 125 mm Hg; 48.9% had mean C-SBP ≥ 130 mm Hg. Early morning hypertension (morning H-SBP ≥ 125 mm Hg) was found in 65.9% of patients. Although 51.1% of patients had well-controlled C-SBP, 52.5% of these had uncontrolled morning H-SBP. In elderly NVAF patients, morning H-BP was poorly controlled, and masked uncontrolled morning hypertension remains significant.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular MedicineJichi Medical UniversityTochigiJapan
| | - Naoyuki Hasebe
- Department of Cardiology, Nephrology, Pulmonology and NeurologyAsahikawa Medical UniversityHokkaidoJapan
| | - Ken Okumura
- Division of CardiologySaiseikai Kumamoto HospitalKumamotoJapan
| | | | - Masaharu Akao
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | | | - Takanori Ikeda
- Department of Cardiovascular MedicineToho University Omori Medical CenterTokyoJapan
| | | | | | - Hiroyuki Tsutsui
- Department of Cardiovascular MedicineKyushu UniversityFukuokaJapan
| | | | | | - Masahiro Yasaka
- Department of Cerebrovascular and NeurologyNational Hospital Organization Kyushu Medical CenterFukuokaJapan
| | | | - Satoshi Teramukai
- Department of BiostatisticsKyoto Prefectural University of MedicineKyotoJapan
| | - Tetsuya Kimura
- Medical Science DepartmentDaiichi Sankyo Co., Ltd.TokyoJapan
| | - Jumpei Kaburagi
- Medical Science DepartmentDaiichi Sankyo Co., Ltd.TokyoJapan
| | - Atsushi Takita
- Biostatistics and Data Management DepartmentDaiichi Sankyo Co., Ltd.TokyoJapan
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Liu K, Xu Y, Gong S, Li J, Li X, Ye R, Liao H, Chen X. The disadvantage of morning blood pressure management in hypertensive patients. Medicine (Baltimore) 2020; 99:e19278. [PMID: 32080140 PMCID: PMC7034673 DOI: 10.1097/md.0000000000019278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 02/05/2023] Open
Abstract
To investigate whether the control of morning blood pressure (MBP) reflects the control of blood pressure (BP) in other periods (daytime, nighttime and 24-hour) and to assess whether morning BP displays a closer association with subclinical target organ damage (TOD) than the BP measured in other periods.One thousand one hundred forty patients with primary hypertension who completed subclinical TOD detection and 24-hour ambulatory BP monitoring were included in the analysis. Pearson correlation analysis, Kappa consistency test, multiple linear regression analysis, and area under the receiver operating curve were used to analyze the data.Morning BP and daytime BP displayed good agreement, but not 24-hour BP , particularly the nighttime BP (all P < .001). Approximately 39.4% of the hypertensive patients receiving drug treatment who had achieved control of the morning BP presented masked nocturnal hypertension, which was associated with worse subclinical TOD. The BP measured in all periods correlated with subclinical TOD, and the correlation was more obvious in the treatment subgroup. However, morning BP did not independently affect subclinical TOD. Morning BP appeared to exhibit less discriminatory power than nighttime BP, particularly with respect to the urinary albumin to creatinine ratio.The use of morning BP for monitoring during hypertension management may not be enough. Masked uncontrolled nocturnal hypertension should be screened when morning BP is controlled.
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Affiliation(s)
- Kai Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Xu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shenzhen Gong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiangbo Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinran Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Runyu Ye
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hang Liao
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoping Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Muntner P, Shimbo D, Carey RM, Charleston JB, Gaillard T, Misra S, Myers MG, Ogedegbe G, Schwartz JE, Townsend RR, Urbina EM, Viera AJ, White WB, Wright JT. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension 2019; 73:e35-e66. [PMID: 30827125 DOI: 10.1161/hyp.0000000000000087] [Citation(s) in RCA: 660] [Impact Index Per Article: 132.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The accurate measurement of blood pressure (BP) is essential for the diagnosis and management of hypertension. This article provides an updated American Heart Association scientific statement on BP measurement in humans. In the office setting, many oscillometric devices have been validated that allow accurate BP measurement while reducing human errors associated with the auscultatory approach. Fully automated oscillometric devices capable of taking multiple readings even without an observer being present may provide a more accurate measurement of BP than auscultation. Studies have shown substantial differences in BP when measured outside versus in the office setting. Ambulatory BP monitoring is considered the reference standard for out-of-office BP assessment, with home BP monitoring being an alternative when ambulatory BP monitoring is not available or tolerated. Compared with their counterparts with sustained normotension (ie, nonhypertensive BP levels in and outside the office setting), it is unclear whether adults with white-coat hypertension (ie, hypertensive BP levels in the office but not outside the office) have increased cardiovascular disease risk, whereas those with masked hypertension (ie, hypertensive BP levels outside the office but not in the office) are at substantially increased risk. In addition, high nighttime BP on ambulatory BP monitoring is associated with increased cardiovascular disease risk. Both oscillometric and auscultatory methods are considered acceptable for measuring BP in children and adolescents. Regardless of the method used to measure BP, initial and ongoing training of technicians and healthcare providers and the use of validated and calibrated devices are critical for obtaining accurate BP measurements.
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Yoo JK, Sun DD, Parker RS, Urey MA, Romero SA, Lawley JS, Sarma S, Vongpatanasin W, Crandall CG, Fu Q. Augmented venoarteriolar response with ageing is associated with morning blood pressure surge. Exp Physiol 2018; 103:1448-1455. [DOI: 10.1113/ep087166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/09/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Jeung-Ki Yoo
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
- The University of Texas Southwestern Medical Center; Dallas TX USA
| | - Dan-Dan Sun
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
| | - Rosemary S. Parker
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
| | - Marcus A. Urey
- The University of Texas Southwestern Medical Center; Dallas TX USA
| | - Steven A. Romero
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
- The University of Texas Southwestern Medical Center; Dallas TX USA
| | - Justin S. Lawley
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
- The University of Texas Southwestern Medical Center; Dallas TX USA
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
- The University of Texas Southwestern Medical Center; Dallas TX USA
| | | | - Craig G. Crandall
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
- The University of Texas Southwestern Medical Center; Dallas TX USA
| | - Qi Fu
- Institute for Exercise and Environmental Medicine; Texas Health Presbyterian Hospital Dallas; Dallas TX USA
- The University of Texas Southwestern Medical Center; Dallas TX USA
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Morning Blood Pressure Surge Relates to Autonomic Neural Activity in Young Non-Dipping Adults: The African-PREDICT Study. Heart Lung Circ 2018; 28:1197-1205. [PMID: 30093314 DOI: 10.1016/j.hlc.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/24/2018] [Accepted: 07/04/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND It is well established that an exaggerated morning blood pressure surge (MBPS) is associated with an increased risk for cardiovascular disease development in hypertensive individuals. However, in non-dipping individuals, a lower surge was reportedly associated with increased cardiovascular risk. Sympathetic nervous system activity is involved in 24-hour blood pressure fluctuations, including night-time dipping and the MBPS. To better understand this interaction, we investigated associations of MBPS with heart-rate variability and baroreceptor sensitivity in young healthy dippers and non-dippers. METHODS We included black and white men and women (n=827), aged 20-30 years and determined the MBPS using two formulas: the sleep-trough and dynamic morning surge. For autonomic function we determined baroreceptor sensitivity and heart-rate variability. RESULTS The majority of non-dippers in this population were black (70.4%), presenting lower sleep-trough and dynamic morning surge (all p<0.001). Heart-rate variability was comparable between dippers and non-dippers, whereas baroreceptor sensitivity was higher in non-dippers (p=0.021). Despite a suppressed MBPS profile in non-dippers, we found both sleep-trough (β=-0.25; p=0.039) and dynamic morning surge (β=-0.14; p=0.047) to be inversely and independently associated with 24-hour heart-rate variability (total power). These results were absent in dippers. CONCLUSIONS In conclusion, we found a higher night-time blood pressure coupled with lower MBPS in young healthy non-dippers. Furthermore, this lower MBPS was independently and negatively associated with autonomic neural activity, suggesting increased autonomic function involvement in MBPS suppression of non-dippers. The predictive value of suppressed nocturnal dipping pattern should be investigated while taking autonomic neural activity into account.
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Kadi H, Avci E, Usta A, Demirtaş AO. Morning blood pressure surge and its relation to insulin resistance in patients of reproductive age with polycystic ovary syndrome. Reprod Biol Endocrinol 2018; 16:75. [PMID: 30092787 PMCID: PMC6085642 DOI: 10.1186/s12958-018-0394-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our aim in this study was to investigate morning blood pressure surge (MBPS) in patients of reproductive age with polycystic ovary syndrome (PCOS) and its relation to insulin resistance (IR). METHODS Fifty-three patients with PCOS without additional illness were included in the study. Forty-two age-matched subjects without PCOS were selected as the control group. All study subjects underwent 24-h blood pressure monitoring. Patients with additional illnesses, drug users, smokers, and alcohol and drug abusers were excluded. Blood insulin, fasting glucose, lipid profile, and hormone profile were measured. Insulin resistance was calculated using the HOMA-IR formula. RESULTS Median age (years) was 27 (20-33) in the PCOS group and 27 (22-33) in the control group. Body mass index was higher in the PCOS group. Office systolic and diastolic blood pressure was higher in the PCOS group. Mean awakening 2-h BPs (mmHg) was 110 ± 7 in the control group and 118 ± 5 in the PCOS group (p < 0.001). Mean MBPS (mmHg) was 21 ± 6 in the control group and 29 ± 8 in the PCOS group. Mean MBPS was higher in the PCOS group (p < 0.001). IR was more frequent in the PCOS group. Based on logistic regression analysis, the presence of PCOS and IR were independent predictors for MBPS. CONCLUSIONS The results of our study showed that MBPS increased excessively when compared to non-PCOS controls in young women with PCOS during reproductive age. In addition, PCOS and insulin resistance were independent risk factors for exaggerated MBPS.
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Affiliation(s)
- Hasan Kadi
- Cardiology Department, Balikesir University Faculty of Medicine, Balikesir, Turkey.
| | - Eyup Avci
- Cardiology Department, Balikesir University Faculty of Medicine, Balikesir, Turkey
| | - Akin Usta
- Gynecology and Obstetrics Department, Balikesir University Faculty of Medicine, Balikesir, Turkey
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Sangthong B, Ubolsakka-Jones C, Pachirat O, Jones DA. Breathing Training for Older Patients with Controlled Isolated Systolic Hypertension. Med Sci Sports Exerc 2017; 48:1641-7. [PMID: 27128667 DOI: 10.1249/mss.0000000000000967] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Isolated systolic hypertension (ISH) is very common but difficult to manage with conventional medication. We investigated whether slow breathing training, with and without an inspiratory load, could reduce the resting blood pressure of older well-managed ISH patients. METHODS Thirty ISH patients (66 ± 4 yr) were randomized into loaded breathing (six breaths per min, 18 cm H2O), unloaded breathing (six breaths per min, no load), or control (normal breathing) groups. After a 2-wk run-in, loaded and unloaded groups trained at home for 30 min every day for 8 wk. Morning home blood pressure and heart rate were measured daily throughout the study. At the end of training, all participants reverted to normal breathing, and blood pressure and heart rate were recorded for a further 8 wk. RESULTS Compared to the pretraining run-in period, systolic blood pressure was reduced by 18 ± 7 and 11 ± 4 mm Hg for loaded and unloaded groups, respectively (P < 0.001), the reduction being significantly larger for the loaded group (P < 0.05) after 8-wk training. There were no changes in the control group. After the end of training, systolic blood pressure remained below pretraining levels for a further 6 wk for the loaded group but for only 2 wk with the unloaded group. There was a small nonsignificant reduction in diastolic blood pressure with training, as there was for heart rate. Pulse pressures were reduced by 11 ± 5 and 5 ± 6 mm Hg for loaded and unloaded groups, respectively (P < 0.01). CONCLUSION Slow breathing training, especially with an inspiratory load, is very effective in reducing resting systolic and pulse pressures and could be a valuable adjunct in the management of ISH.
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Affiliation(s)
- Benjarat Sangthong
- 1Faculty of Associated Medical Science, School of Physical Therapy, Khon Kaen University, THAILAND; 2Faculty of Physical Therapy, Rungsit University, THAILAND; 3Department of Medicine, Khon Kaen University, THAILAND; and 4School of Healthcare Sciences, Manchester Metropolitan University, UNITED KINGDOM
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15
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Abstract
PURPOSE OF REVIEW Hypertension is a leading cause of cardiovascular morbidity and mortality, affecting nearly 80 million individuals in the United States alone. Accurate measurement of blood pressure (BP) is the crucial first step to reduce the associated cardiovascular risk of hypertension. For decades, clinicians have relied on office BP measurements for the diagnosis and subsequent management of hypertension. However, it has been clearly demonstrated that ambulatory BP measurements are a better predictor of cardiovascular risk and can provide clinicians with important additional information to improve BP control and reduce cardiovascular risk. This article reviews the available data and provides clinical insights into the use of ambulatory BP monitoring for the management of hypertension. RECENT FINDINGS Ambulatory BP monitoring is uniquely capable of identifying patients with white-coat hypertension (WCH), masked hypertension and abnormal nocturnal BP profiles. Recently, ambulatory BP data have demonstrated the negative impact of WCH on right ventricular function, a greater prevalence of masked hypertension than previously recognized and the detrimental impact of nocturnal hypertension even in controlled hypertension. SUMMARY Ambulatory BP monitoring provides clinicians with the most comprehensive evaluation of hypertension and the ability to define individual BP phenotypes. Hence, these out-of-office measurements can be utilized to improve hypertension control, translating into a reduction of cardiovascular events.
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May RW, Seibert GS, Sanchez-Gonzalez MA, Fitzgerald MC, Fincham FD. Dispositional self-control: relationships with aerobic capacity and morning surge in blood pressure. Stress 2017; 20:29-35. [PMID: 27841087 DOI: 10.1080/10253890.2016.1260543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The psychological, behavioral and psychosocial implications of self-control are well established, but relatively little is known about its implications for physical health. This study examined the association between self-control and two important indicators of cardiovascular risk: morning blood pressure surge (MBPS) and maximum oxygen consumption (VO2max). Undergraduate students (N = 78) completed a measure of dispositional self-control (Brief Self-Control Scale), participated in a 24-h ambulatory assessment of heart rate (HR) and blood pressure (BP), and completed the YMCA Cycle Ergometer Submaximal Test. Regression analyzes yielded a significant positive relationship between self-control and VO2max. Results also indicated a significant negative association between self-control and MBPS, independent of average 24-h blood pressure and VO2max scores. These findings expand our understanding of the relationship between dispositional self-control and MBPS. Study limitations and directions for future research are discussed.
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Affiliation(s)
- Ross W May
- a Family Institute , The Florida State University , Tallahassee , FL , USA
| | - Gregory S Seibert
- a Family Institute , The Florida State University , Tallahassee , FL , USA
| | - Marcos A Sanchez-Gonzalez
- b Division of Clinical & Translational Research , Larkin Community Hospital , South Miami , FL , USA
| | | | - Frank D Fincham
- a Family Institute , The Florida State University , Tallahassee , FL , USA
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17
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Dézsi CA, Szentes V. Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Prothrombotic Processes and Myocardial Infarction Risk. Am J Cardiovasc Drugs 2016; 16:399-406. [PMID: 27580998 PMCID: PMC5126203 DOI: 10.1007/s40256-016-0185-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Acute ischemic events occur most frequently at dawn and in the early hours of the morning. The development of these severe clinical events exhibits a temporal relationship with changes in various hemodynamic, prothrombotic, and hormonal processes. The authors highlight not only these relationships but also the potential protective effect of increased bradykinin levels and the inhibition of different angiotensin II (AT-II) receptors (AT2, AT4) against unfavorable prothrombotic influences, which—based on studies to date—decreases the risk of acute cardiovascular events. Comparisons are presented between the different effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on factors that influence thrombus formation and myocardial infarction risk.
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Affiliation(s)
- Csaba András Dézsi
- Department of Cardiology, Petz Aladár County Teaching Hospital, Vasvári Pál str. 2-4, Gyor, 9024, Hungary.
| | - Veronika Szentes
- Department of Cardiology, Petz Aladár County Teaching Hospital, Vasvári Pál str. 2-4, Gyor, 9024, Hungary
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18
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Turak O, Afsar B, Siriopol D, Ozcan F, Cagli K, Yayla C, Oksuz F, Mendi MA, Kario K, Covic A, Kanbay M. Morning Blood Pressure Surge as a Predictor of Development of Chronic Kidney Disease. J Clin Hypertens (Greenwich) 2016; 18:444-8. [PMID: 26530334 PMCID: PMC8031569 DOI: 10.1111/jch.12707] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/06/2015] [Accepted: 08/10/2015] [Indexed: 08/16/2023]
Abstract
Blood pressure (BP) usually increases upon awakening--a physiological mechanism called morning BP surge (MBPS). BP values above the MBPS threshold are associated with target organ damage, including left ventricular hypertrophy and proteinuria. Despite these data, there have been no studies that have investigated the association between elevated MBPS and the development of incident chronic kidney disease (CKD). In this study, patients with essential hypertension were included and underwent ambulatory BP measurements and MBPS. Patients were followed for a median of 3.33 years. In total, 622 patients were enrolled. The mean age of patients was 57.6±12.4 years, 54.0% were men, 16.7% had diabetes, and 10.6% had prevalent cardiovascular disease. During follow-up, 32 patients developed CKD. Higher MBPS, analyzed both as continuous and categorical variables, was associated with incident CKD in all models. Elevated MBPS is associated with kidney function deterioration and the development of CKD. Studies are needed to further examine underlying mechanisms regarding MBPS and these renal outcomes.
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Affiliation(s)
- Osman Turak
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Baris Afsar
- Department of NephrologyNumune State HospitalKonyaTurkey
| | - Dimitrie Siriopol
- Nephrology ClinicDialysis and Renal Transplant Center“C.I. PARHON” University Hospital, and “Grigore T. Popa” University of MedicineIasiRomania
| | - Firat Ozcan
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Kumral Cagli
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Cagri Yayla
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Fatih Oksuz
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Mehmet Ali Mendi
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Kazuomi Kario
- Department of Sleep and Circadian CardiologyJichi Medical University School of MedicineTochigiJapan
| | - Adrian Covic
- Nephrology ClinicDialysis and Renal Transplant Center“C.I. PARHON” University Hospital, and “Grigore T. Popa” University of MedicineIasiRomania
| | - Mehmet Kanbay
- Division of NephrologyDepartment of MedicineKoc University School of MedicineIstanbulTurkey
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Kario K, Saito I, Kushiro T, Teramukai S, Yaginuma M, Mori Y, Okuda Y, Kobayashi F, Shimada K. Persistent olmesartan-based blood pressure-lowering effects on morning hypertension in Asians: the HONEST study. Hypertens Res 2016; 39:334-41. [PMID: 26739871 PMCID: PMC4865473 DOI: 10.1038/hr.2015.148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/12/2015] [Accepted: 10/26/2015] [Indexed: 11/23/2022]
Abstract
Using data from the large-scale HONEST (Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure) study, we investigated the characteristics of the effects of olmesartan-based treatment on morning hypertension in Asian hypertensive patients. Specifically, we investigated the relationship between baseline blood pressure (BP) and BP reduction after 16 weeks by linear regression analyses; determinants of BP reduction were also investigated. For both morning home BP (MHBP) and clinic BP (CBP), reduced systolic BP (SBP) after 16 weeks was associated with baseline SBP (P<0.001). The slope of the regression lines was similar for morning home SBP (MHSBP) (-0.744) and clinic SBP (-0.735). Although sex, concomitant diabetes mellitus and concomitant hepatic disease significantly influence the relationship between BP reduction and baseline BP for MHSBP, none were deemed clinically relevant. In conclusion, olmesartan-based treatment robustly reduced baseline high MHBP, similar to CBP, and the effect was associated with baseline BP but unaffected by patient background factors.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | | | | | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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20
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Hodgkinson JA, Tucker KL, Martin U, Beesley L, McManus RJ. The use of ambulatory blood pressure measurement. Br J Hosp Med (Lond) 2016; 76:631-7. [PMID: 26551492 DOI: 10.12968/hmed.2015.76.11.631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Measurement of ambulatory blood pressure is recommended by the National Institute for Health and Care Excellence guidelines to confirm the diagnosis of hypertension in the UK. This article describes the use of ambulatory devices, and discusses the benefits and disadvantages of their use in clinical practice.
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Affiliation(s)
- James A Hodgkinson
- Research Fellow in Primary Care Clinical Sciences, University of Birmingham, Birmingham
| | - Katherine L Tucker
- Senior Researcher in the Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Una Martin
- Reader in Clinical Pharmacology and Lead for Hypertension Service in the School of Clinical and Experimental Medicine, University of Birmingham, Birmingham
| | - Louise Beesley
- Clinical Nurse Specialist in Hypertension at Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Birmingham
| | - Richard J McManus
- Professor of Primary Care and General Practitioner in the Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG
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21
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Abstract
There has been a dramatic shift in the manner in which blood pressure (BP) is measured to provide far more comprehensive clinical information than that provided by a single set of office BP readings. Extensive clinical and epidemiological research shows an important role of ambulatory BP monitoring (ABPM) in the management of hypertensive patients. A 24-h BP profile helps to determine the absence of nocturnal dipping status and evaluate BP control in patients on antihypertensive therapy. The ability to detect white-coat or masked hypertension is enhanced by ambulatory BP monitoring. In 2001, the Center for Medicare and Medicaid Services approved ABPM for reimbursement for the identification of patients with white-coat hypertension. In 2011, the National Institute for Health and Clinical Excellence (NICE) in the UK published guidelines that recommended the routine use of ABPM in all patients suspected of having hypertension. The European Society of Hypertension (ESH) 2013 guidelines also support greater use of ABPM in clinical practice. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to its cost, the complexity of data evaluation, as well as patient inconvenience. In this review, we evaluate the clinical importance of ABPM, highlighting its role in the current management of hypertension.
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Affiliation(s)
- William B White
- Division of Hypertension and Clinical Pharmacology, Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06032-3940, USA,
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Brain Angiotensin II Type 1 Receptor Blockade Improves Dairy Blood Pressure Variability via Sympathoinhibition in Hypertensive Rats. Int J Hypertens 2015; 2015:759629. [PMID: 25918643 PMCID: PMC4396736 DOI: 10.1155/2015/759629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 11/17/2022] Open
Abstract
Abnormal blood pressure (BP) elevation in early morning is known to cause cardiovascular events. Previous studies have suggested that one of the reasons in abnormal dairy BP variability is sympathoexcitation. We have demonstrated that brain angiotensin II type 1 receptor (AT1R) causes sympathoexcitation. The aim of the present study was to investigate whether central AT1R blockade attenuates the excess BP elevation in rest-to-active phase in hypertensive rats or not. Stroke-prone spontaneously hypertensive rats (SHRSP) were treated with intracerebroventricular infusion (ICV) of AT1R receptor blocker (ARB), oral administration of hydralazine (HYD), or ICV of vehicle (VEH). Telemetric averaged mean BP (MBP) was measured at early morning (EM), after morning (AM), and night (NT). At EM, MBP was significantly lower in ARB to a greater extent than in HYD compared to VEH, though MBP at AM was the same in ARB and HYD. At NT, MBP was also significantly lower in ARB than in HYD. These results in MBP were compatible to those in sympathoexcitation and suggest that central AT1R blockade attenuates excess BP elevation in early active phase and continuous BP elevation during rest phase independent of depressor response in hypertensive rats.
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23
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Sheppard JP, Hodgkinson J, Riley R, Martin U, Bayliss S, McManus RJ. Prognostic significance of the morning blood pressure surge in clinical practice: a systematic review. Am J Hypertens 2015; 28:30-41. [PMID: 25315474 PMCID: PMC4261916 DOI: 10.1093/ajh/hpu104] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 04/16/2014] [Accepted: 05/04/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND An exaggerated morning blood pressure surge (MBPS) may be associated with stroke and other cardiovascular events, but the threshold at which an MBPS becomes pathological is unclear. This study aimed to systematically review the existing literature and establish the most appropriate definition of pathological MBPS. METHODS A MEDLINE search strategy was adapted for a range of literature databases to identify all prospective studies relating an exaggerated MBPS to cardiovascular endpoints. Hazard ratios (HRs) were extracted and synthesized using random-effects meta-analysis. RESULTS The search strategy identified 2,964 unique articles, of which 17 were eligible for the study. Seven different definitions of MBPS were identified; the most common was a prewaking surge (mean blood pressure for 2 hours after wake-up minus mean blood pressure for 2 hours before wake-up; n = 6 studies). Summary meta-analysis gave no clear evidence that prewaking MBPS (defined by a predetermined threshold: >25-55 mm Hg) was associated with all cardiovascular events (n = 2 studies; HR = 0.94, 95% confidence interval (CI) = 0.39-2.28) or stroke (n = 2 studies; HR = 1.26, 95% CI = 0.92-1.71). However, using a continuous scale, which has more power to detect an association, there was evidence that a 10 mm Hg increase in MBPS was related to an increased risk of stroke (n = 3 studies; HR = 1.11, 95% CI = 1.03-1.20). CONCLUSIONS These findings suggest that when measured and analyzed as a continuous variable, increasing levels of MBPS may be associated with increased risk of stroke. Large, protocol-driven individual patient data analyses are needed to accurately define this relationship further.
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Affiliation(s)
- James Peter Sheppard
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, UK; Primary Care Clinical Sciences NIHR School for Primary Care Research, University of Birmingham, Edgbaston, Birmingham, UK;
| | - James Hodgkinson
- Primary Care Clinical Sciences NIHR School for Primary Care Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Richard Riley
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Una Martin
- School of Clinical and Experimental Medicine, University of Birmingham, Edgbaston, Birmingham, UK
| | - Susan Bayliss
- School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, UK
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Redon J, Lurbe E. Ambulatory Blood Pressure Monitoring Is Ready to Replace Clinic Blood Pressure in the Diagnosis of Hypertension. Hypertension 2014; 64:1169-74; discussion 1174. [DOI: 10.1161/hypertensionaha.114.03883] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Josep Redon
- From the Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA (J.R.), and Pediatric Department, Consorcio Hospital General (E.L.), University of Valencia, Valencia, Spain; and CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain (J.R., E.L.)
| | - Empar Lurbe
- From the Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA (J.R.), and Pediatric Department, Consorcio Hospital General (E.L.), University of Valencia, Valencia, Spain; and CIBER Fisiopatología Obesidad y Nutrición, Instituto de Salud Carlos II, Madrid, Spain (J.R., E.L.)
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Barochiner J, Alfie J, Aparicio LS, Cuffaro PE, Rada MA, Morales MS, Galarza CR, Marín MJ, Waisman GD. Meal-induced blood pressure fall in patients with isolated morning hypertension. Clin Exp Hypertens 2014; 37:364-8. [DOI: 10.3109/10641963.2014.972564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Turak O, Afsar B, Ozcan F, Canpolat U, Grbovic E, Mendi MA, Oksuz F, Siriopol D, Covic A, Caliskan M, McFann K, Johnson RJ, Kanbay M. Relationship between elevated morning blood pressure surge, uric acid, and cardiovascular outcomes in hypertensive patients. J Clin Hypertens (Greenwich) 2014; 16:530-5. [PMID: 24919769 DOI: 10.1111/jch.12359] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 05/01/2014] [Accepted: 05/08/2014] [Indexed: 01/19/2023]
Abstract
Early morning blood pressure surge (MBPS) is a risk factor for cardiovascular events (CVEs), but the relationship with uric acid is not well understood. The authors aimed to determine the association between MBPS and increased uric acid and the effect of elevated MBPS and uric acid combination on CVEs. A total of 921 patients underwent 24-hour ambulatory blood pressure monitoring and were followed for a median of 40 months. During this period, 103 (11.2%) CVEs occurred. There was a significant relationship between increasing quartiles of serum uric acid level and increasing values of MBPS (P<.0001). Patients in the highest quartile stratified by elevated MBPS and serum uric acid level had a 3.55 odds of major CVE compared with patients in the lowest quartile. Serum uric acid is associated with MBPS and development of new CVEs.
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Affiliation(s)
- Osman Turak
- Department of Cardiology, Türkiye Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey
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Afsar B, Elsurer R. The relationship between central hemodynamics, morning blood pressure surge, glycemic control and sodium intake in patients with type 2 diabetes and essential hypertension. Diabetes Res Clin Pract 2014; 104:420-6. [PMID: 24780746 DOI: 10.1016/j.diabres.2014.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/25/2014] [Accepted: 03/20/2014] [Indexed: 12/11/2022]
Abstract
AIMS The current study aimed to investigate the relationship between morning blood pressure surge (MBPS), hemodynamic parameters, glycemic control and 24-h urinary sodium excretion (USE) in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS MBPS and central hemodynamic parameters were assessed from ambulatory blood pressure measurements. In addition to routine biochemistry, 24h urine collection was performed to measure protein, albumin and sodium excretion. RESULTS There were 146 (38%) patients with T2DM and 238 (72%) patients without T2DM (control group). Patients with T2DM had statistically higher MBPS compared with patients without T2DM (P<0.0001). In patients with T2DM, MBPS was correlated with HbA1c (rho=0.311, P<0.0001), 24h urinary sodium excretion (USE) (rho=0.292, P=0.004) and various hemodynamic parameters. Additionally, regression analysis showed that being male (P=0.006), the presence of coronary artery disease (P=0.023), HbA1c (P=0.012), and 24h USE (P=0.001) were independently related with log MBPS in T2DM patients. CONCLUSION This study demonstrated that T2DM was an independent risk factor for increased MBPS and MBPS was associated with central hemodynamic parameters. Additionally poor glycemic control and sodium intake were associated with worse MBPS in T2DM.
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Affiliation(s)
- Baris Afsar
- Konya Numune State Hospital, Department of Nephrology, Turkey.
| | - Rengin Elsurer
- Selcuklu Faculty of Medicine, Selcuk University, Department of Nephrology, Turkey
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Uzu T, Sakaguchi M, Tsuda A, Kadota A, Yokomaku Y, Kume S, Kanasaki M, Isshiki K, Araki SI, Sugiomoto T, Maegawa H, Kashiwagi A. Effects of blood pressure and the renin-angiotensin system on platelet activation in type 2 diabetes. J Diabetes Investig 2014; 1:196-201. [PMID: 24843432 PMCID: PMC4020721 DOI: 10.1111/j.2040-1124.2010.00048.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aims/Introduction: Platelet‐derived microparticles (PDMP) are released from the platelets either after activation or in response to physical stimulation in vivo. The present study examined the association between blood pressure and PDMP, and the effects of high‐dose angiotensin receptor blockers (ARB) on PDMP in patients with type 2 diabetes. Materials and Methods: The study subjects consisted of 28 type 2 diabetes patients with blood pressure ≥130/80 mmHg who were treated with valsartan (80 mg daily). The patients were randomly assigned to take either 80 mg of telmisartan (Tel group) or 160 mg of valsartan (Val group) and then were followed up for 24 weeks. Thereafter, the patients were switched to combination therapy (5 mg of amlodipine with 40 mg of telmisartan [Tel group] or 80 mg of valsartan [Val group]) for 12 weeks. Results: Although the ambulatory blood pressure did not change, the PDMP levels were significantly decreased from baseline to week 24 (high dose ARB). In contrast, combination therapy reduced both blood pressure and PDMP levels compared with the baseline. Although the PDMP level was significantly correlated with the morning BP elevation at baseline and week 36 (combination therapy), this same relationship was not found at week 24. There were no significant differences in the blood pressure and PDMP levels between the two groups. Conclusions: Patients with morning hypertension might be at risk for cardiovascular diseases. High‐dose renin‐angiotensin system inhibition and blood pressure control are both considered to reduce cardiovascular events in patients with type 2 diabetes. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00048.x, 2010)
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Affiliation(s)
- Takashi Uzu
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masayoshi Sakaguchi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Atsuko Tsuda
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Aya Kadota
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yukiyo Yokomaku
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shinji Kume
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masami Kanasaki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Keiji Isshiki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shin-Ichi Araki
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Toshiro Sugiomoto
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiroshi Maegawa
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Atsunori Kashiwagi
- Department of Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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Qin X, Zhang Q, Yang S, Sun Z, Chen X, Huang H. Blood Pressure Variability and Morning Blood Pressure Surge in Elderly Chinese Hypertensive Patients. J Clin Hypertens (Greenwich) 2014; 16:511-7. [PMID: 24775732 DOI: 10.1111/jch.12333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/02/2014] [Accepted: 04/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Xiaobo Qin
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Qin Zhang
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Suping Yang
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Zhongbo Sun
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Xiaojie Chen
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Huiling Huang
- Department of Cardiovascular Medicine; Affiliated First Hospital of Sun Yat-sun University; Guangzhou China
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Isegawa K, Hirooka Y, Kishi T, Yasukawa K, Utsumi H, Sunagawa K. Benefit of azilsartan on blood pressure elevation around rest-to-active phase in spontaneously hypertensive rats. Clin Exp Hypertens 2014; 37:45-50. [DOI: 10.3109/10641963.2014.897721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Yoshitaka Hirooka
- Department of Advanced Cardiovascular Regulation and Therapeutics, and
| | - Takuya Kishi
- Department of Advanced Therapeutics for Cardiovascular Diseases, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan,
| | - Keiji Yasukawa
- Department of Bio-Functional Science, Graduate School of Pharmaceutical Sciences, and
- Innovation Center for Medical Redox Navigation, Kyushu University, Fukuoka, Japan
| | - Hideo Utsumi
- Innovation Center for Medical Redox Navigation, Kyushu University, Fukuoka, Japan
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Tanaka T, Miura SI, Tanaka M, Uehara Y, Hirano T, Saku K. Efficacies of Controlling Morning Blood Pressure and Protecting the Kidneys by Treatment With Valsartan and Nifedipine CR or Valsartan and Amlodipine (MONICA Study). J Clin Med Res 2013; 5:432-40. [PMID: 24171055 PMCID: PMC3808261 DOI: 10.4021/jocmr1563w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2013] [Indexed: 01/18/2023] Open
Abstract
Background It is controversial whether a single-pill fixed-dose combination of angiotensin II type 1 receptor blocker and calcium channel blocker (CCB) is effective for all types of hypertension. Methods Thirty-five patients with uncontrolled blood pressure (BP) under treatment with valsartan 80 mg/day or amlodipine 5 mg/day were enrolled. They were randomly divided into two treatment groups: a single-pill fixed-dose combination of valsartan 80 mg/day and amlodipine 5 mg/day in the morning (VA group), or valsartan 80 mg/day in the morning and nifedipine CR 20 mg/day at night (VN group), and treated for 16 weeks. If the patient did not reach the target office BP at 8 weeks, they received double doses of CCBs. Results In the VN group, morning diastolic BP was significantly lower than the respective values in the VA group at 8 weeks. The percentage of patients who required a double dose of CCB in the VN group was significantly lower than that in the VA group. At 16 weeks, the BP levels in both groups were significantly reduced. Urinary albumin/creatinine at 16 weeks was significantly less than that at 0 weeks in the VN group. Conclusion Combination therapy with valsartan and nifedipine CR may help to control morning BP and protect the kidneys.
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Affiliation(s)
- Tohru Tanaka
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan ; Tanaka Clinic, Kitakyusyu, Japan ; Mihagino Hospital, Kitakyusyu, Japan
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Sunbul M, Sunbul EA, Kosker SD, Durmus E, Kivrak T, Ileri C, Oguz M, Sari I. Depression and anxiety are associated with abnormal nocturnal blood pressure fall in hypertensive patients. Clin Exp Hypertens 2013; 36:354-8. [DOI: 10.3109/10641963.2013.827701] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kario K, Saito I, Kushiro T, Teramukai S, Mori Y, Hiramatsu K, Kobayashi F, Shimada K. Enhanced blood pressure-lowering effect of olmesartan in hypertensive patients with chronic kidney disease-associated sympathetic hyperactivity: HONEST study. J Clin Hypertens (Greenwich) 2013; 15:555-61. [PMID: 23889717 PMCID: PMC3884768 DOI: 10.1111/jch.12132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/09/2013] [Accepted: 04/12/2013] [Indexed: 01/12/2023]
Abstract
To investigate the blood pressure (BP)-lowering effect of olmesartan in relation to chronic kidney disease (CKD)-associated sympathetic nerve activity, a subanalysis was performed using data from the first 16 weeks of the Home BP Measurement With Olmesartan-Naive Patients to Establish Standard Target Blood Pressure (HONEST) study, a prospective observational study of hypertensive patients. Essential hypertensive patients who took no antihypertensive agent at baseline were classified based on baseline morning home systolic BP (MHSBP) in quartiles. In each class, patients were further classified based on baseline morning home pulse rate (MHPR). A subgroup analysis in patients with/without chronic kidney disease (CKD) was performed. A total of 5458 patients (mean age, 63.0 years; 51.6% women) were included. In the 4th quartile of baseline MHSBP (≥165 mm Hg), patients with MHPR ≥70 beats per minute had a greater BP reduction (by 3.2 mm Hg) than those with MHPR <70 beats per minute after 16 weeks of olmesartan-based treatment (P=.0005). An even greater BP reduction (by 6.6 mm Hg) was observed in patients with CKD than in patients without CKD in this group (P=.0084). Olmesartan was more effective in hypertensive patients with high MHSBP and MHPR ≥70 beats per minute, especially in patients with CKD. Olmesartan may have enhanced BP-lowering effects by improving renal ischemia in hypertensive CKD patients with potential increased sympathetic nerve activity.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan.
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Miura SI, Saku K. How important is it to control nocturnal hypertension with angiotensin II type 1 receptor blockers? Hypertens Res 2013; 36:194-5. [DOI: 10.1038/hr.2012.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Choi HJ. Blood pressure variability and its management in hypertensive patients. Korean J Fam Med 2012; 33:330-5. [PMID: 23267418 PMCID: PMC3526715 DOI: 10.4082/kjfm.2012.33.6.330] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 10/24/2012] [Indexed: 01/19/2023] Open
Abstract
Optimizing treatment for hypertension has focused on reducing cardiovascular risk through reduction of mean blood pressure (BP) under the basic assumption that lower is better, as long as diastolic BP is sufficient to maintain coronary perfusion. However, antihypertensive therapy as currently practiced does not eliminate all hazards associated with BP elevation. Blood pressure variability (BPV) correlates closely with target-organ damage independent of mean BP and transient increases in BP are also triggers of vascular events. So far, there is no definitive outcome data relating specific reduction in BPV to decline cardiovascular events or death. Thus, the decision whether BPV should be considered a new therapeutic target is left to the clinical judgment of physicians and individualized for each patient. However, new evidence suggests that taking an antihypertensive medication at bedtime significantly affects BPV and lowers the risk of cardiovascular events and death. This strategy may provide a means of individualizing treatment of hypertension according to the circadian BPV of each patient and may be a new option to optimize BP control and reduce risk.
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Affiliation(s)
- Hee-Jeong Choi
- Department of Family Medicine, Eulji University School of Medicine, Daejeon, Korea
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White WB, Maraka S. Is it possible to manage hypertension and evaluate therapy without ambulatory blood pressure monitoring? Curr Hypertens Rep 2012; 14:366-73. [PMID: 22639014 DOI: 10.1007/s11906-012-0277-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the management of patients with hypertension, blood pressure (BP) has been traditionally measured in the physician's office. The contribution of ambulatory BP monitoring (ABPM) to the management of hypertensive patients has been increasingly recognized through clinical and epidemiological research. Ambulatory BP monitoring can enhance the ability to detect white-coat or masked hypertension, determine the absence of nocturnal dipping status, and evaluate BP control in patients on antihypertensive therapy. Recently, the United Kingdom National Clinical Guideline Centre published guidelines for the clinical management of primary hypertension in adults, recommending the routine use of ABPM to make the initial diagnosis of hypertension. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to the cost of the equipment, data evaluation, and staff training as well as the possible inconvenience to the patient. In this review, we summarize the clinical importance of ABPM and discuss the current guidelines for establishing the diagnosis of hypertension.
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Affiliation(s)
- William B White
- Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06032-3940, USA.
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Lee JH, Bae JW, Park JB, Park CG, Youn HJ, Choi DJ, Ahn YK, Shin JH, Rim SJ, Bae JH, Kim DW. Morning hypertension in treated hypertensives: baseline characteristics and clinical implications. Korean Circ J 2011; 41:733-43. [PMID: 22259604 PMCID: PMC3257457 DOI: 10.4070/kcj.2011.41.12.733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 11/21/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Morning hypertension is closely related to target organ damage and cardiovascular events. Little data is available concerning the baseline characteristics and comprehensive blood pressure analysis of hypertensive patients on treatment with morning hypertension. SUBJECTS AND METHODS We evaluated 1,087 hypertensive patients who had taken stable anti-hypertensive medication at least 6 months. The enrolled patients measured their home blood pressure for 7 days. Baseline characteristics and the laboratory data were analyzed. Morning hypertension was defined as a morning blood pressure ≥135/85 mm Hg and systolic or diastolic blood pressure difference between morning and evening exceeding 10 mm Hg. RESULTS One hundred seventy three patients with morning hypertension showed a preponderance of males, older patients, alcohol consumers, and greater waist circumference and waist-to-hip ratio despite the same body mass index. Impaired fasting glucose and metabolic syndrome were more prevalent in the patients with morning hypertension. The morning hypertensives took more anti-hypertensive drugs and displayed higher blood pressure in the clinic and at home. CONCLUSION The worse clinical variables and relatively poorly controlled blood pressure of those with morning hypertension supports a potential relationship of morning hypertension with poor cardiovascular outcome. Morning blood pressure should be monitored at home for the optimal treatment of hypertension.
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Affiliation(s)
- Ju-Hee Lee
- Cardiovascular Center of Chungbuk National University Hospital, Cheongju, Korea
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Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
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Effect of dosing time of angiotensin II receptor blockade titrated by self-measured blood pressure recordings on cardiorenal protection in hypertensives: the Japan Morning Surge-Target Organ Protection (J-TOP) study. J Hypertens 2010; 28:1574-83. [DOI: 10.1097/hjh.0b013e3283395267] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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