1
|
Park CH, Jhee JH, Chun KH, Seo J, Lee CJ, Park SH, Hwang JT, Han SH, Kang SW, Park S, Yoo TH. Nocturnal systolic blood pressure dipping and progression of chronic kidney disease. Hypertens Res 2024; 47:215-224. [PMID: 37452154 DOI: 10.1038/s41440-023-01368-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/18/2023]
Abstract
The relationship between declining nocturnal blood pressure (BP) and adverse cardiovascular outcomes is well-recognized. However, the relationship between diurnal BP profile and the risk of chronic kidney disease (CKD) progression is unclear. Herein, we examined the association between nocturnal systolic SBP (SBP) dipping and CKD progression in 1061 participants at the Cardiovascular and Metabolic Disease Etiology Research Center-High Risk (CMERC-HI). The main exposure was diurnal systolic BP (SBP) profile and diurnal SBP difference ([nighttime SBP-daytime SBP] × 100/daytime SBP). The primary outcome was CKD progression, defined as a composite of ≥ a 50% decline in the estimated glomerular filtration rate from baseline or the initiation of kidney replacement therapy. During 4749 person-years of follow-up (median, 4.8 years), the composite outcome occurred in 380 (35.8%) participants. Compared to dippers, the hazard ratios (HRs) for the risk of adverse kidney outcomes were 1.02 (95% confidence interval [CI], 0.64-1.62), 1.30 (95% CI, 1.02-1.66), and 1.40 (95% CI, 1.03-1.90) for extreme dipper, non-dipper, and reverse dipper, respectively. In a continuous modeling, a 10% increase in diurnal SBP difference was associated with a 1.21-fold (95% CI, 1.07-1.37) higher risk of CKD progression. Thus, decreased nocturnal SBP decline was associated with adverse kidney outcomes in patients with CKD. Particularly, patients with non-dipping and reverse dipping patterns were at higher risk for CKD progression than those with a dipping pattern.
Collapse
Affiliation(s)
- Cheol Ho Park
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Gangnam Severance Hospital, Yonsei University, Seoul, Republic of Korea
| | - Kyeong-Hyeon Chun
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang, Republic of Korea
| | - Jiwon Seo
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Gangnam Severance Hospital, Yonsei University, Seoul, Republic of Korea
| | - Chan Joo Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo-Hyun Park
- Food Functionality Research Division, Korea Food Research Institute, Wanju, Republic of Korea
| | - Jin-Taek Hwang
- Food Functionality Research Division, Korea Food Research Institute, Wanju, Republic of Korea
- Department of Food Biotechnology, University of Science and Technology, Daejeon, Republic of Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Tae-Hyun Yoo
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Strain Imaging for the Early Detection of Cardiac Remodeling and Dysfunction in Primary Aldosteronism. Diagnostics (Basel) 2022; 12:diagnostics12020543. [PMID: 35204632 PMCID: PMC8871189 DOI: 10.3390/diagnostics12020543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 12/30/2022] Open
Abstract
Speckle tracking echocardiography is a novel technique to quantify cardiac function and deformation. It has been applied in a series of cardiovascular diseases for the evaluation of early cardiac impairment. We recently used this technique to investigate cardiac structure and function in patients with primary aldosteronism. Cardiac damage usually occurs earlier in patients with primary aldosteronism than those with primary hypertension, probably because aldosterone hypersecretion is more commonly observed in the former than the latter patients. In this article, we will review the imaging studies, especially with speckle tracking echocardiography, for the detection of early cardiac dysfunction in primary aldosteronism as a disease model.
Collapse
|
3
|
Cicco S, Calvanese C, Susca N, Inglese G, Nardiello E, Ciampi S, Tedesco PA, Cirulli A, Panettieri I, Vacca A, Ranieri G. Right atrium enlargement is related to increased heart damage and mortality in well-controlled hypertension. Nutr Metab Cardiovasc Dis 2022; 32:420-428. [PMID: 34893418 DOI: 10.1016/j.numecd.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM Left heart remodeling is a well-known pathophysiological effect of arterial hypertension. Right Heart status is not considered in its evaluation. No data are available on right atrium (RA) and its impact on the outcome in hypertension. We wondering to understand whether RA may play a role as a marker of an increased risk for organ damage in well-controlled hypertensives, to probe the clinical significance and whether it could indicate an increased risk. METHODS AND RESULTS We studied well-controlled hypertensive patients. Heart damage was assessed by echocardiography. Patients were subdivided into those with RA area ≤18 cm2 (normal RA - Group 1) (554 pts, 227 M, aged 60.35 ± 10.48 years) and those >18 cm2 (Increased RA - Group 2) (101 pts, 71 M, age 61.65 ± 9.46 years). Group 2 had a higher left ventricle mass (LVM) and left atrium volume (LAV) both as absolute value (both p < 0.0001) and indexed for body surface area (LVMi p < 0.013; LAVi p = 0.0013). Group 2 showed an increased vascular stiffness (p < 0.0001) and carotid stenosis percentage (p = 0.011). TAPSE (p < 0.0001) resulted significantly increased. In The RA area was significantly correlated directly to LVM and LAV in both groups, but these correlations persisted in indexed values only in Group 2. Moreover, in this group there was a significant direct correlation between RA area and Tricuspid s'wave at echocardiography TDI analysis. Finally, Group 2 had an increased mortality rate compared to Group 1 (Log-Rank p = 0.0006). CONCLUSION Group 2 hypertensive patients showed more alterations in dimensional and volumetric left heart parameters, and an increased mortality.
Collapse
Affiliation(s)
- Sebastiano Cicco
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy; Centro Ipertensione Arteriosa, UOC Medicina Interna Ospedaliera, AUO Ospedali Riuniti, Foggia, Italy
| | - Chiara Calvanese
- Centro Ipertensione Arteriosa, UOC Medicina Interna Ospedaliera, AUO Ospedali Riuniti, Foggia, Italy
| | - Nicola Susca
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy
| | - Gianfranco Inglese
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy
| | - Esther Nardiello
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy
| | - Saverio Ciampi
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy
| | - Pietro A Tedesco
- Centro Ipertensione Arteriosa, UOC Medicina Interna Ospedaliera, AUO Ospedali Riuniti, Foggia, Italy
| | - Anna Cirulli
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy
| | - Immacolata Panettieri
- Centro Ipertensione Arteriosa, UOC Medicina Interna Ospedaliera, AUO Ospedali Riuniti, Foggia, Italy
| | - Angelo Vacca
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy.
| | - Giuseppe Ranieri
- Centro Ipertensione Arteriosa, Clinica Medica "G. Baccelli", Dip di Scienze Biomediche e Oncologia umana, Università di Bari "Aldo Moro", Bari, Italy
| |
Collapse
|
4
|
OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1377-1386. [DOI: 10.1093/eurjpc/zwac020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/02/2021] [Accepted: 01/27/2022] [Indexed: 11/14/2022]
|
5
|
Di Raimondo D, Musiari G, Casuccio A, Colomba D, Rizzo G, Pirera E, Pinto A, Tuttolomondo A. Cardiac Remodeling According to the Nocturnal Fall of Blood Pressure in Hypertensive Subjects: The Whole Assessment of Cardiac Abnormalities in Non-Dipper Subjects with Arterial Hypertension (Wacanda) Study. J Pers Med 2021; 11:jpm11121371. [PMID: 34945843 PMCID: PMC8704210 DOI: 10.3390/jpm11121371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 01/31/2023] Open
Abstract
Objective: Several epidemiological studies suggest that the preservation of the physiological circadian rhythm of blood pressure or its disruption affects the extent of the organ damage developed by the patient. If we classify the circadian rhythm of blood pressure into four nocturnal profiles, significant differences emerge in terms of organ damage burden and prognosis: reverse dippers have the worst prognosis while dippers and mild dippers fall into an intermediate risk range. The risk profile of extreme dippers is still debated, and the available data are very conflicting and inconclusive. Starting from this gap of knowledge, we aimed to evaluate, retrospectively, in a cohort of hypertensive subjects, the degree of cardiac involvement in relation to the different nocturnal blood pressure profiles. Methods: We retrospectively evaluated 900 patients with essential hypertension, of whom 510 met our study criteria. We graded the 510 patients in relation to the percentage of reduction in mean systolic blood pressure (SBP) at night-time compared with day-time, considering this as a continuous variable, and then compared the extreme quintiles with each other and with the middle quintile (considered as reference). Results: Patients with less (or no) reduction in nocturnal SBP (reverse dipper) showed a higher level of organ damage and comorbidities. With regard to echocardiographic indexes, patients with maximum nocturnal pressure reduction (extreme dipper) showed a lower level of remodeling and/or impairment of E/e’ ratio, Right Atrium Area, Basal Right Ventricular Diameter, Inferior Vena Cava Average Diameter, and Tricuspidal Anular Plane Systolic Excursion compared also with hypertensive patients with a physiological nocturnal pressure reduction, even after correction for the main confounders. Conclusions: These data suggest that extreme dippers may constitute the subgroup of hypertensive patients with the lowest 24-h pressure load and, therefore, less cardiac remodeling.
Collapse
|
6
|
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.
Collapse
|
7
|
The prognostic importance of right ventricular remodeling and the circadian blood pressure pattern on the long-term cardiovascular outcome. J Hypertens 2021; 38:1525-1530. [PMID: 32371765 DOI: 10.1097/hjh.0000000000002432] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to investigate the predictive value of right ventricular (RV) remodeling and 24-h blood pressure (BP) patterns on long-term cardiovascular prognosis in the initially untreated hypertensive patients. METHODS The current study included 505 initially untreated hypertensive patients who were consequently included in this study from 2007 to 2012. All the patients underwent laboratory analysis, 24-h BP monitoring and echocardiographic examination at baseline. The patients were followed for a median period of 9 years. The adverse outcome was defined as the hospitalization due to cardiovascular events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or cardiovascular death). RESULTS During the 9-year follow-up period adverse cardiovascular events occurred in 82 hypertensive patients. Night-time SBP, the nondipping BP pattern, left ventricle hypertrophy, RV hypertrophy, right atrial enlargement, RV diastolic dysfunction, and RV systolic dysfunction were associated with adverse cardiovascular events. Nevertheless, night-time SBP, the nondipping BP pattern, mitral E/e', left ventricle hypertrophy, and RV hypertrophy were the only independent predictors of cardiovascular events. When all four BP patterns were included in the model, only the reverse dipping BP pattern was an independent predictor of cardiovascular events. CONCLUSION The present investigation showed that RV hypertrophy and the reverse dipping BP pattern were independent long-term predictors of the cardiovascular outcome. Detailed echocardiographic evaluation and 24-h ambulatory blood pressure monitoring should be performed even in low-risk hypertensive patients.
Collapse
|
8
|
Abstract
: Extreme dipping (i.e. a marked blood pressure fall during night-time period) is an alteration of circadian blood pressure (BP) rhythm frequently observed in the setting of systemic hypertension as well as in the general population. Some reports have suggested that cardiovascular prognosis in extreme dippers (ED) is similar as in dippers, whereas other studies have documented either a better or worse prognosis in ED. Available information on clinical and prognostic implications of ED is scanty and data provided by studies are controversial. Furthermore, a comprehensive report summarizing the key features of this BP pattern is lacking. The present review focuses on a number of issues concerning ED pattern such as the prevalence and clinical correlates, mechanisms underlying this BP phenotype association with hypertension mediated organ damage (HMOD) and prognostic value in predicting cardiovascular events and all-cause mortality. The reported prevalence of this BP rhythm alteration ranges from 5% to 30%, depending on diagnostic criteria, clinical and demographic characteristics of subjects. Most studies targeting the association of this condition with HMOD failed to find consistent findings in support of an adverse impact of ED on vascular, renal of cardiac structure and function. Available data on ED as compared to low risk reference group (i.e. dippers) do not allow to conclude that high BP variability resulting from a marked BP fall at night adversely affects cardiovascular prognosis at the community level and in the general hypertensive population. Thus, further studies aimed to assess the prognostic significance of ED as well as the impact of therapeutic interventions aimed to normalize this circadian BP pattern, are highly needed.
Collapse
|
9
|
Nwabuo CC, Vasan RS. Pathophysiology of Hypertensive Heart Disease: Beyond Left Ventricular Hypertrophy. Curr Hypertens Rep 2020; 22:11. [PMID: 32016791 DOI: 10.1007/s11906-020-1017-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Given that the life expectancy and the burden of hypertension are projected to increase over the next decade, hypertensive heart disease (HHD) may be expected to play an even more central role in the pathophysiology of cardiovascular disease (CVD). A broader understanding of the features and underlying mechanisms that constitute HHD therefore is of paramount importance. RECENT FINDINGS HHD is a condition that arises as a result of elevated blood pressure and constitutes a key underlying mechanism for cardiovascular morbidity and mortality. Historically, studies investigating HHD have primarily focused on left ventricular (LV) hypertrophy (LVH), but it is increasingly apparent that HHD encompasses a range of target-organ damage beyond LVH, including other cardiovascular structural and functional adaptations that may occur separately or concomitantly. HHD is characterized by micro- and macroscopic myocardial alterations, structural phenotypic adaptations, and functional changes that include cardiac fibrosis, and the remodeling of the atria and ventricles and the arterial system. In this review, we summarize the structural and functional alterations in the cardiac and vascular system that constitute HHD and underscore their underlying pathophysiology.
Collapse
Affiliation(s)
| | - Ramachandran S Vasan
- Framingham Heart Study, 73 Mt. Wayte Avenue, Suite 2, Framingham, MA, 01702, USA. .,Departments of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA, USA. .,Department of Medicine, Sections of Preventive Medicine and Epidemiology, and Cardiovascular Medicine, Boston University Schools of Medicine, Boston, MA, USA.
| |
Collapse
|
10
|
Palatini P, Verdecchia P, Beilin LJ, Eguchi K, Imai Y, Kario K, Ohkubo T, Pierdomenico SD, Saladini F, Schwartz JE, Wing L, Signorotti S, Reboldi G. Association of Extreme Nocturnal Dipping With Cardiovascular Events Strongly Depends on Age. Hypertension 2020; 75:324-330. [DOI: 10.1161/hypertensionaha.119.14085] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Whether extreme dipping is associated with cardiovascular events (CVE) is unclear. The present study was conducted to test the hypothesis that the prognostic role of extreme dipping varies as a function of age. The analysis was performed in 10 868 participants (53% men) aged 53±15 (mean±SD) years enrolled in 8 prospective studies. Using the ambulatory systolic blood pressure nocturnal decline, we identified 4 groups: dippers (>10%–20%), nondippers (>0%–10%), reverse dippers (≤0%), and extreme dippers (>20%). The association between dipping category and CVE was estimated as a function of age using Cox models adjusted for sex, average 24-hour systolic blood pressure, and traditional risk factors. During a median follow-up of 5.7 years, there were a total of 829 CVE (168 fatal). For extreme dippers, no increase in risk of CVE was observed among the participants <70 years (hazard ratio, 0.99 [95% CI, 0.73–1.34];
P
=0.93) compared with dippers. In contrast, among the participants ≥70 years, there was a significant increase in risk (hazard ratio, 1.88 [95% CI, 1.14–3.11];
P
=0.013). Among the octogenarians, the hazard ratio (95% CI) for CVE were 2.34 (1.12–4.93) for nondippers (
P
=0.024), 3.91 (1.75–8.73) for reverse dippers (
P
=0.001), and 4.12 (1.64–10.37) for extreme dippers (
P
=0.003) compared with dippers. These data show that extreme dipping is not associated with poorer outcome in people younger than 70 years. A U-shaped relationship between nocturnal blood pressure dipping and adverse outcome is present in subjects older than 70 years. In the octogenarian extreme dippers, the risk of CVEs was 4× higher than in the dippers and similar to that in the reverse dippers.
Collapse
Affiliation(s)
- Paolo Palatini
- From the University of Padova, Padua, Italy (P.P., F.S.)
| | | | | | - Kazuo Eguchi
- Saitama Red Cross Hospital, Tochigi, Japan (K.E., K.K.)
| | - Yutaka Imai
- Tohoku Institute for Monitoring of Blood Pressure, Sendai, Japan (Y.I., T.O.)
| | - Kazuomi Kario
- Saitama Red Cross Hospital, Tochigi, Japan (K.E., K.K.)
| | - Takayoshi Ohkubo
- Tohoku Institute for Monitoring of Blood Pressure, Sendai, Japan (Y.I., T.O.)
- Teikyo University School of Medicine, Tokyo, Japan (T.O.)
| | | | | | - Joseph E. Schwartz
- Columbia University, New York, NY (J.E.S.)
- Stony Brook University, New York, NY (J.E.S.)
| | - Lindon Wing
- Flinders University, Adelaide, Australia (L.W.)
| | | | | |
Collapse
|
11
|
Do reverse dippers have the highest risk of right ventricular remodeling? Hypertens Res 2019; 43:213-219. [DOI: 10.1038/s41440-019-0351-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/25/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023]
|
12
|
Abstract
PURPOSE OF REVIEW Given the emerging knowledge that circadian rhythmicity exists in every cell and all organ systems, there is increasing interest in the possible benefits of chronotherapy for many diseases. There is a well-documented 24-h pattern of blood pressure with a morning surge that may contribute to the observed morning increase in adverse cardiovascular events. Historically, antihypertensive therapy involves morning doses, usually aimed at reducing daytime blood pressure surges, but an absence of nocturnal dipping blood pressure is also associated with increased cardiovascular risk. RECENT FINDINGS To more effectively reduce nocturnal blood pressure and still counteract the morning surge in blood pressure, a number of studies have examined moving one or more antihypertensives from morning to bedtime dosing. More recently, such studies of chronotherapy have studied comorbid populations including obstructive sleep apnea, chronic kidney disease, or diabetes. Here, we summarize major findings from recent research in this area (2013-2017). In general, nighttime administration of antihypertensives improved overall 24-h blood pressure profiles regardless of disease comorbidity. However, inconsistencies between studies suggest a need for more prospective randomized controlled trials with sufficient statistical power. In addition, experimental studies to ascertain mechanisms by which chronotherapy is beneficial could aid drug design and guidelines for timed administration.
Collapse
Affiliation(s)
- N P Bowles
- Oregon Institute of Occupational Health Sciences, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd. L606, Portland, OR, 97239, USA.
| | - S S Thosar
- Oregon Institute of Occupational Health Sciences, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd. L606, Portland, OR, 97239, USA
| | - M X Herzig
- Oregon Institute of Occupational Health Sciences, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd. L606, Portland, OR, 97239, USA
| | - S A Shea
- Oregon Institute of Occupational Health Sciences, Oregon Health and Sciences University, 3181 S.W. Sam Jackson Park Rd. L606, Portland, OR, 97239, USA
| |
Collapse
|
13
|
Abstract
BACKGROUND We sought to investigate right ventricular (RV) and right atrial mechanics in patients with daytime, night-time and daytime-night-time hypertension. METHODS This cross-sectional study included 256 untreated patients who underwent 24-h ambulatory blood pressure monitoring and complete echocardiographic examination including strain analysis. Night-time hypertension was defined as nocturnal SBP at least 120 mmHg and/or DBP at least 70 mmHg and daytime hypertension as SBP at least 135 mmHg and/or DBP at least 85 mmHg. RESULTS RV structure, diastolic function and global longitudinal RV strain in patients with nocturnal hypertension are intermediate between daytime and daytime-night-time hypertension. On the other side, RV systolic and diastolic strain rates referring to the RV free wall are significantly deteriorated in the patients with nocturnal and daytime-night-time hypertension in comparison with normotension and daytime hypertension. Right atrial conduit function is significantly reduced in the patients with nocturnal and day-night-time hypertension comparing with other two groups, whereas right atrial reservoir and pump functions are intermediate between daytime and daytime-night-time hypertension. A 24-h SBP is independently of other clinical and echocardiographic parameters associated with RV and right atrial global strain. CONCLUSION RV mechanics is worse in night-time and daytime-night-time hypertensive patients than in normotensive controls and isolated daytime hypertensive patients. A 24-h SBP is independently associated with right heart mechanics.
Collapse
|
14
|
Tadic M, Cuspidi C, Bombelli M, Grassi G. Right heart remodeling induced by arterial hypertension: Could strain assessment be helpful? J Clin Hypertens (Greenwich) 2018; 20:400-407. [PMID: 29370476 DOI: 10.1111/jch.13186] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/22/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022]
Abstract
Left ventricular structural and functional changes in patients with arterial hypertension are well established. However, the influence of arterial hypertension on right ventricular (RV) remodeling is still being investigated. The introduction of strain analysis provided an insight into RV function and mechanics. Previous research has demonstrated the predictive value of RV longitudinal strain in patients with various cardiovascular conditions, such as pulmonary hypertension, heart failure, congenital heart diseases, and valvular disease. Nowadays, we are aware of the fact that conventional echocardiographic methods usually do not provide necessary information about RV dysfunction in patients with arterial hypertension, which is why the evaluation of new parameters that could detect RV subtle changes in hypertension is essential. The present review article is an overview of the main principles of RV deformation and a summary of the current knowledge and clinical significance of RV strain in patients with arterial hypertension.
Collapse
Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Cesare Cuspidi
- Clinical Research Unit, Istituto Auxologico Italiano, University of Milan-Bicocca, Meda, Italy
| | - Michele Bombelli
- Department of Health Science, University of Milano-Bicocca, Milano, Italy
| | - Guido Grassi
- Department of Health Science, University of Milano-Bicocca, Milano, Italy.,Department of Clinical Sciences and Community Health, Fondazione Ospedale Maggiore Policlinico di Milano, University of Milano, Milano, Italy
| |
Collapse
|
15
|
The association of night-time systolic blood pressure with ultrasound markers of subclinical cardiac and vascular disease. Blood Press Monit 2017; 22:18-26. [PMID: 27845956 PMCID: PMC5214226 DOI: 10.1097/mbp.0000000000000223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Supplemental Digital Content is available in the text. Introduction The aim of this study was to examine the association of night-time systolic blood pressure (BP) with subclinical cardiac dysfunction measured by global longitudinal strain (GLS) and subclinical vascular damage measured by carotid intima–media thickness (CIMT) and carotid plaques. Methods GLS was measured by speckle-tracking analysis of echocardiogram images. CIMT was measured at the distal 1 cm of the common carotid artery. The presence of carotid plaques was recorded. Philips QLAB cardiac and vascular ultrasound quantification software was used for analysis. The association of night-time systolic BP with GLS, CIMT and carotid plaques was assessed using linear and logistic regression. Results Fifty (response rate 63%) individuals took part in this study. In univariable models, night-time systolic BP was significantly associated with GLS [β coefficient 0.85 for every 10 mmHg increase, 95% confidence interval (CI): 0.3–1.4] and carotid plaques (odds ratio 1.9 for every 10 mmHg increase, 95% CI: 1.1–3.2). Univariable analysis of daytime systolic BP did not show any statistically significant associations. In age-adjusted and sex-adjusted models, the association for night-time systolic BP and GLS remained significant (β coefficient 0.68 for every 10 mmHg increase, 95% CI: 0.1–1.3). The association for carotid plaques was no longer statistically significant. In multivariable models, findings were diminished. Discussion Our results suggest a trend towards an association between night-time systolic BP and subclinical cardiac and vascular disease. When assessing ambulatory blood pressure monitoring results, the absolute night-time systolic BP seems to be a better prognostic parameter than daytime systolic BP, but ultimately a large randomised controlled trial involving chronotherapy is necessary to fully address this.
Collapse
|
16
|
Evaluation of right and left heart mechanics in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy. Int J Cardiovasc Imaging 2015; 31:1159-67. [DOI: 10.1007/s10554-015-0682-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/13/2015] [Indexed: 11/26/2022]
|
17
|
Sunbul M, Bozbay M, Mammadov C, Cincin A, Atas H, Ozsenel EB, Sari I, Basaran Y. Effect of vitamin D deficiency and supplementation on myocardial deformation parameters and epicardial fat thickness in patients free of cardiovascular risk. Int J Cardiovasc Imaging 2015; 31:765-72. [DOI: 10.1007/s10554-015-0622-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/16/2015] [Indexed: 01/02/2023]
|
18
|
Left and right atrial phasic function and deformation in untreated patients with prediabetes and type 2 diabetes mellitus. Int J Cardiovasc Imaging 2014; 31:65-76. [DOI: 10.1007/s10554-014-0536-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/08/2014] [Indexed: 02/07/2023]
|
19
|
Tadic M, Cuspidi C, Sljivic A, Andric A, Ivanovic B, Scepanovic R, Ilic I, Jozika L, Marjanovic T, Celic V. Effects of the metabolic syndrome on right heart mechanics and function. Can J Cardiol 2013; 30:325-31. [PMID: 24484912 DOI: 10.1016/j.cjca.2013.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/08/2013] [Accepted: 12/08/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We sought to investigate right ventricular (RV) and right atrial (RA) deformation obtained using 3-dimensional echocardiography (3DE) and 2-dimensional (2DE) strain in subjects with the metabolic syndrome (MS). METHODS This cross-sectional study included 108 untreated subjects with the MS and 75 control subjects similar according to sex and age. The MS was defined by the presence ≥ 3 American Heart Association/National Heart, Lung, and Blood Institute criteria. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination. RESULTS 2DE global longitudinal strain of the RV was significantly decreased in the MS group compared with the control subjects (-24 ± 5 vs -27 ± 5%; P < 0.001). Similar results were obtained for the RA longitudinal strain (40 ± 5 vs 44 ± 7%; P < 0.001). Systolic and early diastolic RV and RA strain rates were decreased, whereas late diastolic strain rates were increased among the MS participants compared with the control subjects. 3DE RV ejection fraction was significantly decreased in the MS subjects (55 ± 4 vs 58 ± 4%; P < 0.001). The multivariate analysis of MS criteria showed that systolic blood pressure, waist circumference, and fasting glucose were independently associated with RV and/or RA myocardial function and deformation. CONCLUSIONS RV mechanics and RA mechanics, assessed using 3DE and 2DE strain, were significantly deteriorated in the MS subjects. Among all MS risk factors, systolic blood pressure, abdominal circumference, and fasting glucose were the most responsible for the right heart remodelling.
Collapse
Affiliation(s)
- Marijana Tadic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia.
| | - Cesare Cuspidi
- University of Milan-Bicocca and Istituto Auxologico Italiano, Clinical Research Unit, Meda, Italy
| | - Aleksandra Sljivic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Anita Andric
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Branislava Ivanovic
- Clinical Centre of Serbia, Clinic of Cardiology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Radisav Scepanovic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Irena Ilic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Ljilja Jozika
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Tamara Marjanovic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Vera Celic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| |
Collapse
|