1
|
The Key Role of Ambulatory Blood Pressure Monitoring in the Detection of Masked Hypertension and Other Phenomena in Frail Geriatric Patients. Medicina (B Aires) 2021; 57:medicina57111221. [PMID: 34833439 PMCID: PMC8622895 DOI: 10.3390/medicina57111221] [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: 10/03/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: This study aims to determine prevalence of masked uncontrolled hypertension (MUH) in frail geriatric patients with arterial hypertension and thus show the role of ambulatory blood pressure monitoring (ABPM) since hypertension occurs in more than 80% of people 60+ years and cardiovascular diseases are the main cause of death worldwide. Despite modern pharmacotherapy, use of combination therapy and normal office blood pressure (BP), patients’ prognoses might worsen due to inadequate therapy (never-detected MUH). Materials and Methods: 118 frail geriatric patients (84.2 ± 4.4 years) treated for arterial hypertension with office BP < 140/90 mmHg participated in the study. 24-h ABPM and clinical examination were performed. Results: Although patients were normotensive in the office, 24-h measurements showed that BP values in 72% of hypertensives were not in the target range: MUH was identified in 47 (40%) patients during 24 h, in 48 (41%) patients during daytime and nocturnal hypertension in 60 (51%) patients. Conclusions: ABPM is essential for frail geriatric patients due to high prevalence of MUH, which cannot be detected based on office BP measurements. ABPM also helps to detect exaggerated morning surge, isolated systolic hypertension, dipping/non-dipping, and set and properly manage adequate treatment, which reduces incidence of cardiovascular events and contributes to decreasing the financial burden of society.
Collapse
|
2
|
Richard NA, Hodges L, Koehle MS. Elevated peak systolic blood pressure in endurance-trained athletes: Physiology or pathology? Scand J Med Sci Sports 2021; 31:956-966. [PMID: 33382462 DOI: 10.1111/sms.13914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 01/21/2023]
Abstract
Blood pressure is a function of cardiac output and peripheral vascular resistance. During graded exercise testing (GXT), systolic blood pressure (SBP) is expected to increase gradually along with work rate, oxygen consumption, heart rate, and cardiac output. Individuals exposed to chronic endurance training attain a greater exercise SBP than in their untrained state and sedentary counterparts, but it is currently unknown what is considered a safe upper limit. This review discusses key studies examining blood pressure response in sedentary individuals and athletes. We highlight the physiological characteristics of highly fit individuals in terms of cardiovascular physiology and exercise blood pressure and review the state of the current literature regarding the safety of high SBP during exercise in this particular subgroup. Findings from this review indicate that a consensus on what is a normal SBP response to exercise in highly fit subjects and direct causation linking high GXT SBP to pathology is lacking. Consequently, applying GXT SBP guidelines developed for a "normal" population to endurance-trained individuals appears unsupported at this time. Lack of evidence for poor outcomes leads us to infer that elevated peak SBP in this subgroup could more likely reflect an adaptive response to training, rather than a pathological outcome. Future studies should track clinical outcomes of those achieving elevated SBP and develop athlete-specific guidelines.
Collapse
Affiliation(s)
| | - Lynette Hodges
- School of Sport, Exercise and Nutrition, Massey University, Palmerston North, New Zealand
| | - Michael S Koehle
- School of Kinesiology, University of British Columbia, Vancouver, Canada.,Division of Sports Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|
3
|
Taguchi S, Tamura K. Afternoon blood pressure increase on home blood pressure measurement: A forgotten entity? J Clin Hypertens (Greenwich) 2020; 22:2202-2203. [PMID: 33058448 DOI: 10.1111/jch.14078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Shiniya Taguchi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
4
|
Zhang DY, Cheng YB, Guo QH, Wang Y, Sheng CS, Huang QF, An DW, Li MX, Huang JF, Xu TY, Wang JG, Li Y. Subtypes of masked hypertension and target organ damage in untreated outpatients. Blood Press 2020; 29:299-307. [PMID: 32400191 DOI: 10.1080/08037051.2020.1763159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Dong-Yan Zhang
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi-Bang Cheng
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qian-Hui Guo
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ying Wang
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chang-Sheng Sheng
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi-Fang Huang
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - De-Wei An
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ming-Xuan Li
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian-Feng Huang
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting-Yan Xu
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Li
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Key Lab of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
5
|
Abstract
Ethn Dis. 2019;29(4):545-548; doi:10.18865/ed.29.4.545
Collapse
Affiliation(s)
- George A. Mensah
- Center for Translation Research and Implementation Science; National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| |
Collapse
|
6
|
Left ventricular mass independently associates with masked hypertension in young healthy adults. J Hypertens 2018; 36:1689-1696. [DOI: 10.1097/hjh.0000000000001740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
7
|
Morning blood pressure surge in young black and white adults: The African-PREDICT Study. J Hum Hypertens 2018; 33:22-33. [DOI: 10.1038/s41371-018-0089-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/09/2022]
|
8
|
Erdogmus S, Kutlay S, Celebi ZK, Aydın T, Ors Sendogan D, Kumru G, Keven K, Nergizoglu G, Erturk S, Sengul S. Clinical Correlates of Ambulatory Blood Pressure Phenotypes at a Tertiary Care Hospital in Turkey. Kidney Blood Press Res 2018; 43:690-700. [PMID: 29763911 DOI: 10.1159/000489742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Hypertension and its complications are major public health issues worldwide due to their association with high cardiovascular morbidity and mortality. Despite significant progress in health, the prevalence of hypertension is increasing. Ambulatory blood pressure monitoring (ABPM) is becoming increasingly important for the management of hypertension. In this study, we aimed to investigate the clinical and laboratory correlates of ambulatory blood pressure (ABP) phenotypes at a tertiary care hospital in Turkey. METHODS The characteristics of 1053 patients were retrospectively obtained from the hospital database. Hypertension was defined as patients with office blood pressure (BP) ≥140/90 mmHg and/or previously diagnosed hypertension and/or the use of antihypertensive medication. According to the office BP and ABPM results patients were identified namely: (1) sustained normotensive (SNT) patients (both office BP and ABPM were normal), (2) sustained hypertensive (SHT) patients (both office BP and ABPM were high), (3) masked hypertensive (MHT) patients (office BP were normal, but ABPM were high), (4) white coat hypertensive (WCHT) patients (office BP were above limits, but ABPM were normal). RESULTS A total of 1053 patients were included to the study (female/male: 608/445 and mean age 55 ± 15 years). The mean age of patients with hypertension was significantly higher than without hypertension (p< 0.0001). Hypertension was more frequent in females (p=0.009). The rates of history of diabetes mellitus (DM), hyperlipidemia (HL), and chronic kidney disease (CKD) were higher in patients with hypertension (p< 0.0001). Among patients with hypertension (n=853, 81%), ABPM results showed that 388 (45%) of patients had SHT, 92 (11%) had MHT, and 144 (17%) had WCHT, whereas 229 (27%) had SNT. Patients with MHT were significantly older than patients with SNT (p=0.025). The prevalence of SHT was higher in men than in women, whereas the prevalence of WCHT was higher in women than in men (p< 0.0001). There was no significant difference between 4 groups with regard to body mass index (p=0.142), a history of DM (p=0.189) and smoking status (self-reported) (p=0.306). Patients with SHT had the highest prevalence of history of hypertension, HL and CKD (p< 0.0001). Among patients without hypertension, 26 (13%) of patients had MHT and none of those patients was on antihypertensive treatment. CONCLUSION Potential usages of ABPM in Turkey may include screening of high risk individuals who have traditional cardiovascular risk factors. It also provides clinicians valuable information on abnormal ABP phenotypes. Future studies are needed to clarify the risk factors of different ABP phenotypes and to evaluate the role of ABPM on detection and control of hypertension.
Collapse
Affiliation(s)
- Siyar Erdogmus
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey,
| | - Sim Kutlay
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Zeynep Kendi Celebi
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Tolga Aydın
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Damla Ors Sendogan
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Gizem Kumru
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Kenan Keven
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Gokhan Nergizoglu
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Sehsuvar Erturk
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| | - Sule Sengul
- Ankara University School of Medicine, Department of Nephrology, Ankara, Turkey
| |
Collapse
|
9
|
Dolan E, James K. Current approach to masked hypertension: From diagnosis to clinical management. Clin Exp Pharmacol Physiol 2017; 44:1272-1278. [DOI: 10.1111/1440-1681.12190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 10/16/2013] [Accepted: 10/20/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Eamon Dolan
- Stroke and Hypertension Unit; Connolly Hospital; Dublin Ireland
| | - Kirstyn James
- Stroke and Hypertension Unit; Connolly Hospital; Dublin Ireland
| |
Collapse
|
10
|
Ma Y, Sun S, Peng CK, Fang Y, Thomas RJ. Ambulatory Blood Pressure Monitoring in Chinese Patients with Obstructive Sleep Apnea. J Clin Sleep Med 2017; 13:433-439. [PMID: 27855748 DOI: 10.5664/jcsm.6498] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 10/18/2016] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVES Nocturnal blood pressure (BP) dipping in patients with obstructive sleep apnea (OSA) has not yet been well investigated in Chinese patients, in whom the relationship of OSA and body mass index (BMI) is weaker than that in Caucasians. The aim of this study was to evaluate the BP profile, and the relationships between nocturnal BP and the severity of OSA, in Chinese patients. METHODS Consecutive Chinese adult outpatients with suspected OSA had overnight polysomnography (PSG), office BP, and 24-h ambulatory BP monitoring (ABPM). The apnea-hypopnea index (AHI) and nocturnal oxygen saturation level were recorded, and BP patterns were classified based on the ABPM. RESULTS Fifty-six subjects (40 male and 16 female, 48.59 ± 13.27 y) were evaluated. There were 14 patients with mild OSA (25.0%, AHI: 10.56 ± 3.42 events/h), 16 with moderate OSA (28.6%, AHI: 23.536 ± 3.42 events/h) and 26 with severe OSA (46.4%, AHI: 51.52 ± 3.42 events/h). There were 18 dippers (32.1%), 27 non-dippers (48.2%), and 11 reverse dippers (19.6%). As OSA severity increased, non-dipping also increased. A total of 67.9% of the OSA patients showed overall hypertension on ABPM, 57.1% had daytime hypertension only, and 73.2% had nighttime hypertension. CONCLUSIONS OSA severity is associated with 24-h BP profiles in a population with only mild increases in BMI. These results can influence clinical practice, OSA management, and hypertension treatment policies.
Collapse
Affiliation(s)
- Yan Ma
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Shuchen Sun
- Department of Otolaryngology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,South Campus Sleep Center, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chung-Kang Peng
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Yeming Fang
- Cardiovascular Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Robert J Thomas
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| |
Collapse
|
11
|
Gijón-Conde T, Graciani A, López-García E, Guallar-Castillón P, García-Esquinas E, Rodríguez-Artalejo F, Banegas JR. Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain. Hypertens Res 2017; 40:613-619. [DOI: 10.1038/hr.2017.9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 12/10/2016] [Accepted: 12/15/2016] [Indexed: 11/09/2022]
|
12
|
Erdem F, Cakır U, Yıldırım O, Alcelik A, Donmez I, Tuman TC, Caglar SO, Erdem A, Yazıcı M. A new diagnostic tool for masked hypertension: impaired sleep quality. Arch Med Sci 2016; 12:1207-1213. [PMID: 27904509 PMCID: PMC5108374 DOI: 10.5114/aoms.2015.51177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/25/2016] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the relationship between masked hypertension and impaired sleep quality. Additionally, we evaluated the diagnostic role and prevalence of poor sleep quality among patients with newly diagnosed masked hypertension. MATERIAL AND METHODS A total of 112 individuals, 72 patients with newly diagnosed masked hypertension and 40 normotensive healthy volunteers, were included in this study. All patients underwent evaluation comprising 12-lead electrocardiography, transthoracic echocardiography, 24-hour Holter ECG, and basic laboratory tests. Additionally, all participants completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI). RESULTS The total PSQI score was significantly higher in the masked hypertension group than in the normotensive healthy volunteers (4.13 ±2.43 vs. 2.33 ±1.67, p < 0.001). A PSQI score > 5 was found in 45.8% (n = 33) of patients in the masked hypertension group and 15% (n = 6) of patients in the normotensive group (p < 0.001). The non-dipper pattern was found in 17.5% of the healthy volunteer group and 59.94% (n = 41) of the masked hypertension group (p < 0.001). When we compared the dipping pattern of the masked hypertension groups, there was a significant difference in PSQI score between the dipper and non-dipper groups (4.87 ±3.21 vs. 3.58 ±2.33, p < 0.001). Multiple logistic regression analyses showed that masked hypertension, LV mass, and LV mass index score were independent predictors of poor PSQI. CONCLUSIONS This study demonstrates impaired sleep quality in subjects with masked hypertension, particularly those with a non-dipper pattern. Additionally, this study indicates that impaired sleep quality may help diagnose masked hypertension, particularly in the non-dipper group.
Collapse
Affiliation(s)
- Fatma Erdem
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Ugur Cakır
- Department of Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Osman Yıldırım
- Department of Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Aytekin Alcelik
- Department of Internal Medicine, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Ibrahim Donmez
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Taha Can Tuman
- Department of Psychiatry, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Sabri Onur Caglar
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Alim Erdem
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| | - Mehmet Yazıcı
- Department of Cardiology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey
| |
Collapse
|
13
|
Aspectos clínicos actuales del monitoreo ambulatorio de presión arterial. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2016; 86:255-9. [DOI: 10.1016/j.acmx.2015.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 11/21/2022] Open
|
14
|
Algamal AM. Frequency of masked hypertension and its relation to target organ damage in the heart. Egypt Heart J 2016. [DOI: 10.1016/j.ehj.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
15
|
Unsal S, Ozkara A, Albayrak T, Ozturk Y, Beysel S, Kucukler FK. Evaluation of prehypertension and masked hypertension rate among clinically normotensive patients. Clin Exp Hypertens 2016; 38:218-24. [PMID: 26818410 DOI: 10.3109/10641963.2015.1047951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The present cross-sectional study was aimed to identify pre-hypertension and masked hypertension rate in clinically normotensive adults in relation to socio-demographic, clinical and laboratory parameters. METHODS A total of 161 clinically normotensive adults with office blood pressure (OBP) <140/90 mmHg without medication were included in this single-center cross-sectional study. OBP, home BP (HBP) recordings and ambulatory BP monitoring (ABPM) were used to identify rates of true normotensives, true pre-hypertensives and masked hypertensives. Data on sociodemographic and clinical characteristics were collected in each subject and evaluated with respect to true normotensive vs. pre-hypertensive patients with masked hypertension or true pre-hypertensive. Target organ damage (TOD) was evaluated in masked hypertensives based on laboratory investigation. RESULTS Masked hypertension was identified in 8.7% of clinically normotensives. Alcohol consumption was significantly more common in masked hypertension than in true pre-hypertension (28.6 vs. 0.0%, p = 0.020) with risk ratio of 2.7 (95% CI 1.7-4.4). Patients with true pre-hypertension and masked hypertension had significantly higher values for body mass index, waist circumference, systolic and diastolic OBP and HBP (p < 0.05 for each) compared to true normotensive subjects. ABPM revealed significantly higher values for day-time and night-time systolic and diastolic BP (p = 0.002 for night-time diastolic BP, p < 0.001 for others) in masked hypertension than true pre-hypertension. CONCLUSIONS Given that the associations of pre-hypertension with TOD might be attributable to the high prevalence of insidious presentation of masked hypertension among pre-hypertensive individuals, ABPM seems helpful in early identification and management of masked hypertension in the pre-hypertensive population.
Collapse
Affiliation(s)
- S Unsal
- a Department of Family Medicine , Cankiri Public Hospital , Cankiri , Turkey
| | - A Ozkara
- b Department of Family Medicine , Hitit University , Corum , Turkey .,c Department of Family Medicine , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - T Albayrak
- c Department of Family Medicine , Ankara Numune Training and Research Hospital , Ankara , Turkey
| | - Y Ozturk
- d Department of Biochemistry , Gazi University Medical Faculty Hospital , Ankara , Turkey
| | - S Beysel
- e Department of Endocrinology and Metabolism , Diskapi Yildirim Beyazit Training and Research Hospital , Ankara , Turkey , and
| | - F K Kucukler
- f Department of Endocrinology and Metabolism , Hitit University , Corum , Turkey
| |
Collapse
|
16
|
Ateş İ, Altay M, Kaplan M, Ozkayar N, Toprak G, Alagüney ME, Özkara A. Relationship between socioeconomic level, and the prevalence of masked hypertension and asymptomatic organ damage. Med Sci Monit 2015; 21:1022-30. [PMID: 25864373 PMCID: PMC4403375 DOI: 10.12659/msm.892684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background This study aimed to determine the prevalence of masked hypertension (MHT) and its association with asymptomatic organ damage (AOD) in a low socioeconomic district of Ankara, Turkey. Material/Methods We retrospectively reviewed data obtained from the medical records of 712 patients with no known diagnosis of hypertension who presented to a polyclinic due to symptoms related to elevated blood pressure (BP) and were screened for MHT. Essential hypertension (EHT) existed in 86 patients screened for AOD. The presence of AOD in patients diagnosed with MHT and EHT was recorded. Results Among the 712 patients, 206 were diagnosed with EHT. Among the remaining 506 patients, 73 were diagnosed with MHT. The patients with MHT had significantly higher left ventricular mass index, carotid intima-media thickness, and 24-h urinary microalbuminuria level (all indicators of AOD) than those with EHT. Conclusions A significantly higher percentage of patients with MHT had AOD, as compared to those with EHT, in a low socioeconomic district of Ankara. Based on this finding, patients who present with hypertensive symptoms but have a normal BP should be advised to measure their BP at home.
Collapse
Affiliation(s)
- İhsan Ateş
- Department of Nephrology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mustafa Altay
- Department of Internal Medicine, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Mustafa Kaplan
- Department of Internal Medicine, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Nihal Ozkayar
- Department of Nephrology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Güvenc Toprak
- Department of Internal Medicine, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - M Erdem Alagüney
- Department of Internal Medicine, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Adem Özkara
- Department of Family Medicine, Ankara Numune Education and Research Hospital, Ankara, Turkey
| |
Collapse
|
17
|
Kul S, Uyarel H, Guvenc TS, Ozcelik HK, Yalcinsoy M, Asoglu E, Bulut I, Erdogan E, Ozseker ZF, Gungor S, Gunluoglu G, Gunaydin ZY. Circadian blood pressure pattern in sarcoidosis patients. Blood Press 2014; 24:23-9. [PMID: 25204332 DOI: 10.3109/08037051.2014.952927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Autonomic dysfunction (AD) is frequent in sarcoidosis and considered a result of small fiber neuropathy. A non-dipper blood pressure (BP) pattern, which is also linked to AD, is associated with increased risk of cardiovascular and renal diseases. The aim of the present study was to evaluate the non-dipping BP pattern in normotensive patients with pulmonary sarcoidosis (PS). METHODS Sixty-three normotensive patients with PS (group 1) and 49 healthy subjects (group 2) were prospectively enrolled. Ambulatory BP monitoring was performed in all participants over a 24-h period. RESULTS The non-dipping BP pattern was significantly more frequent in patients with PS compared with the control group (80% vs 53%, respectively, p = 0.002). More advanced PS (grade 2) was an independent predictor of non-dipper BP pattern (odds ratio = 10.4, 95% confidence interval 1.1-95.4, p = 0.03). Masked hypertension and body mass index were also found to be other predictors of non-dipping BP pattern. CONCLUSIONS The present study showed that non-dipping BP pattern is frequently observed in normotensive patients with PS. The probable mechanism underlying the non-dipping BP in PS is autonomic nervous system dysfunction. PS represents an independent risk factor for non-dipping BP and these patients have increased cardiovascular risk.
Collapse
Affiliation(s)
- Seref Kul
- Department of Cardiology, Faculty of Medicine, Bezmialem Vakif University , Istanbul , Turkey
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Grossman A, Cohen N, Shemesh J, Koren‐Morag N, Leibowitz A, Grossman E. Exaggerated blood pressure response to exercise is not associated with masked hypertension in patients with high normal blood pressure levels. J Clin Hypertens (Greenwich) 2014; 16:277-82. [PMID: 24674054 PMCID: PMC8031933 DOI: 10.1111/jch.12303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/15/2013] [Accepted: 12/28/2013] [Indexed: 08/10/2024]
Abstract
The association between exaggerated blood pressure (BP) response to exercise (ExBPR) and "masked hypertension" is unclear. Medical records of patients with high-normal BP who were evaluated in the Chaim Sheba Screening Institute Ramat Gan, Israel, during the years 2002-2007 and referred for 24-hour ambulatory BP monitoring (ABPM) and exercise test were reviewed. Data on exercise tests performed in the preceding 5 years were retrieved. Reproducible ExBPR was defined when it was recorded at least twice. BP levels on 24-hour ABPM were compared between patients with a normal BP response and those with an ExBPR (systolic BP ≥200 mm Hg). Sixty-nine normotensive patients with high normal BP levels were identified. ExBPR was recorded in 43 patients and was reproducible in 28. BP levels on 24-hour ABPM were similar in patients with and without ExBPR. In patients with high-normal BP levels, ExBPR is not associated with masked hypertension.
Collapse
Affiliation(s)
- Alon Grossman
- Internal Medicine E Rabin Medical CenterTel‐AvivIsrael
| | - Noa Cohen
- Internal Medicine D and Hypertension UnitThe Chaim Sheba Medical CenterTel‐AvivIsrael
| | - Joseph Shemesh
- Grace Ballas Research Unit of the Cardiac Rehabilitation InstituteThe Chaim Sheba Medical CenterTel‐AvivIsrael
| | - Nira Koren‐Morag
- Department of Epidemiology and Preventive MedicineSackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Avshalom Leibowitz
- Internal Medicine D and Hypertension UnitThe Chaim Sheba Medical CenterTel‐AvivIsrael
| | - Ehud Grossman
- Internal Medicine D and Hypertension UnitThe Chaim Sheba Medical CenterTel‐AvivIsrael
| |
Collapse
|
19
|
Angeli F, Reboldi G, Poltronieri C, Bartolini C, D'Ambrosio C, de Filippo V, Verdecchia P. Clinical utility of ambulatory blood pressure monitoring in the management of hypertension. Expert Rev Cardiovasc Ther 2014; 12:623-34. [PMID: 24678697 DOI: 10.1586/14779072.2014.903155] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Accurate blood pressure (BP) measurement is essential for the diagnosis, monitoring and management of hypertension. However, conventional office-based BP readings have several limitations that include a low reproducibility, the white-coat effect and the existence of masked hypertension. These limitations can be addressed through the use of ambulatory BP monitoring. Because ambulatory monitoring provides measurements at specific time intervals throughout a 24-hour period, this technique represents a better picture of the normal fluctuations in BP levels associated with daily activities and sleep. In addition, end-organ damage associated with hypertension is more closely related to ambulatory BP than office BP measurements and ambulatory BP profile give better prediction of clinical outcome than conventional BP measurements.
Collapse
Affiliation(s)
- Fabio Angeli
- Division of Cardiology and Cardiovascular Pathophysiology, University Hospital "S.M. della Misericordia", Perugia, Italy
| | | | | | | | | | | | | |
Collapse
|
20
|
Alessi A, Brandão AA, de Paiva AMG, Nogueira ADR, Feitosa A, Gonzaga CDC, Amodeo C, Mion D, de Souza DDSM, Barbosa E, Lima Junior E, Nobre F, Fuchs FD, Chaves Junior H, Schneider JC, Gemelli J, Villela-Martin JF, Scala LCN, Gomes MAM, Malachias MVB, de Morais NS, Moreira Filho O, Passarelli Junior O, Jardim PCBV, Miranda RD, Póvoa R, Fuchs SC, Baiocchi S, Jardim TV, Barroso WKS. I Brazilian position paper on prehypertension, white coat hypertension and masked hypertension: diagnosis and management. Arq Bras Cardiol 2014; 102:110-8. [PMID: 24676366 PMCID: PMC3987343 DOI: 10.5935/abc.20140011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 12/03/2013] [Accepted: 12/03/2013] [Indexed: 01/22/2023] Open
Affiliation(s)
- Alexandre Alessi
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | | | - Audes Feitosa
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | - Celso Amodeo
- Brazilian Society of Cardiology Arterial Hypertension Department
| | - Decio Mion
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | - Eduardo Barbosa
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | - Fernando Nobre
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | | | - João Gemelli
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | | | | | | | | | | | | | | | | - Rui Póvoa
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | - Sergio Baiocchi
- Brazilian Society of Cardiology Arterial Hypertension Department
| | | | | |
Collapse
|
21
|
Bacaksiz A, Erdogan E, Sonmez O, Sevgili E, Tasal A, Onsun N, Topukcu B, Kulaç B, Uysal O, Goktekin O. Ambulatory blood pressure monitoring can unmask hypertension in patients with psoriasis vulgaris. Med Sci Monit 2013; 19:501-9. [PMID: 23800996 PMCID: PMC3699538 DOI: 10.12659/msm.889197] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Psoriasis vulgaris is one of the most prevalent chronic, inflammatory skin disorders. Patients with psoriasis have excess risk of essential hypertension. Masked hypertension (MH), defined as normal office blood pressure (BP) with elevated ambulatory BP (ABPM), has been drawing attention recently due to its association with increased risk of developing sustained hypertension, cardiovascular morbidity, and mortality. The aim of this study was to investigate the prevalence of MH in psoriatic patients. MATERIAL AND METHODS On hundred and ten middle-aged, normotensive, non-obese patients with psoriasis vulgaris and 110 age- and sex-matched normotensive controls were included in the study. ABPM was performed in all participants over a 24-h period. The clinical severity of the disease was determined according to current indexes. RESULTS The prevalence of MH among subjects with psoriasis vulgaris was 31.8% and increased compared to control subjects (p<0.01). Predictors of MH in patients with psoriasis vulgaris were detected as male sex, smoking, obesity-related anthropometric measures, and disease activity. Male sex, waist circumference, and diffuse psoriatic involvement were detected as independent predictors of MH. CONCLUSIONS MH is prevalent in patients with psoriasis vulgaris. Assessment with ABPM and close follow-up for development of hypertension is reasonable.
Collapse
Affiliation(s)
- Ahmet Bacaksiz
- Department of Cardiology, Bezmiâlem Foundation University, Istanbul, Turkey.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Díez J. Hypertensive heart disease. Hypertension 2013. [DOI: 10.2217/ebo.12.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Javier Díez
- Javier Díez is Full Professor of Medicine at the University of Navarra (Pamplona, Spain). His group studies the mechanisms involved in myocardial remodeling associated with cardiac pressure overload, as well as noninvasive biomarkers and novel therapeutic targets for myocardial remodeling
| |
Collapse
|
23
|
Abstract
BACKGROUND Psoriasis vulgaris is one of the most prevalent chronic, inflammatory skin disorders. Patients with psoriasis carry an excess risk of hypertension and adverse cardiovascular (CV) events. Blood pressure (BP) has a circadian rhythm characterised with lower values at night. A blunted nocturnal BP decline defined as non-dipping accelerates the development of hypertension and CV diseases. The aim of this study is to evaluate circadian variation of blood pressure in normotensive middle-aged patients with psoriasis vulgaris. METHODS Seventy adult patients with psoriasis vulgaris (group 1) and 70 age and sex-matched healthy individuals (group 2) were included in the study. Ambulatory BP monitoring was performed in all participants over a 24-h period. Non-dippers are defined as those who show a reduction in BP of less than 10 % between the average day and night systolic BP. RESULTS Although mean 24-h BPs were similar in both groups, night-time BPs were significantly higher in psoriatic patients (115.1 ± 7.7 vs. 109.9 ± 6.0 mmHg and 72.1 ± 7.0 vs. 67.6 ± 5.5 mmHg, respectively; p < 0.05). The non-dipping pattern of BP changes was significantly more common in patients with psoriasis vulgaris compared with the control group (65.9 vs. 34.1 %, p < 0.01). Psoriasis severity and BMI are independent predictors of impaired nocturnal BP regulation. CONCLUSIONS Patients with psoriasis vulgaris had increased nocturnal BP and heart rate. This is the first study to demonstrate a blunted nocturnal BP decrease in normotensive patients with psoriasis.
Collapse
|
24
|
Abstract
BACKGROUND Increased blood pressure (BP) is common after liver transplantation. However, there is scarce information on its control. METHODS In this prospective, cross-sectional, multicenter study, we determined BP according to the recommended international standards in 921 liver transplant patients during one routine outpatient visit to assess their grade of control of BP. At the time of the study, 490 patients had been previously diagnosed with arterial hypertension and were receiving antihypertensive treatment, and 431 were not previously diagnosed as hypertensive. RESULTS In the hypertensive group, arterial hypertension was uncontrolled (BP >140/90 mm Hg [>130/80 in diabetics]) in 158 (32%) patients and controlled in 332 (68%) patients. In a multivariate analysis, only diabetes was identified as a significant predictor of uncontrolled hypertension. Among patients not previously diagnosed as hypertensive, BP was increased in 106 (25%) and normal in 325 (75%). On multivariate analysis, the only variable independently associated with increased BP in this group was metabolic syndrome. CONCLUSION BP is not adequately controlled in a noticeable percentage of liver transplant patients, especially in subjects with diabetes or metabolic syndrome.
Collapse
|
25
|
|
26
|
Ambulatory blood pressure monitoring in the elderly. Int J Hypertens 2011; 2012:548286. [PMID: 22229085 PMCID: PMC3249829 DOI: 10.1155/2012/548286] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 09/08/2011] [Indexed: 12/03/2022] Open
Abstract
The incidence of hypertension is high in the elderly and is present in 2/3 of the patients older than 65 years. Prevalence can reach 90% in patients older than 80 years. The presence of isolated systolic hypertension (ISH) is characteristic of this population. However, the prevalence of hypertension by ambulatory blood pressure monitoring (ABPM) is not well known. In this study, we analyzed the special characteristics of hypertension in this population, giving special emphasis on ABPM readings.
Collapse
|
27
|
Orías M, Correa-Rotter R. Chronotherapy in hypertension: a pill at night makes things right? J Am Soc Nephrol 2011; 22:2152-5. [PMID: 22080422 DOI: 10.1681/asn.2011101012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
28
|
Kayrak M, Bacaksiz A, Vatankulu MA, Ayhan SS, Kaya Z, Ari H, Sonmez O, Gok H. Exaggerated blood pressure response to exercise--a new portent of masked hypertension. Clin Exp Hypertens 2011; 32:560-8. [PMID: 21091361 DOI: 10.3109/10641963.2010.503298] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Masked hypertension (MHT) is a popular entity with increased risk of developing sustained hypertension, heart attack, stroke, and death. Subjects have normal blood pressure (BP) at office but elevated values at night so it is difficult to diagnose. Exaggerated blood pressure response to exercise (EBPR) is also a predictor of future hypertension. To investigate the relationship between these two entities, we evaluated 61 normotensive subjects with EBPR. The subjects underwent 24-h ambulatory blood pressure monitoring (ABPM). The prevalence of masked hypertension among subjects with EBPR was 41%. Body mass index (BMI), non-high density lipoprotein (HDL) cholesterol, diastolic blood pressure (DBP) at peak exercise and recovery, nondipping DBP pattern, and elevated early morning average BPs were associated with masked hypertension. In multivariate logistic regression analysis, the DBP measured at peak exercise was detected as an independent predictor of MHT in subjects with EBPR. Subjects with abnormally elevated BP during exercise are prone to MHT, necessitate medical assessment and close follow-up for hypertension.
Collapse
Affiliation(s)
- Mehmet Kayrak
- Department of Cardiology, Selcuk University, Meram School of Medicine Hospital, Konya, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Beetz N, Hein L. The physiological roles of phosducin: from retinal function to stress-dependent hypertension. Cell Mol Life Sci 2011; 68:599-612. [PMID: 21069424 PMCID: PMC11114795 DOI: 10.1007/s00018-010-0550-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/09/2010] [Accepted: 09/29/2010] [Indexed: 01/26/2023]
Abstract
In the time since its discovery, phosducin's functions have been intensively studied both in vivo and in vitro. Phosducin's most important biochemical feature in in vitro studies is its binding to heterotrimeric G protein βγ-subunits. Data on phosducin's in vivo relevance, however, have only recently been published but expand the range of biological actions, as shown both in animal models as well as in human studies. This review gives an overview of different aspects of phosducin biology ranging from structure, phylogeny of phosducin family members, posttranscriptional modification, biochemical features, localization and levels of expression to its physiological functions. Special emphasis will be placed on phosducin's function in the regulation of blood pressure. In the second part of this article, findings concerning cardiovascular regulation and their clinical relevance will be discussed on the basis of recently published data from gene-targeted mouse models and human genetic studies.
Collapse
Affiliation(s)
- Nadine Beetz
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Freiburg, Albertstrasse 25, 79104 Freiburg, Germany
- Centre for Biological Signaling Studies (bioss), University of Freiburg, Freiburg, Germany
| | - Lutz Hein
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Freiburg, Albertstrasse 25, 79104 Freiburg, Germany
- Centre for Biological Signaling Studies (bioss), University of Freiburg, Freiburg, Germany
| |
Collapse
|
30
|
Abstract
Blood pressure (BP) varies according to many internal and external factors, and behavioral factors have an important role in diurnal BP variation. BP rises sharply on waking in the morning and falls during sleep at night, although it varies throughout the day and night. These changes in BP are closely related to mental and physical activities, and the sympathetic nervous system mainly contributes to the diurnal variation in BP. Other behavioral factors, such as food consumption and obesity, dietary intake of sodium, drinking and smoking habits, consumption of coffee and tea, and bathing, also affect the diurnal variation in BP. Alterations in diurnal BP variation due to behavioral factors are frequently seen in patients with hypertension and can be classified as morning hypertension, daytime hypertension and nighttime hypertension. Appropriate lifestyle modifications may normalize or improve both the level and rhythm of BP in these patients.
Collapse
|
31
|
Yoon HJ, Ahn Y, Park JB, Park CG, Youn HJ, Choi DJ, Shin JH, Kim DW, Rim SJ, Bae JH. Are Metabolic Risk Factors and Target Organ Damage More Frequent in Masked Hypertension Than in White Coat Hypertension? Clin Exp Hypertens 2010; 32:480-5. [DOI: 10.3109/10641963.2010.496517] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
32
|
Abstract
Blood pressure (BP) may be high during usual daily life in one out of 7-8 individuals with normal BP in the clinic or doctor's office. This condition is usually defined as masked hypertension (MH). Prevalence of MH varied across different studies depending on patient characteristics, populations studied, and different definitions of MH. Self-measured BP and ambulatory BP (ABP) have been widely used to identify subjects with MH. Various factors have been identified as possible determinants of MH. Cigarette smoking, alcohol, physical activity, job, and psychological stress may increase BP out of the clinical environment in otherwise normotensive individuals, leading to MH. In most studies, target organ damage was comparable in subjects with MH and those with sustained hypertension, and greater than in those with true normotension. Subjects with MH showed a 1.5- to 3-fold higher risk of major cardiovascular (CV) disease than those with normotension, and their risk was not different from that of patients with sustained hypertension. In an overview of literature, we found that the risk of major CV disease was higher in subjects with MH than in the normotensive subjects regardless of the definition of MH based on self-measured BP (hazard ratio (HR) 2.13; 95% confidence interval (CI): 1.35-3.35; P = 0.001) or 24-h ABP (HR 2.00; 95% CI: 1.54-2.60; P < 0.001). MH is an insidious and prognostically adverse condition that can be reliably diagnosed by self-measured BP and ABP. MH should be searched for in subjects who appear to be more likely to have this condition. Antihypertensive treatment is envisaged in these subjects, although the associated outcome benefits are still undetermined.
Collapse
|
33
|
Kawano Y, Horio T, Kamide K, Iwashima Y, Yoshihara F, Nakamura S. Blood Pressure and Medication During Long-Term Antihypertensive Therapy Based on Morning Home SBP in Hypertensive Patients: Hypertension Control Based On Home Systolic Pressure (HOSP) Substudy. Clin Exp Hypertens 2010; 32:239-43. [DOI: 10.3109/10641963.2010.491889] [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]
|
34
|
Kobayashi M, Obara T, Ohkubo T, Fukunaga H, Satoh M, Metoki H, Asayama K, Inoue R, Kikuya M, Mano N, Miyakawa M, Imai Y. Practice and awareness of physicians regarding casual-clinic blood pressure measurement in Japan. Hypertens Res 2010; 33:960-4. [PMID: 20535112 DOI: 10.1038/hr.2010.89] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The optimal procedure for casual-clinic blood pressure (CBP) measurement is outlined in the 2004 Japanese guidelines. We investigated the status of physicians' practices and their awareness of CBP measurement immediately and 4 years after the publication of the guidelines using a questionnaire regarding CBP. This survey was conducted among physicians who attended educational seminars on hypertension in 2004-2005 and in 2007-2008; the questionnaire was distributed, completed and collected just before the start of the seminars. Of the 1966 respondents to the 2004-2005 survey and the 2995 respondents to the 2007-2008 survey, the proportion of physicians who answered that CBP was more important than self-measured BP at home (home BP) was less than 10% in both surveys. The proportion of physicians who used a mercury sphygmomanometer (68.1-75.5%) was higher than those who used an automatic and electronic sphygmomanometer (20.7-29.0%) in both surveys. However, the use of an automatic and electronic sphygmomanometer slightly increased from 20.7% in 2004-2005 to 29.0% in 2007-2008. Physicians who were younger or working in a hospital were less likely to measure CBP using the conditions of the guidelines. Approximately 50% of physicians correctly recognized the reference values of hypertension based on CBP measurement (systolic/diastolic, 140/90 mm Hg) in both surveys. The status of physicians' practice and awareness of CBP measurement varied by physicians' age, specialty and work place and those situations did not change over 4 years, underlying the importance of clarifying factors inherent in these situations.
Collapse
Affiliation(s)
- Mitsuru Kobayashi
- Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Kimura T, Senda S, Masugata H, Yamagami A, Okuyama H, Kohno T, Hirao T, Fukunaga M, Okada H, Goda F. Seasonal blood pressure variation and its relationship to environmental temperature in healthy elderly Japanese studied by home measurements. Clin Exp Hypertens 2010; 32:8-12. [PMID: 20144067 DOI: 10.3109/10641960902929479] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of the present study was to examine seasonal blood pressure variation and its relationship to environmental temperature in healthy elderly Japanese, as studied by home measurements. Fifteen healthy elderly Japanese (79.3 +/- 5.9 yrs) measured their blood pressure at home each morning for more than 25 times per month for 3 years. Monthly mean outdoor temperatures were obtained from the Takamatsu meteorological Observatory. The highest levels of systolic and diastolic blood pressure measured at home were observed in February (129 +/- 14 and 81 +/- 13 mmHg). The lowest levels of systolic and diastolic blood pressure measured at home were observed in August (117 +/- 11 and 73 +/- 10 mmHg). Likewise, the lowest and highest means of outdoor temperature were observed in February (5.0 degrees C) and August (29.2 degrees C), respectively. Hence, both systolic and diastolic blood pressure demonstrated a close inverse correlation with the means of outdoor temperature (r = -0.973, p < 0.001 and r = -0.985, p < 0.001, respectively). A 1 degree C decrease in the mean outdoor temperature was associated with rises of 0.43 mmHg in systolic blood pressure (SBP) and 0.29 mmHg in diastolic blood pressure (DBP). Seasonal variations in home blood pressure and outdoor temperature showed complete correspondence in healthy elderly Japanese, with the blood pressures being inversely related to the ambient temperature. These seasonal home blood pressure variations should be kept in mind when controlling blood pressure in elderly patients.
Collapse
Affiliation(s)
- Toshiaki Kimura
- Department of Integrated Medicine, Kagawa University, Kagawa, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
|
37
|
Affiliation(s)
- Javier Díez
- From the Division of Cardiovascular Sciences (J.D.), Centre of Applied Medical Research, University of Navarra, Pamplona, Spain; Ochsner Clinic Foundation (E.D.F.), New Orleans, La
| | - Edward D. Frohlich
- From the Division of Cardiovascular Sciences (J.D.), Centre of Applied Medical Research, University of Navarra, Pamplona, Spain; Ochsner Clinic Foundation (E.D.F.), New Orleans, La
| |
Collapse
|
38
|
Abstract
The number of well-controlled hypertensives is unacceptably low worldwide. Respecting the circadian variation of blood pressure, nontraditional antihypertensives, and treatment in early stages of hypertension are potential ways to improve hypertension therapy. First, prominent variations in circadian rhythm are characteristic for blood pressure. The revolutionary MAPEC (Ambulatory Blood Pressure Monitoring and Cardiovascular Events) study, in 3000 adult hypertensives investigates, whether chronotherapy influences the cardiovascular prognosis beyond blood pressure reduction per se. Second, melatonin, statins and aliskiren are hopeful drugs for hypertension treatment. Melatonin, through its scavenging and antioxidant effects, preservation of NO availability, sympatholytic effect or specific melatonin receptor activation exerts antihypertensive and anti-remodeling effects and may be useful especially in patients with nondipping nighttime blood pressure pattern or with nocturnal hypertension and in hypertensives with left ventricular hypertrophy (LVH). Owing to its multifunctional physiological actions, this indolamine may offer cardiovascular protection far beyond its hemodynamic benefit. Statins exert several pleiotropic effects through inhibition of small guanosine triphosphate-binding proteins such as Ras and Rho. Remarkably, statins reduce blood pressure in hypertensive patients and more importantly they attenuate LVH. Addition of statins should be considered for high-risk hypertensives, for hypertensives with LVH, and possibly for high-risk prehypertensive patients. The direct renin inhibitor, aliskiren, inhibits catalytic activity of renin molecules in circulation and in the kidney, thus lowering angiotensin II levels. Furthermore, aliskiren by modifying the prorenin conformation may prevent prorenin activation. At present, aliskiren should be considered in hypertensive patients not sufficiently controlled or intolerant to other inhibitors of renin-angiotensin system. Third, TROPHY (Trial of Preventing Hypertension) is the first pharmacological intervention for prehypertensive patients revealing that treatment with angiotensin II type 1 receptor blocker attenuates hypertension development and thus decreases the risk of cardiovascular events.
Collapse
Affiliation(s)
- Fedor Simko
- Department of Pathophysiology, Comenius University, Bratislava, Slovak Republic
- 3rd Clinic of Medicine, School of Medicine, Comenius University, Bratislava, Slovak Republic
| | - Olga Pechanova
- Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovak Republic
- Institute of Physiology and Center of Cardiovascular Research, Academy of Sciences of the Czech Republic, Prague, Czech Republic
| |
Collapse
|
39
|
Abstract
A new pathophysiologic paradigm on HHD is emerging. This entity is the result of the pathologic structural remodeling of the myocardium in response to a mosaic of hemodynamic and nonhemodynamic factors altered in hypertension more than just the adaptive hypertrophy of the left ventricular wall to increased pressure. The potential clinical relevance of this paradigm is given by the fact that it entails a new approach to HHD in terms of more detailed diagnosis and more demanding treatment. But this novel view of HHD may also have epidemiologic importance. In fact, the possibility that myocardial individuals prone to develop HHD may be detected before the appearance of clinical detectable LVH opens a new way to the prevention of cardiac complications associated with hypertension and its impact on the heart, namely heart failure.
Collapse
Affiliation(s)
- Javier Díez
- Department of Cardiology and Cardiovascular Surgery, Molecular Cardiology Unit, School of Medicine, UniversityClinic, University of Navarra, Pamplona, Spain.
| |
Collapse
|