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rs2253820 Variant Controls Blood Pressure Dip After Stroke by Increasing CLOCK–BMAL1 Expression. Transl Stroke Res 2022:10.1007/s12975-022-01063-y. [DOI: 10.1007/s12975-022-01063-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/01/2022] [Accepted: 07/06/2022] [Indexed: 10/16/2022]
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Triantafyllidi H, Birmpa D, Schoinas A, Benas D, Thymis I, Varoudi M, Voutsinos D, Ikonomidis I. Is there any true distinction in extreme dipping versus nondipping or dipping phenotype regarding hypertension-mediated organ damage in newly diagnosed and never-treated hypertensive patients? J Hum Hypertens 2022; 36:51-60. [PMID: 33589763 DOI: 10.1038/s41371-021-00491-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 01/31/2023]
Abstract
Dipping phenomena is defined as nocturnal BP fall >10% during 24-h ambulatory blood pressure (BP) monitoring (ABPM) which carries a favorable cardiovascular risk (CVR) prognosis due to reduced 24-h hypertension burden. To date, extreme dipping phenotype (defined as BP decrease ≥20%) has led to controversial prognostic results regarding CVR. We aimed to explore hypertension-mediated organ damage (HMOD) in extreme dippers compared to the other dipping phenotypes (nondipping, dipping). From 490 consecutive patients with newly diagnosed never-treated arterial hypertension (mean age 51 ± 11 years, 294 males) subjected to 24-h ABPM, we studied 52 extreme dippers, 52 age- and gender-matched nondippers, and 52 age- and gender-matched dippers. All patients were subjected to arterial stiffness (PWV), 24-h microalbumin levels, carotid intima-media thickness (cIMT), diastolic dysfunction (E/Ea), and left ventricular mass index (LVMI) evaluation. ANOVA analysis found no differences regarding HMOD between groups. Multiple regression analysis revealed the following independent direct relationships between: (i) office SBP and PWV in nondippers (β = 0.35, p = 0.01) and extreme dippers (β = 0.49, p < 0.001), (ii) office SBP and E/Ea in extreme dippers (β = 0.39, p = 0.007), (iii) 24-h diurnal and nocturnal SBP and E/Ea in dippers (β = 0.40, p = 0.004, β = 0.39, p = 0.005, and β = 0.40, p = 0.004, respectively), and (iv) 24-h and nocturnal SBP and LVMI in nondippers (β = 0.29, p = 0.04 and β = 0.36, p = 0.009, respectively). In the early phases of untreated-arterial hypertension disease, extreme dipping phenotype in middle-aged hypertensives does not imply an adverse or favorable prognosis regarding the incidence of HMOD either as continuous variables or as abnormal HMOD compared to other dipping phenotypes.
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Affiliation(s)
- Helen Triantafyllidi
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece.
| | - Dionyssia Birmpa
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
| | - Antonios Schoinas
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
| | - Dimitris Benas
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
| | - Ioannis Thymis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
| | - Mary Varoudi
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
| | - Dimitris Voutsinos
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
| | - Ignatios Ikonomidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, ATTIKON Hospital, Athens, Greece
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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.
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Extreme dipping and target organ damage: is there any relationship? J Hum Hypertens 2021; 35:755-757. [PMID: 33623131 DOI: 10.1038/s41371-021-00501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tadic M, Cuspidi C, Celic V, Pencic B, Mancia G, Grassi G, Stankovic G, Ivanovic B. The Prognostic Effect of Circadian Blood Pressure Pattern on Long-Term Cardiovascular Outcome is Independent of Left Ventricular Remodeling. J Clin Med 2019; 8:jcm8122126. [PMID: 31810363 PMCID: PMC6947325 DOI: 10.3390/jcm8122126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/14/2019] [Accepted: 11/28/2019] [Indexed: 01/19/2023] Open
Abstract
We aimed to investigate the predictive value of 24 h blood pressure (BP) patterns on adverse cardiovascular (CV) outcome in the initially untreated hypertensive patients during long-term follow-up. This study included 533 initially untreated hypertensive patients who were involved in this study in the period between 2007 and 2012. All participants underwent laboratory analysis, 24 h BP monitoring, and echocardiographic examination at baseline. The patients were followed for a median period of nine years. The adverse outcome was defined as the hospitalization due to CV events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or CV death). During the nine-year follow-up period, adverse CV events occurred in 85 hypertensive patients. Nighttime SBP, non-dipping BP pattern, LV hypertrophy (LVH), left atrial enlargement (LAE), and LV diastolic dysfunction (LV DD) were risk factors for occurrence of CV events. However, nighttime SBP, non-dipping BP pattern, LVH, and LV DD were the only independent predictors of CV events. When all four BP pattern were included in the model, non-dipping and reverse dipping BP patterns were associated with CV events, but only reverse-dipping BP pattern was independent predictor of CV events. The current study showed that reverse-dipping BP pattern was predictor of adverse CV events independently of nighttime SBP and LV remodeling during long-term follow-up. The assessment of BP patterns has very important role in the long-time prediction in hypertensive population.
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Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany
- Correspondence: ; Tel.: +49-1763-236-0011; Fax: +49-3045-066-5111
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano IRCCS, Viale della Resistenza 23, 20036 Meda, Italy
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje”, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - Biljana Pencic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje”, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - Giuseppe Mancia
- Department of Medicine and Surgery, Clinica Medica, University Milano-Bicocca, 20126 Milan, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, Clinica Medica, University Milano-Bicocca, 20126 Milan, Italy
| | - Goran Stankovic
- Clinic of Cardiology, Clinical Center of Serbia, Koste Todorovic 8, 11000 Belgrade, Serbia
| | - Branislava Ivanovic
- Clinic of Cardiology, Clinical Center of Serbia, Koste Todorovic 8, 11000 Belgrade, Serbia
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Cuspidi C, Tadic M, Grassi G. Extreme dipping: More complex than it looks. J Clin Hypertens (Greenwich) 2019; 21:1284-1285. [PMID: 31448856 DOI: 10.1111/jch.13656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 06/23/2019] [Indexed: 11/28/2022]
Abstract
Information on clinical and prognostic implications of the extreme dipping (ED) pattern is scanty and findings provided by studies are controversial. Increasing evidence suggests than mean night-time blood pressure (BP), a powerful predictor of cardiovascular outcomes, in ED can be markedly different between patients and distributed over a wide range of values ranging from hypotension to hypertension. On the whole, these findings emphasize the need to know that the ED pattern is a heterogeneous phenotype that deserve to be evaluated more in detail in future studies.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.,IRCCS, Istituto Auxologico Italiano, Milano, Italy
| | - Marijana Tadic
- Department of Cardiology, Charité-University-Medicine Campus Virchow Klinikum, Berlin, Germany
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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