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Habas E, Akbar RA, Alfitori G, Farfar KL, Habas E, Errayes N, Habas A, Al Adab A, Rayani A, Geryo N, Elzouki ANY. Effects of Nondipping Blood Pressure Changes: A Nephrologist Prospect. Cureus 2023; 15:e42681. [PMID: 37649932 PMCID: PMC10464654 DOI: 10.7759/cureus.42681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Blood pressure (BP) variations depend on various internal, environmental, and behavioral factors. BP fluctuations occur both in normotensive and hypertensive people. Although it fluctuates over the 24-hr day and night, the morning BP increases after waking up and declines throughout sleep. It is typical for BP to decrease by 10% to 20%, while sleeping, known as dipping BP. However, if there is no decrease in nighttime mean systolic BP or a drop of less than 10 mmHg, it is called nondipping BP. Conversely, reverse dipping BP means an increase in mean systolic BP instead of a drop during the night. Reverse dipping is observed in hypertension (HTN), diabetes mellitus (DM), chronic kidney disease (CKD), and obstructive sleep apnea (OSA) syndrome. The introduction of ambulatory BP monitoring (ABPM) led to the emergence of identifying normal and elevated BP patterns. Non-dipping BP increases the risk of cardiovascular system (CVS) complications such as left ventricular hypertrophy, proteinuria, glomerular filtration rate (GFR) reduction, and CKD progression. A loss or blunting of the normal BP profile is recognized as a deleterious variant, and restoring abnormal BP patterns has been reported to significantly impact end-organ damage, morbidity, and mortality. In this non-systematic clinically-oriented, comprehensive review, we aim to update the BP variables and the pathophysiology of nondipping BP and point out the areas which need more investigation from a nephrology perspective because the nondipping BP increases the risk of proteinuria, GFR reduction, and CKD progression. A literature search of PubMed, Google, EMBASE, and Google Scholar was conducted. Checks of selected papers and relevant reviews complemented the electronic search. With improved BP measurement methods, the physiology of BP profile variations is readily detectable during the day and night. A nondipping BP profile is a distinct BP pattern that may have significant end-organ damage effects and therapeutic importance for nephrologists. The pathophysiology of the nondipping BP variant must be clarified to prevent complications, and further investigations are required. Furthermore, there is debate about the best BP index to utilize: systolic BP, diastolic BP, mean arterial pressure, or a mixture of all. All these areas are important and need new research projects.
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Affiliation(s)
| | - Raza A Akbar
- Internal Medicine, Hamad General Hospital, Doha, QAT
| | | | | | - Eshrak Habas
- Internal Medicine, Tripoli University, Tripoli, LBY
| | - Nada Errayes
- Medical Education, University of Lincoln, Lincoln, GBR
| | - Aml Habas
- Renal and Dialysis, Tripoli Pediatric Hospital, Tripoli, LBY
| | - Aisha Al Adab
- Pulmonary Medicine, Hamad General Hospital, Doha, QAT
| | - Amnna Rayani
- Hemato-Oncology, Tripoli Pediatric Hospital, Tripoli University, Tripoli, LBY
| | - Nagat Geryo
- Internal Medicine, Hamad General Hospital, Doha, QAT
| | - Abdel-Naser Y Elzouki
- Medicine, Hamad General Hospital, Doha, QAT
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
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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.
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Effect of dipping and nondipping pattern of blood pressure on subclinical left ventricular dysfunction assessed by two-dimensional speckle tracking in hypertensive patients. Blood Press Monit 2021; 27:43-49. [PMID: 34417374 DOI: 10.1097/mbp.0000000000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the left ventricular (LV) function by conventional two-dimensional speckle tracking echocardiography (2D STE) to detect subclinical LV systolic dysfunction in patients with dipper and nondipper hypertension. METHODS One hundred consecutive patients with hypertension were included in our study. Clinical evaluation, baseline laboratory investigations, 24 ambulatory blood pressure monitoring 2D echocardiographic examination and 2D STE were performed for all patients. Patients were classified as dippers and nondippers according to their nighttime MAP (mean arterial blood pressure) reduction rate of ≥10 or <10%, respectively. RESULTS Of 100 patients, 71% were nondippers while 29% were dippers. Nondippers had a significantly lower global longitudinal strain (LS) value (-22.45 ± 3.26 vs. -18.2 ± 3.3, P < 0.001), global circumferential strain (CS) value (-24.23 ± 3.56 vs. -19.16 ± 8.25, P < 0.001) and global radial strain (RS) value (35.04 ± 11.16 vs. 29.58 ± 8.44, P = 0.009). It was found that nondipper status was associated with worsening of LS by 2.737, (P = 0.001), CS by 3.446, (P = 0.002), RS by -3.256, (P = 0.158) and DM also was found associated with worsening of LS by 1.849, (P = 0.062), CS by 3.284 (P = 0.018), RS by -2.499 (P = 0.381). CONCLUSION The nondipping hypertension pattern is associated with subclinical LV systolic dysfunction as shown by the impaired global myocardial strain in all three directions.
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Candan S, Candan OO, Karabag T. The relationship between nocturnal blood pressure drop and body composition indices among hypertensive patients. J Clin Hypertens (Greenwich) 2020; 22:616-622. [PMID: 32092245 PMCID: PMC8029921 DOI: 10.1111/jch.13832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/19/2020] [Accepted: 01/26/2020] [Indexed: 11/28/2022]
Abstract
Among hypertensive subjects, the lack of physiological blood pressure drop as part of diurnal blood pressure variations is termed as non-dipper blood pressure. Herein, we investigated the relationship between hypertension character and body composition indices. This study included a total of 104 patients (54 M, mean age: 47.6 ± 12.1 years). Patients' heights, weights, and waist and hip circumferences were measured, and body composition indices were calculated. All patients' office blood pressure measurements and 24-hour ambulatory blood pressure readings were recorded. A blood pressure drop of at least 10% compared with daytime blood pressure readings is called dipper blood pressure, while a drop of less than 10% is termed as non-dipper blood pressure. Based on ambulatory blood pressure readings, the patients were grouped into Group 1 (dipper pattern; 51 pts, 34 M, mean age 45.6 ± 12.3) and Group 2 (non-dipper pattern, 53 pts; 20 M, mean age 49.6 ± 11.6). The proportion of females and smokers were significantly lower in Group 1 than Group 2. BRI, BAI, waist-to-height ratio, and waist circumference were significantly higher in Group 2 than Group 1. There were significant positive correlations between body roundness index (BRI), body adiposity index (BAI), waist-to-weight ratio, and WC and nocturnal mean systolic and diastolic blood pressure readings. Percent systolic nocturnal drop was significantly correlated with waist-to-height ratio, BAI, and BRI. Similarly, percent diastolic nocturnal drop and waist-to-height ratio, BAI, and BRI were correlated. In conclusion, the relatively new body composition indices, namely BRI and BAI, are more closely related to nocturnal blood pressure readings among non-dipper subjects.
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Affiliation(s)
- Selcuk Candan
- Department of Internal MedicineIstanbul Education and Research HospitalIstanbulTurkey
| | - Ozlem Ozdemir Candan
- Department of Internal MedicineIstanbul Education and Research HospitalIstanbulTurkey
| | - Turgut Karabag
- Department of CardiologyIstanbul Education and Research HospitalIstanbulTurkey
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Smith DF, Amin RS. OSA and Cardiovascular Risk in Pediatrics. Chest 2019; 156:402-413. [PMID: 30790552 DOI: 10.1016/j.chest.2019.02.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/21/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023] Open
Abstract
OSA occurs in approximately 1% to 5% of children in the United States. Long-term cardiovascular risks associated with OSA in the adult population are well documented. Although changes in BP regulation occur in children with OSA, the pathways leading to chronic cardiovascular risks of OSA in children are less clear. Risk factors associated with cardiovascular disease in adult populations could carry the same future risk for children. It is imperative to determine whether known mechanisms of cardiovascular diseases in adults are like those that lead to pediatric disease. Early pathophysiologic changes may lead to a lifetime burden of cardiovascular disease and early mortality. With this perspective in mind, our review discusses pathways leading to cardiovascular pathology in children with OSA and provides a comprehensive overview of recent research findings related to cardiovascular sequelae in the pediatric population.
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Affiliation(s)
- David F Smith
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Raouf S Amin
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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Kim YS, Davis SCAT, Stok WJ, van Ittersum FJ, van Lieshout JJ. Impaired nocturnal blood pressure dipping in patients with type 2 diabetes mellitus. Hypertens Res 2018; 42:59-66. [PMID: 30401911 DOI: 10.1038/s41440-018-0130-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 01/21/2023]
Abstract
Hypertension is a common comorbidity of type 2 diabetes mellitus (T2DM). Both conditions are associated with an increased cardiovascular risk, which is reduced by tight blood pressure (BP) and glycemic control. However, nondipping BP status continues to be an enduring cardiovascular risk factor in T2DM. Cardiovascular autonomic neuropathy and endothelial dysfunction have been proposed as potential mechanisms. This study tested the hypothesis that microvascular disease rather than cardiovascular autonomic neuropathy interferes with the physiological nocturnal BP reduction. Cardiovascular autonomic function and baroreflex sensitivity were determined in 22 type 2 diabetic patients with (DM+) and 23 diabetic patients without (DM-) manifest microvascular disease. BP dipping status was assessed from 24-hour ambulatory BP measurements. Sixteen nondiabetic subjects served as controls (CTRL). Cardiovascular autonomic function was normal in all subjects. Baroreflex sensitivity was lower in DM- compared with CTRL (7.7 ± 3.3 vs. 12.3 ± 8.3 ms·mm Hg-1; P < 0.05) and was further reduced in DM + (4.6 ± 2.0 ms·mm Hg-1; P < 0.01 vs. DM- and CTRL). The nocturnal decline in systolic and diastolic BP was blunted in DM- (12% and 14% vs. 17% and 19% in CTRL; P < 0.05) and even more so in DM+ (8% and 11%; P < 0.05 vs. DM- and P < 0.001 vs. CTRL). A nocturnal reduction in pulse pressure was observed in CTRL and DM- but not in DM+ (P < 0.05 vs. DM- and P < 0.01 vs. CTRL). In T2DM, progression of microvascular disease interferes with the normal nocturnal BP decline and coincides with a persistently increased pulse pressure and reduced baroreflex sensitivity, contributing to their increased cardiovascular risk.
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Affiliation(s)
- Yu-Sok Kim
- Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands. .,Laboratory for Clinical Cardiovascular Physiology, Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.
| | - Shyrin C A T Davis
- Laboratory for Clinical Cardiovascular Physiology, Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Wim J Stok
- Laboratory for Clinical Cardiovascular Physiology, Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands
| | - Frans J van Ittersum
- Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes J van Lieshout
- Laboratory for Clinical Cardiovascular Physiology, Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.,Department of Internal Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.,MRC/Arthritis Research UK Centre for Musculoskeletal Ageing Research, Queen's Medical Centre, School of Life Sciences, University of Nottingham Medical School, Nottingham, United Kingdom
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Association of nocturnal blood pressure patterns with inflammation and central and peripheral estimates of vascular health in rheumatoid arthritis. J Hum Hypertens 2018. [DOI: 10.1038/s41371-018-0047-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Tadic M, Cuspidi C, Pencic-Popovic B, Celic V, Mancia G. The influence of night-time hypertension on left ventricular mechanics. Int J Cardiol 2017; 243:443-448. [DOI: 10.1016/j.ijcard.2017.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/06/2017] [Accepted: 06/05/2017] [Indexed: 01/10/2023]
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Göksülük H, Habibova U, Ongun A, Akbulut M, Özyüncü N, Kürklü TST, Erol C. Evaluation of the effect of dipping pattern in hypertensive patients on the left ventricular systolic functions by two-dimensional strain analysis. Echocardiography 2017; 34:668-675. [DOI: 10.1111/echo.13516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Hüseyin Göksülük
- Cardiology Department; Avicenna Hospital; Ankara University; Ankara Turkey
| | - Ulvin Habibova
- Cardiology Department; Avicenna Hospital; Ankara University; Ankara Turkey
| | - Aydan Ongun
- Cardiology Department; Avicenna Hospital; Ankara University; Ankara Turkey
| | - Müge Akbulut
- Cardiology Department; Avicenna Hospital; Ankara University; Ankara Turkey
| | - Nil Özyüncü
- Cardiology Department; Avicenna Hospital; Ankara University; Ankara Turkey
| | | | - Cetin Erol
- Cardiology Department; Avicenna Hospital; Ankara University; Ankara Turkey
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Reduced capacity of autonomic and baroreflex control associated with sleep pattern in spontaneously hypertensive rats with a nondipping profile. J Hypertens 2017; 35:558-570. [DOI: 10.1097/hjh.0000000000001205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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11
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Nondipping status and impaired nitroglycerin-mediated vasodilation in resistant hypertension. J Hypertens 2015; 33:1533-5. [DOI: 10.1097/hjh.0000000000000641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Climie RED, Srikanth V, Beare R, Keith LJ, Fell J, Davies JE, Sharman JE. Aortic reservoir characteristics and brain structure in people with type 2 diabetes mellitus; a cross sectional study. Cardiovasc Diabetol 2014; 13:143. [PMID: 25338824 PMCID: PMC4221700 DOI: 10.1186/s12933-014-0143-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/06/2014] [Indexed: 01/09/2023] Open
Abstract
Background Central hemodynamics help to maintain appropriate cerebral and other end-organ perfusion, and may be altered with ageing and type 2 diabetes mellitus (T2DM). We aimed to determine the associations between central hemodynamics and brain structure at rest and during exercise in people with and without T2DM. Methods In a sample of people with T2DM and healthy controls, resting and exercise measures of aortic reservoir characteristics (including excess pressure integral [Pexcess]) and other central hemodynamics (including augmentation index [AIx] and aortic pulse wave velocity [aPWV]) were recorded. Brain volumes (including gray matter volume [GMV] and white matter lesions [WML]) were derived from magnetic resonance imaging (MRI) scans. Multivariable linear regression was used to study the associations of hemodynamic variables with brain structure in the two groups adjusting for age, sex, daytime systolic BP (SBP) and heart rate. Results There were 37 T2DM (63 ± 9 years; 47% male) and 37 healthy individuals (52 ± 8 years; 51% male). In T2DM, resting aPWV was inversely associated with GMV (standardized β = −0.47, p = 0.036). In healthy participants, resting Pexcess was inversely associated with GMV (β = −0.23, p = 0.043) and AIx was associated with WML volume (β = 0.52, p = 0.021). There were no associations between exercise hemodynamics and brain volumes in either group. Conclusions Brain atrophy is associated with resting aortic stiffness in T2DM, and resting Pexcess in healthy individuals. Central vascular mechanisms underlying structural brain changes may differ between healthy individuals and T2DM.
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The role of autonomic and baroreceptor reflex control in blood pressure dipping and nondipping in rats. J Hypertens 2014; 32:806-16. [DOI: 10.1097/hjh.0000000000000099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Does a nondipping pattern influence left ventricular and left atrial mechanics in hypertensive patients? J Hypertens 2013; 31:2438-46. [DOI: 10.1097/hjh.0b013e3283651c24] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nighttime blood pressure, systolic blood pressure variability, and left ventricular mass index in children with hypertension. Pediatr Nephrol 2013; 28:1275-82. [PMID: 23564040 DOI: 10.1007/s00467-013-2468-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 02/21/2013] [Accepted: 03/13/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Nighttime blood pressure (BP) and systolic BP variability on ambulatory blood pressure monitoring (ABPM) have been strongly associated with target-organ damage in hypertensive adults. The clinical relevance of these variables in children with hypertension remains under-studied. METHODS The study group included children aged 5-18 years old referred to the outpatient nephrology clinic for an elevated casual BP who underwent an ABPM and echocardiography (ECHO) study and did not have secondary hypertension. The interpretation of ABPM parameters and left ventricular mass index (LVMI) was based on normative references. RESULTS Seventy-two children fulfilled the inclusion criteria. The association of various potential predictors including age, BMI z-score, casual BP z-score and ABPM parameters (BP z-score, BP load, nocturnal dipping and BP variability- within-subject standard deviation (SD) of BP) with LVMI was analyzed. On adjusted regression analysis, nighttime systolic BP load [standardized regression coefficient (β) 0.23; p < 0.05] and daytime systolic BP variability (β 0.37; p < 0.05) had significant association with LVMI. CONCLUSIONS In children with primary hypertension, nighttime systolic BP load and daytime systolic BP variability had a stronger association with LVMI than casual BP and other ABPM parameters. Future longitudinal studies are needed to establish the causality among these variables.
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Shivpuri S, Allison MA, Macera CA, Lindsay S, Gallo LC. Associations between nocturnal blood pressure dipping and the metabolic syndrome in high- vs. low-acculturated Mexican American women. Am J Hypertens 2013; 26:1030-6. [PMID: 23645325 DOI: 10.1093/ajh/hpt061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Less nocturnal blood pressure (BP) dipping has been associated with greater odds for the metabolic syndrome (MetS), a constellation of risk factors associated with cardiovascular disease (CVD). Little work has examined this association in Hispanics, who have elevated rates of MetS, or investigated differences in this relationship by level of acculturation. The purpose of this study was to examine the association between BP dipping and MetS in Hispanic women and to determine if this association is moderated by acculturation status. METHODS Two hundred eighty-six Mexican American women underwent assessment of MetS components (BP, waist circumference, fasting glucose, high-density lipoprotein cholesterol, and triglycerides) and completed a 36-hour ambulatory BP monitoring protocol, during which systolic BP (SBP) and diastolic BP readings were obtained. Nocturnal BP dipping was calculated as the percentage difference between average daytime and nighttime BP. Acculturation was defined by the language (Spanish, English) in which participants preferred to complete study instruments. RESULTS Although no significant main effects for BP dipping or acculturation emerged for MetS, the SBP dipping by acculturation interaction was significantly related to MetS (P < 0.01). Simple slope analyses revealed that less SBP dipping related to greater odds of MetS in high-acculturated women, but SBP dipping and MetS were unrelated in low-acculturated women. CONCLUSIONS The strength of the association between BP dipping and CVD risk (as measured by MetS) appears to vary by acculturation in Hispanic women. Future studies should explore mechanisms behind the BP dipping and CVD risk association and relevant modifying factors.
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Affiliation(s)
- Smriti Shivpuri
- San Diego State University/University of California-San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
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Wuerzner G, Bochud M, Zweiacker C, Tremblay S, Pruijm M, Burnier M. Step count is associated with lower nighttime systolic blood pressure and increased dipping. Am J Hypertens 2013; 26:527-34. [PMID: 23467208 DOI: 10.1093/ajh/hps094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Higher nighttime blood pressure (BP) and the loss of nocturnal dipping of BP are associated with an increased risk for cardiovascular events. However, the determinants of the loss of nocturnal BP dipping are only beginning to be understood. We investigated whether different indicators of physical activity were associated with the loss of nocturnal dipping of BP. METHODS We conducted a cross-sectional study of 103 patients referred for 24-hour ambulatory monitoring of BP. We measured these patients' step count (SC), active energy expenditure (AEE), and total energy expenditure simultaneously, using actigraphs. RESULTS In our study population of 103 patients, most of whom were hypertensive, SC and AEE were associated with nighttime systolic BP in univariate (SC, r = -0.28, P < 0.01; AEE, r = -0.20, P = 0.046) and multivariate linear regression analyses (SC, coefficient beta = -5.37, P < 0.001; AEE, coefficient beta = -0.24, P < 0.01). Step count was associated with both systolic (r = 0.23, P = 0.018) and diastolic (r = 0.20, P = 0.045) BP dipping. Nighttime systolic BP decreased progressively across the categories of sedentary, moderately active, and active participants (125mm Hg, 116mm Hg, 112mm Hg, respectively; P = 0.002). The degree of BP dipping of BP increased progressively across the same three categories of activity (respectively 8.9%, 14.6%, and 18.6%, P = 0.002, for systolic BP and respectively 12.8%, 18.1%, and 22.2%, P = 0.006, for diastolic BP). CONCLUSIONS Step count is continuously associated with nighttime systolic BP and with the degree of BP dipping independently of 24-hour mean BP. The combined use of an actigraph for measuring indicators of physical activity and a device for 24-hour measurement of ambulatory BP may help identify patients at increased risk for cardiovascular events in whom increased physical activity toward higher target levels may be recommended.
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Affiliation(s)
- Gregoire Wuerzner
- Service of Nephrology, Lausanne University Hospital, Lausanne, Switzerland.
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Exercise aortic stiffness: reproducibility and relation to end-organ damage in men. J Hum Hypertens 2013; 27:516-22. [PMID: 23389297 DOI: 10.1038/jhh.2013.5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/19/2012] [Accepted: 01/01/2013] [Indexed: 11/09/2022]
Abstract
Resting aortic stiffness (pulse wave velocity; aortic PWV (aPWV)) independently predicts end-organ damage and mortality. Exercise haemodynamics have been shown to unmask cardiovascular abnormalities, otherwise undetectable at rest, but the response of aPWV to exercise has never been examined. This study aimed to develop a technique to measure exercise aPWV, determine reproducibility and relation to subclinical end-organ damage with aging. Healthy younger (n=17, 30±8 years) and older (n=18, 54±8 years) untreated men underwent cardiovascular assessment at rest and during low intensity semirecumbent cycling. Tonometry was used to assess aPWV and central blood pressure (BP). All participants underwent 24 h ambulatory BP (ABP) monitoring. Kidney function was assessed by estimated glomerular filtration rate (eGFR). Fifteen participants had testing repeated within 28±18 days. Exercise aPWV had good reproducibility (mean difference=-0.35±0.61 m s(-1), intraclass correlations=0.874, P<0.001) and was increased 26% above resting values in younger men (5.8±0.9 vs 7.3±1.6 m s(-1), P<0.001) and 19% above resting values in older men (6.3±1.0 vs 7.4±0.9 m s(-1), P<0.001). Exercise, but not resting, aPWV was significantly correlated with eGFR in older men (r=-0.633, P=0.005), and this was maintained after correction for age, body mass index and daytime systolic ABP (r=-0.656, P=0.008). Conversely, in younger men there was no significant association between eGFR and aPWV either at rest (r=-0.031, P=0.906) or during exercise (r=-0.117, P=0.655). Exercise aPWV is reproducible and significantly associated with kidney function in healthy older men. Further studies to determine the physiology and clinical relevance of raised exercise aPWV are warranted.
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Nighttime blood pressure dipping in postmenopausal women with coronary heart disease. Am J Hypertens 2012; 25:1077-82. [PMID: 22785406 DOI: 10.1038/ajh.2012.95] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Blunted nighttime blood pressure (BP) dipping is prognostic of cardiovascular morbidity and mortality. This relationship may be stronger among women than men. The present study hypothesized that coronary artery disease (CAD) and advancing age would be associated with reduced BP dipping in postmenopausal women. The effects of daytime physical activity and nighttime sleep quality on BP dipping were also examined. METHODS 54 postmenopausal women with CAD (≥50% occlusion of at least one major coronary vessel) and 48 age-matched (range 50-80 years) postmenopausal women without CAD (non-CAD) underwent 24-h ambulatory BP monitoring and actigraphic evaluations of daytime physical activity and nighttime sleep efficiency. RESULTS Women with CAD evidenced higher nighttime systolic BP (SBP) (P = 0.05) and blunted SBP dipping (P = 0.017), blunted diastolic BP (DBP) dipping (P = 0.047), and blunted pulse pressure dipping (P = 0.01), compared to non-CAD women. Multivariable regression models showed that the presence of CAD, age, daytime physical activity, and nighttime sleep efficiency were independently related to the magnitude of SBP dipping, together accounting for 25% of its variability. DBP dipping showed similar associations. CONCLUSIONS For postmenopausal women, the presence of CAD and advancing age are accompanied by blunted nighttime BP dipping, which may increase the risk of adverse cardiovascular events. Lifestyle changes that increase daytime physical activity and improve nighttime sleep quality may help improve cardiovascular risk by enhancing nighttime BP dipping.
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Castiglioni P, Parati G, Brambilla L, Brambilla V, Gualerzi M, Di Rienzo M, Coruzzi P. Detecting Sodium-Sensitivity in Hypertensive Patients. Hypertension 2011; 57:180-5. [DOI: 10.1161/hypertensionaha.110.158972] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paolo Castiglioni
- From the Don C. Gnocchi Foundation (P.Ca., L.B., V.B., M.G., M.D., P.Co.), Milan, Italy; Department of Clinical Medicine and Prevention (G.P.), University of Milano-Bicocca, Milan, Italy; Department of Cardiology (G.P.), Istituto Auxologico Italiano, Milan, Italy; and Department of Clinical Sciences (P.Co.), University of Parma, Parma, Italy
| | - Gianfranco Parati
- From the Don C. Gnocchi Foundation (P.Ca., L.B., V.B., M.G., M.D., P.Co.), Milan, Italy; Department of Clinical Medicine and Prevention (G.P.), University of Milano-Bicocca, Milan, Italy; Department of Cardiology (G.P.), Istituto Auxologico Italiano, Milan, Italy; and Department of Clinical Sciences (P.Co.), University of Parma, Parma, Italy
| | - Lorenzo Brambilla
- From the Don C. Gnocchi Foundation (P.Ca., L.B., V.B., M.G., M.D., P.Co.), Milan, Italy; Department of Clinical Medicine and Prevention (G.P.), University of Milano-Bicocca, Milan, Italy; Department of Cardiology (G.P.), Istituto Auxologico Italiano, Milan, Italy; and Department of Clinical Sciences (P.Co.), University of Parma, Parma, Italy
| | - Valerio Brambilla
- From the Don C. Gnocchi Foundation (P.Ca., L.B., V.B., M.G., M.D., P.Co.), Milan, Italy; Department of Clinical Medicine and Prevention (G.P.), University of Milano-Bicocca, Milan, Italy; Department of Cardiology (G.P.), Istituto Auxologico Italiano, Milan, Italy; and Department of Clinical Sciences (P.Co.), University of Parma, Parma, Italy
| | - Massimo Gualerzi
- From the Don C. Gnocchi Foundation (P.Ca., L.B., V.B., M.G., M.D., P.Co.), Milan, Italy; Department of Clinical Medicine and Prevention (G.P.), University of Milano-Bicocca, Milan, Italy; Department of Cardiology (G.P.), Istituto Auxologico Italiano, Milan, Italy; and Department of Clinical Sciences (P.Co.), University of Parma, Parma, Italy
| | - Marco Di Rienzo
- From the Don C. Gnocchi Foundation (P.Ca., L.B., V.B., M.G., M.D., P.Co.), Milan, Italy; Department of Clinical Medicine and Prevention (G.P.), University of Milano-Bicocca, Milan, Italy; Department of Cardiology (G.P.), Istituto Auxologico Italiano, Milan, Italy; and Department of Clinical Sciences (P.Co.), University of Parma, Parma, Italy
| | - Paolo Coruzzi
- From the Don C. Gnocchi Foundation (P.Ca., L.B., V.B., M.G., M.D., P.Co.), Milan, Italy; Department of Clinical Medicine and Prevention (G.P.), University of Milano-Bicocca, Milan, Italy; Department of Cardiology (G.P.), Istituto Auxologico Italiano, Milan, Italy; and Department of Clinical Sciences (P.Co.), University of Parma, Parma, Italy
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Tsioufis C, Andrikou I, Thomopoulos C, Syrseloudis D, Stergiou G, Stefanadis C. Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes. J Hum Hypertens 2010; 25:281-93. [DOI: 10.1038/jhh.2010.113] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Fatigue and autonomic dysfunction in non-alcoholic fatty liver disease. Clin Auton Res 2010; 19:319-26. [PMID: 19768633 DOI: 10.1007/s10286-009-0031-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 08/18/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fatigue is a significant symptom in nonalcoholic fatty liver disease (NAFLD) that impacts upon quality of life and is unrelated to liver disease severity. We examined the relationship between parameters of blood pressure regulation with perception of fatigue in NAFLD. METHODS Thirty-four non-diabetic subjects with histologically proven, non-cirrhotic NAFLD (26 [77%] males and 8 [23%] females) (mean +/- SD age 54 +/- 11) and 34 age, sex and BMI matched non-diabetic controls underwent subjective and objective evaluation of cardiovascular autonomic function (24 h blood pressure and head up tilt testing). All subjects completed the fatigue impact scale. RESULTS The NAFLD group had significantly higher autonomic symptom burden assessed using the orthostatic grading scale (OGS) compared to controls (4 +/- 4 vs. 1 +/- 2; p = 0.0003). Increasing orthostatic symptoms correlated with increasing fatigue (p = 0.006; r(2) = 0.3). Fatigue in NAFLD correlated inversely with 24 h measurement of systolic, diastolic and mean blood pressures (all p < 0.03; r(2) = 0.2). This relationship was predominantly related to lower blood pressure at night (p < 0.003; r(2) = 0.3). On head up tilt testing 57% of the NAFLD group had neurally-mediated hypotension (vasovagal syncope and/or orthostatic hypotension) (p = 0.006 compared to controls). The degree of blood pressure drop in response to standing correlated with fatigue severity (p = 0.008; r(2) = 0.3) and the autonomic symptom burden (OGS) (p = 0.03; r(2) = 0.2). CONCLUSION Autonomic symptoms are prevalent in NAFLD and associate with objective measures of autonomic dysfunction. Fatigue in NAFLD is associated with lower blood pressure and autonomic dysfunction. Studies are needed to determine whether this is a potential therapeutic target for fatigue in NAFLD.
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Friedman O, Logan AG. Nocturnal blood pressure profiles among normotensive, controlled hypertensive and refractory hypertensive subjects. Can J Cardiol 2009; 25:e312-6. [PMID: 19746250 DOI: 10.1016/s0828-282x(09)70142-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Nocturnal blood pressure abnormalities are independently associated with an increased risk of death and cardiovascular disease. It is unclear, however, whether they are related to the presence or severity of hypertension. OBJECTIVES To determine and compare the prevalence of sleep pattern disturbances in normotensive (NT) and hypertensive patients. METHODS The present cross-sectional study assessed the nocturnal blood pressure profiles from 24 h ambulatory blood pressure monitoring of refractory hypertensive (RH) (n=26), controlled hypertensive (CH) (n=52) and NT (n=52) subjects who were matched for age, sex and body mass index. Results are expressed as mean +/- SD or proportion, as appropriate. RESULTS During sleep, the percentage fall in mean arterial pressure was 15.1+/-6.1% in the NT group, 11.5+/-7.0% in the CH group and 7.7+/-7.7% in the RH group (P<0.0001). The corresponding proportions of nondipping were 25.0%, 42.3% and 61.5%, respectively (P=0.006), and those of nocturnal hypertension were 9.6%, 23.1% and 84.6%, respectively (P<0.0001). All pairwise comparisons of nocturnal blood pressure fall were significant. The proportion of subjects in the RH group who experienced a rise in nocturnal blood pressure (19.2%) was significantly greater than the proportions in the NT and CH groups (P=0.001), as was the proportion of subjects with nocturnal hypertension (P<0.0001). There was less extreme dipping in RH, although the difference was not statistically significant (P=0.08). CONCLUSIONS A significantly higher prevalence of nondipping, nocturnal hypertension and nocturnal blood pressure rising in RH was demonstrated. These sleep disturbances or independently, their cause, may account for the difficulties in attaining blood pressure control.
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Affiliation(s)
- Oded Friedman
- Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada
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Friedman O, Logan AG. Can nocturnal hypertension predict cardiovascular risk? Integr Blood Press Control 2009; 2:25-37. [PMID: 21949613 PMCID: PMC3172086 DOI: 10.2147/ibpc.s4364] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Indexed: 11/23/2022] Open
Abstract
Nocturnal hypertension and non-dipping of blood pressure during sleep are distinct entities that often occur together and are regarded as important harbingers of poor cardiovascular prognosis. This review addresses several aspects related to these blood pressure abnormalities including definitions, diagnostic limitations, pathogenesis and associated patient profiles, prognostic significance, and therapeutic strategies. Taken together, persistent nocturnal hypertension and non-dipping blood pressure pattern, perhaps secondary to abnormal renal sodium handling and/or altered nocturnal sympathovagal balance, are strongly associated with deaths, cardiovascular events, and progressive loss of renal function, independent of daytime and 24-hour blood pressure. Several pharmacological and non-pharmacological approaches may restore nocturnal blood pressure and circadian blood pressure rhythm to normal; however, whether this translates to a clinically meaningful reduction in unfavorable cardiovascular and renal consequences remains to be seen.
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Affiliation(s)
- Oded Friedman
- Samuel Lunenfeld Research Institute, Division of Nephrology, Mount Sinai Hospital
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Routledge FS, McFetridge-Durdle JA, Dean CR. Stress, menopausal status and nocturnal blood pressure dipping patterns among hypertensive women. Can J Cardiol 2009; 25:e157-63. [PMID: 19536383 DOI: 10.1016/s0828-282x(09)70089-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A less than 10% decline in blood pressure during the night is known as a nondipping blood pressure (BP) pattern. Nondipping BP has been shown to be associated with target organ damage and poorer cardiovascular outcomes. Additionally, some evidence suggests that hyper-tensive nondipping women are at greater risk for target organ damage than hypertensive nondipping men. OBJECTIVE To determine whether stress, demographics, menopausal status or sleep quality are associated with nondipping BP among hyperten-sive women. METHODS A cross-sectional study design was used to describe the rela-tionship between stress and dipping status among a sample of hypertensive women and to describe the sample by age, ethnicity, marital status, meno-pausal status, current medications and sleep quality. RESULTS The study sample consisted of 47 women (mean [+/- SD] age 57+/-13.9 years) with essential or office hypertension who underwent 24 h ambulatory BP monitoring, and completed stress and sleep quality measurements. Thirty-one women (66%) were classified as dippers and 16 (34%) were classified as nondippers. Nondippers were older (P=0.04), postmenopausal (P=0.003) and had lower stress scores (P=0.02) than their dipper counterparts. Postmenopausal status sig-nificantly predicted nondipping (OR 16; 95% CI 1.9 to 136.4). CONCLUSION These findings were of interest given that some women had a nondipping BP pattern and significantly lower stress scores. It is pos-sible that there are fundamentally different physiological mechanisms that explain this nondipping phenomenon. In the future, the identification of specific hemodynamic mechanisms associated with nondipping could potentially influence the choice of antihypertensive treatment regimens for nondipper hypertensive patients.
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Perez‐Lloret S, Risk M, Golombek DA, Cardinali DP, Sanchez R, Ramirez A. Blunting of Circadian Rhythms and Increased Acrophase Variability in Sleep‐Time Hypertensive Subjects. Chronobiol Int 2009; 25:99-113. [DOI: 10.1080/07420520801909403] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE To examine blood pressure circadian rhythm in subjects with chronic fatigue syndrome (CFS) and appropriate normal and fatigued controls to correlate parameters of blood pressure regulation with perception of fatigue in an observational cohort study. The cause of CFS remains unknown and there are no effective treatments. METHODS To address whether inactivity was a confounder, we performed a 24-hour ambulatory blood pressure monitoring in the following three subject groups: 1) CFS patients (Fukuda Diagnostic criteria) (n = 38); 2) normal controls (n = 120); and 3) a fatigue comparison group (n = 47) with the autoimmune liver disease primary biliary cirrhosis (PBC). All patients completed a measure of fatigue severity (Fatigue Impact Scale). In view of the different demographics between the patient groups, patients were age- and sex-matched on a case-by-case basis to normal controls and blood pressure parameters were compared. RESULTS Compared with the control population, the CFS group had significantly lower systolic blood pressure (p < .0001) and mean arterial blood pressure (p = .0002) and exaggerated diurnal variation (p = .009). There was a significant inverse relationship between increasing fatigue and diurnal variation of blood pressure in both the CFS and PBC groups (p < .05). CONCLUSION Lower blood pressure and abnormal diurnal blood pressure regulation occur in patients with CFS. We would suggest the need for a randomized, placebo-controlled trial of agents to increase blood pressure such as midodrine in CFS patients with an autonomic phenotype.
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Endeshaw YW, White WB, Kutner M, Ouslander JG, Bliwise DL. Sleep-disordered breathing and 24-hour blood pressure pattern among older adults. J Gerontol A Biol Sci Med Sci 2009; 64:280-5. [PMID: 19196901 DOI: 10.1093/gerona/gln011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To examine the association between sleep-disordered breathing (SDB) and 24-hour blood pressure (BP) pattern among community-dwelling older adults. METHODS A convenience sample of 70 community-dwelling older adults, recruited from senior housing, community centers, and learning centers, were admitted to General Clinical Research Center, Emory University Hospital, Atlanta, Ga. Information regarding demographic and clinical history was obtained using questionnaires. Twenty-four-hour BP monitoring in supine position was performed using Spacelabs model 20207. Breathing during sleep was monitored with the use of a modified sleep recording system (Embletta, PDS), which monitors nasal and oral airflow, chest and abdominal movements, and pulse oximetry. Night time-daytime (night-day) BP ratio (average night-time BP divided by daytime BP) was calculated both for systolic and diastolic BPs. RESULTS Sixty-nine participants, mean age 74.9 +/- 6.4 years (41 [57%] women), completed the study. The mean apnea-hypopnea index (AHI) was 13 +/- 13 per hour of sleep, and 20 participants (29%) had AHI > or =15 per hour of sleep, indicating moderate to severe SDB. Moderate to severe SDB (AHI > or =15 per hour of sleep) was significantly associated with nocturnal hypertension, whereas there was no statistically significant difference in wake-time BP between those with and without moderate to severe SDB. Stepwise multiple regressions showed that AHI independently predicted increased night-day systolic and night-day diastolic BP ratio, even after controlling for nocturia frequency. CONCLUSIONS The results indicate increased BP load associated with increased AHI in this group of older adults. This increased BP load may contribute to increased hypertension-related morbidity and disease burden.
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Affiliation(s)
- Yohannes W Endeshaw
- Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, 1841 Clifton Road NE, Atlanta, GA 30329, USA.
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Perez-Lloret S, Toblli JE, Cardinali DP, Malateste JC, Milei J. Nocturnal hypertension defined by fixed cut-off limits is a better predictor of left ventricular hypertrophy than non-dipping. Int J Cardiol 2008; 127:387-9. [PMID: 17574691 DOI: 10.1016/j.ijcard.2007.04.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 04/01/2007] [Indexed: 11/22/2022]
Abstract
The classification of subjects as nocturnal hypertensives in accordance with non-dipping (i.e. systolic blood pressure - BP - fall <10%) is less reproducible as compared to the fixed cut-off limits method (nocturnal BP means >120/70 mm Hg). The present study was carried out to assess if nocturnal hypertension defined by fixed cut-off limits may be a better predictor of left ventricular hypertrophy (LVH) than to non-dipping. Echocardiography and 24-h ambulatory blood pressure monitoring were performed in 223 subjects. Logistic regression showed that nocturnal hypertension defined by fixed cut-off limits was a significant predictor of LVH (OR=11.1, 95%CI=3.0-40.1) whereas non-dipping was not (OR=1.4, 95%CI=0.4-5.5). No interaction was detected (p<.3). These results suggest that the definition of nocturnal hypertension based on fixed cut-off values is a better predictor of left ventricular hypertrophy than non-dipping.
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Reproducibility of the circadian blood pressure pattern in 24-h versus 48-h recordings: the Spanish Ambulatory Blood Pressure Monitoring Registry. J Hypertens 2008; 25:2406-12. [PMID: 17984661 DOI: 10.1097/hjh.0b013e3282effed1] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the reproducibility of the circadian blood pressure (BP) pattern over a 48-h period by comparing the first 24 h of ambulatory blood pressure monitoring (ABPM) with the following 24 h and with the mean over 48 h. PATIENTS AND METHODS Patients undergoing 48-h ABPM within the National ABPM Registry of the Spanish Society of Hypertension, based on 800 Spacelabs 90207 monitors distributed throughout Spain in hypertension units and primary healthcare centres, were included. Between June 2004 and September 2005, 611 valid 48-h ABPM recordings were obtained, 235 corresponded to patients without antihypertensive treatment. RESULTS The percentages of patients classified as non-dipper for the first 24 h, the second 24 h and the 48-h average were 47, 50 and 48%, respectively. When the first and second 24-h periods were compared, 147 (24%) subjects switched from dipper (D) to non-dipper (ND) or vice-versa. When the first 24-h period was compared to the 48-h average, 66 (11%) subjects switched patterns. The proportions were similar separately for systolic blood pressure (SBP) and diastolic blood pressure (DBP) and between treated and untreated patients. In subjects with poor ABPM reproducibility, night-to-day ratios were of an intermediate value between those of subjects always classified as D or ND. CONCLUSION Categorization of D or ND based on a single 24-h ABPM is moderately reproducible, since one out of every five patients change profile over the following 24 h. Nevertheless, the use of 48-h ABPM in clinical practice should be assessed according to cost-effectiveness criteria. Night-to-day ratios may be helpful in identifying patients with a stable profile.
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Routledge FS, McFetridge-Durdle JA, Dean CR. Night-time blood pressure patterns and target organ damage: a review. Can J Cardiol 2007; 23:132-8. [PMID: 17311119 PMCID: PMC2650649 DOI: 10.1016/s0828-282x(07)70733-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Individuals who do not have a 10% to 20% reduction in blood pressure (BP) during the night are known as 'nondippers'. The cause of this nondipping phenomenon is not fully understood; however, there is a growing body of evidence linking a nondipping BP pattern with target organ damage. OBJECTIVE To review the literature and present an overview of the target organ damage found to be associated with a nondipping BP pattern. METHODS PubMed, CINAHL and Medscape searches of all available English language articles from 1986 to 2005 were performed. Search terms included 'BP nondipping', 'BP dipping' and 'target organ damage'. RESULTS There is evidence to suggest that individuals with hypertension who exhibit a nondipping BP profile are at higher risk of cardiac and extracardiac morbidity and mortality. In particular, nondippers with essential hypertension have been found to have more advanced left ventricular hypertrophy, left ventricular mass and left ventricular mass index, carotid artery wall thickness, carotid artery atherosclerotic plaques, silent cerebral infarct, stroke, cognitive impairment and microalbuminuria. CONCLUSION A better understanding of the importance of the circadian variations of BP may help to identify those at higher risk of cardiovascular morbidity and mortality, as well as lay the foundation for interventions to prevent/treat alterations in night-time BP patterns.
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Hernández del Rey R. Reproducibilidad de la monitorización ambulatoria de la presión arterial en la diabetes mellitus tipo 2. HIPERTENSION Y RIESGO VASCULAR 2006. [DOI: 10.1016/s1889-1837(06)71605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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