Assessment of blood pressure early morning rise

Can Systemic Immune-Inflammation Index Detect the Presence of Exxaggerated Morning Blood Pressure Surge in Newly Diagnosed Treatment-Naive Hypertensive Patients?

Background: The exaggerated morning blood pressure surge (MS) is associated with target organ damage and cardiovascular events. Systemic immune-inflammation index (SII) has been detected as a useful marker in tumors and cardiovascular diseases. The role of inflammation in the pathogenesis of hypertension is a well-known issue. We aimed to investigate whether there is an association between SII and exaggerated MS in newly diagnosed treatment-naive hypertensive patients.Material and Methods: In total, 343 newly diagnosed in clinical and 24-h ambulatory blood pressure (BP) monitoring treatment-naive hypertensive patients were included in this study. Morning surge was defined as the difference between morning BP, which was the mean of BP during 2 h after wake-up, and the lowest BP, which was the mean of three lowest BP during nighttime. A cutoff value of 52.1 mmHg was used to discriminate the high- and low value MS groups. SII was calculated based on neutrophil, platelet, and lymphocyte counts.Results: Neutrophil, platelet, SII, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) were higher, whereas lymphocyte counts were lower in the high-value MS than the low-value MS. These indices were all independently associated with exaggerated MS and SII was superior to all other indices for detecting the presence of exaggerated MS. SII was moderately correlated with morning BP surge (r: 0.489, p < 0.0001).Conclusion: SII was higher in patients with exaggerated MS and was independently associated with exaggerated MS. Furthermore, SII might be a better indicator than platelet, neutrophil, lymphocyte, NLR, and PLR for the presence of exaggerated MS.

A novel measure of the power of the morning blood pressure surge from ambulatory blood pressure recordings

BACKGROUND

We defined a new measure of the morning blood pressure (BP) surge (MBPS) that is derived by the product of the rate of morning rise (RoR) and the amplitude (day-night difference) giving an effective "Power" of the BP rise (BP(Power)). We applied this method to determine whether morning BP(Power) is different in hypertensives compared to normotensives, males compared to females or altered by antihypertensive treatment.

METHODS

BP(Power), RoR, and day-night amplitude were calculated using a double logistic fit of 691 ambulatory recordings.

RESULTS

Ambulatory recordings from untreated male and female subjects showed that upper quartile (distributed by day BP, n = 100) had a 92% greater BP(Power) (P < 0.001) than the lower quartile subjects (n = 100) due to both a faster RoR and greater amplitude. Males had a 29% greater BP(Power) than females (P = 0.003). Untreated hypertensives and white coat hypertensives showed a greater morning BP(Power) (+158% and +86%, respectively) compared to matched normotensives. Subjects taking calcium channel blockers and diuretics alone or in combination with angiotensin receptor blockers had lower morning BP(Power) than those on angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor antagonists alone.

CONCLUSIONS

A new measure of the MBPS, BP(Power) which is based on a mathematical estimate of the rate and amplitude of the rise, is higher in hypertensives, white coat hypertensives, and is modifiable by some specific antihypertensive therapies suggests that it may be theoretically useful to highlight those subjects at greatest risk of cardiovascular events and for determining the most benefit of antihypertensive therapy.

Morning blood pressure surge: the reliability of different definitions

Preliminary evidence suggests that the morning surge (MS) in blood pressure (BP) is an independent predictor of cerebrovascular disease. However, the optimal definition of MS is uncertain. To compare the reproducibility of several MS definitions used in the literature, 132 untreated hypertensives were assessed with ambulatory BP monitoring twice, 2 weeks apart. Five MS definitions were compared. MS-1: the average BP of the first hour after rising minus the average BP of the first hour before rising; MS-2: BP 2 h after rising minus that of 2 h before rising; MS-3: BP 3 h after rising minus that of 3 h before rising; MS-4: BP 2 h after rising minus the average BP during sleep; MS-5: BP 2 h after rising minus the average BP of 3 consecutive readings, centered on the lowest reading during sleep. The reproducibility of each MS definition was assessed using the concordance correlation coefficient (CCC), the standard deviation of differences (SDD) and the coefficient of variation (CV) between repeated MS assessments, and the agreement in detecting "surgers," defined as subjects at the top quartile (Q4) of the MS distribution. CCCs were 0.20/0.30, 0.43/0.45, 0.53/0.51, 0.51/0.47, and 0.46/0.48 (systolic/diastolic) for MS-1 to MS-5 respectively; SDDs were 14.3/11.4, 12.1/9.9, 11.2/9.5, 10.3/8.2, and 11.9/9.8, respectively; CVs were 0.49/0.57, 0.44/0.39, 0.37/0.35, 0.36/0.31, and 0.27/0.24, respectively; and the agreement in detecting "surgers" was 69%/70%, 71%/76%, 75%/75%, 81%/83%, and 74%/75%, with kappa of 0.18/0.20, 0.23/0.36, 0.33/0.33, 0.49/0.53 and 0.29/0.31, respectively. There are important differences in the reproducibility of MS calculated by different methods. MS4 appears to provide the most reproducible definition of MS.

Blood pressure surge on rising

OBJECTIVES

Since cardiovascular complications tend to occur more often in the morning, it is tempting to link this to the surge in blood pressure (BP) on rising. Our objective was to measure BP and heart rate (HR) on rising and compare values with those recorded immediately beforehand and seek variables related to marked changes in the two parameters in a cohort of initially untreated hypertensives.

METHODS

The 24-h ambulatory BP measurement along with an accurate measurement of the BP on rising (either manually or automatically from the device coupled with a position sensor) was obtained in untreated hypertensives. Left ventricular mass was measured with echocardiography at baseline. Patients were then treated and followed by their general physician and news was obtained at regular intervals.

RESULTS

A total of 507 patients with adequate recordings were included. Rising led to a mean increase of 14 mmHg in systolic blood pressure (SBP) and a 13 beats per minute (bpm) increase in HR. This elevation in BP on rising in the morning differed from the alteration in BP on normal changes in position. It was associated with left ventricular hypertrophy at baseline and an increased risk of future cardiovascular complications.

CONCLUSIONS

Our study confirms the surge in BP on rising in the morning. This elevation in BP is accompanied by an acceleration in cardiac rhythm with no significant correlation between the two parameters. The increase in BP on rising was linked with the overall variability in BP, but was independent of the mean BP over 24 h. It was associated with an increased risk of cardiovascular complications independently of age and average 24-h SBP.

Therapeutic effects of evening administration of guanabenz and clonidine on morning hypertension: evaluation using home-based blood pressure measurements

OBJECTIVE

To clarify the effects of bedtime administration of the centrally acting alpha(2)-agonists, guanabenz and clonidine, on morning hypertension.

METHODS

Patients with morning hypertension were assigned to receive once-daily evening administration of guanabenz (2 mg/day, n = 81; 4 mg/day, n = 2) or clonidine (75 microg/day, n = 40; 150 microg/day, n = 10) for 4 weeks, and the blood pressure (BP)-lowering effects of these drugs in the morning and evening were evaluated by assessing self-monitored BP in the home environment. The subjects were then subdivided into different groups according to their evening BP, and the effects of guanabenz and clonidine on evening BP were evaluated further for each group. In addition, as a substitute for the trough/peak ratio, the evening/morning (E/M) ratio was calculated to assess the duration of action of the two alpha(2)-agonists.

RESULTS

Evening dosing with guanabenz or clonidine lowered morning BP significantly. Both drugs decreased evening BP in the subgroup of subjects with a high evening BP, but not in those with a normal evening BP. The individual E/M ratios for guanabenz, but not for clonidine, were significantly greater in those with a high evening BP than in those with a normal evening BP. In the early treatment period, treatment with guanabenz resulted in a higher diastolic E/M ratio in those subjects with a high evening diastolic BP than did treatment with clonidine.

CONCLUSION

The results suggest that evening administration of the central alpha(2)-agonists guanabenz and clonidine effectively suppresses the morning BP elevation in treated hypertensive patients.