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Rahbari-Oskoui FF. Management of Hypertension and Associated Cardiovascular Disease in Autosomal Dominant Polycystic Kidney Disease. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:417-428. [PMID: 38097332 DOI: 10.1053/j.akdh.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/02/2023] [Accepted: 03/15/2023] [Indexed: 12/18/2023]
Abstract
Autosomal dominant polycystic kidney disease is the most commonly inherited disease of the kidneys affecting an estimated 12,000,000 people in the world. Autosomal dominant polycystic kidney disease is a systemic disease, with a wide range of associated features that includes hypertension, valvular heart diseases, cerebral aneurysms, aortic aneurysms, liver cysts, abdominal hernias, diverticulosis, gross hematuria, urinary tract infections, nephrolithiasis, pancreatic cysts, and seminal vesicle cysts. The cardiovascular anomalies are somewhat different than in the general population and also chronic kidney disease population, with higher morbidity and mortality rates. This review will focus on cardiovascular diseases associated with autosomal dominant polycystic kidney disease and their management.
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Affiliation(s)
- Frederic F Rahbari-Oskoui
- Director of the PKD Center of Excellence, Department of Medicine-Renal Division, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA.
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2
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Wang J, Yan Z, Dong X, Li J, Zhao L, Zhang X, Lv C, Zhao Z, Strohl KP, Han F. Diurnal changes in blood pressure and heart rate in children with narcolepsy with cataplexy. J Sleep Res 2023; 32:e13736. [PMID: 36163423 DOI: 10.1111/jsr.13736] [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: 03/23/2020] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
The hypocretin neurons in the lateral hypothalamus are connected not only to brain alertness systems but also to brainstem nuclei that regulate blood pressure and heart rate. The premise is that regulation of blood pressure and heart rate is altered and affected by methylphenidate, a stimulant drug in children with narcolepsy with cataplexy. The changes in 24-hr ambulatory systolic and diastolic blood pressure and heart rate were compared among pre-treated narcolepsy with cataplexy patients (40 males, 10 females), with mean age 10.4 ± 3.5 years (M ± SD, range 5-17 years) with values from 100 archival age-sex-body mass index matched controls. Patients had a lower diurnal systolic blood pressure (-6.5 mmHg; p = 0.000) but higher heart rate (+11.0 bpm; p = 0.000), particularly evident in the waketime, while diastolic blood pressure was comparable. With methylphenidate (18 mg sustained release at 08:00 hours), patients with narcolepsy with cataplexy had higher systolic blood pressure (+4.6 mmHg, p = 0.015), diastolic blood pressure (+3.3 mmHg, p = 0.005) and heart rate (+7.1 bpm, p = 0.028) during wake time, but nighttime cardiovascular values were unchanged from pre-treated values; amplitude variation in cardiovascular values was unchanged over 24 hr. In conclusion, children with narcolepsy with cataplexy had downregulation blood pressure profile but a higher heart rate, and lesser non-dipping profiles. Daytime methylphenidate treatment increases only waketime blood pressure and further elevated heart rate values.
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Affiliation(s)
- Jingyu Wang
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China.,Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Zhihui Yan
- Institute of Materia Medica, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinnan, China
| | - Xiaosong Dong
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Jing Li
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Long Zhao
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Xueli Zhang
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
| | - Changjun Lv
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou, China
| | - Ziyan Zhao
- Institute of Materia Medica, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinnan, China
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Case Western Reserve University, and Cleveland Louis Stokes VA Medical Center, Cleveland, Ohio, USA
| | - Fang Han
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, China
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3
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Mullen MT, Anderson CS. Review of Long-Term Blood Pressure Control After Intracerebral Hemorrhage: Challenges and Opportunities. Stroke 2022; 53:2142-2151. [PMID: 35657328 DOI: 10.1161/strokeaha.121.036885] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blood pressure (BP) is the most important modifiable risk factor for intracerebral hemorrhage (ICH). Elevated BP is associated with an increased risk of ICH, worse outcome after ICH, and in survivors, higher risks of recurrent ICH, ischemic stroke, myocardial infarction, and cognitive impairment/dementia. As intensive BP control probably improves the chances of recovery from acute ICH, the early use of intravenous or oral medications to achieve a systolic BP goal of <140 mm Hg within the first few hours of presentation is reasonable for being applied in most patients. In the long-term, oral antihypertensive drugs should be titrated as soon as possible to achieve a goal BP <130/80 mm Hg and again in all ICH patients regardless of age, location, or presumed mechanism of ICH. The degree of sustained BP reduction, rather than the choice of BP-lowering agent(s), is the most important factor for optimizing risk reduction, with varying combinations of thiazide-type diuretics, long-acting calcium channel blockers, ACE (angiotensin-converting enzyme) inhibitors or angiotensin receptor blockers, being the mainstay of therapy. As most patients will require multiple BP-lowering agents, and physician inertia and poor adherence are major barriers to effective BP control, single-pill combination therapy should be considered as the choice of management where available. Increased population and clinician awareness, and innovations to solving patient, provider, and social factors, have much to offer for improving BP control after ICH and more broadly across high-risk groups. It is critical that all physicians, especially those managing ICH patients, emphasize the importance of BP control in their practice.
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Affiliation(s)
- Michael T Mullen
- Department of Neurology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA (M.T.M.)
| | - Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia (C.S.A.).,The George Institute China at Peking University Health Sciences Center, Beijing (C.S.A.)
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Gourgari E, Mete M, Dimatulac M, Cogen F, Brady T. Blood pressure during sleep is associated with arterial stiffness and urine microalbumin to creatinine ratio in youth with type 1 diabetes. J Diabetes Complications 2020; 34:107678. [PMID: 32718559 PMCID: PMC8893963 DOI: 10.1016/j.jdiacomp.2020.107678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/30/2020] [Accepted: 07/13/2020] [Indexed: 11/23/2022]
Abstract
AIMS To determine whether sleep blood pressure (BP) is associated with increased cardiovascular disease (CVD) risk in youth with type 1 diabetes (T1DM). METHODS We enrolled youth with T1DM, 12-21 years old. Carotid-femoral Pulse Wave Velocity (PWVcf) assessed arterial stiffness, a CVD marker. Sleep systolic and diastolic BP variables were obtained from 24-hour BP Monitoring. Linear regression models analyzed the relationship of each BP variable with PWVcf, adjusted for HbA1c. Correlation of sleep BP with urine microalbumin-to-creatinine ratio (UAC) was examined. RESULTS Nocturnal hypertension was found in 36% and abnormal dipping in 48% of the 25 participants, aged 17.7 ± 2.2 years old. Sleep systolic BP [beta = 0.039, 95% Confidence Interval (CI; 0.006-0.073)], diastolic BP [beta = 0.058, 95% CI (0.003-0.114)], Mean Arterial Pressure (MAP) [beta = 0.075, 95% CI (0.018-0.131)] and MAP index [beta = 3.547, 95% CI (0.867-6.227)] were significantly associated with PWVcf. Sleep diastolic BP, load, MAP correlated with UAC. CONCLUSIONS Blood pressure alterations during sleep are common in youth with T1DM and they are associated with arterial stiffness and UAC. Larger studies are needed to confirm our results and examine whether interventions that target sleep and night-time BP could decrease CVD risk.
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Affiliation(s)
- Evgenia Gourgari
- Division of Pediatric Endocrinology, Department of Pediatrics, Georgetown University, Washington, DC, United States of America.
| | - Mihriye Mete
- MedStar Health Research Institute, Hyattsville, MD, United States of America
| | - Margarita Dimatulac
- Division of Pediatric Endocrinology, Department of Pediatrics, Children's National Health Systems, George Washington University, Washington, DC, United States of America
| | - Fran Cogen
- Clinical Research Unit, Georgetown University, Washington, DC, United States of America
| | - Tammy Brady
- Division of Pediatric Nephrology, Department of Pediatrics, John Hopkins University, Baltimore, MD, United States of America
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Yang K, Zhu X, Feng Y, Shen F, Chen J, Fu N, Sun J, Fu Y. Abnormal blood pressure circadian rhythms are relevant to cerebral infarction and Leukoaraiosis in hypertensive patients. BMC Neurol 2020; 20:36. [PMID: 31992235 PMCID: PMC6988318 DOI: 10.1186/s12883-020-1626-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the relationships between blood pressure (BP) circadian rhythms and acute cerebral infarction (ACI), silent cerebral infarction (SCI) and the severity of leukoaraiosis in hypertensive patients. METHODS A retrospective case-control study was performed among hypertensive patients with 24-h ambulatory blood pressure monitoring (ABPM) and cranial magnetic resonance imaging (MRI). RESULTS A total of 1267 patients were enrolled. Lower nocturnal blood pressure (BP) decreases were observed in ACI patients than in controls (3.3% vs 8.2%, P<0.001). Reverse-dipper pattern (RD) and non-dipper pattern (ND) were found to be independent risk factors for ACI. In ACI patients, both RD and ND BP circadian rhythms were revealed to be independent risk factors for moderate-severe leukoaraiosis. In addition, in SCI patients, RD (OR = 1.7, 95% CI, 0.9-3.0; P = 0.047) or extreme-dipper pattern (ED) (OR = 2.9, 95% CI, 1.2-7.0; P = 0.015) were found to be independent risk factors for moderate-severe leukoaraiosis. Moreover, the greater the severity of leukoaraiosis was, the higher the ratio of abnormal BP circadian rhythms. CONCLUSION RD and ND BP circadian rhythms might not only be relevant to the onset of ACI but also correlate with the severity of leukoaraiosis. Thus, when modulating BP with antihypertensive drugs, the BP circadian rhythms, and not merely the BP level, should warrant more attention.
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Affiliation(s)
- Kang Yang
- Department of Neurology & Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, No.197, Rui Jin Er Road, Shanghai, 200025, China
| | - Xiaodong Zhu
- Department of Neurology, The First Hospital of Jiaxing, Zhejiang, 314000, China
| | - Yulan Feng
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Fanxia Shen
- Department of Neurology & Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, No.197, Rui Jin Er Road, Shanghai, 200025, China
| | - Jie Chen
- Department of Neurology & Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, No.197, Rui Jin Er Road, Shanghai, 200025, China
| | - Ningzhen Fu
- School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Jialan Sun
- Department of Neurology, Pu Dong District Gonli hospital, Shanghai, 200120, China
| | - Yi Fu
- Department of Neurology & Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, No.197, Rui Jin Er Road, Shanghai, 200025, China.
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Tsivgoulis G, Pikilidou M, Katsanos AH, Stamatelopoulos K, Michas F, Lykka A, Zompola C, Filippatou A, Boviatsis E, Voumvourakis K, Zakopoulos N, Manios E. Association of Ambulatory Blood Pressure Monitoring parameters with the Framingham Stroke Risk Profile. J Neurol Sci 2017; 380:106-111. [PMID: 28870547 DOI: 10.1016/j.jns.2017.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/14/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
The Framingham Stroke Risk Profile (FSRP) is a novel and reliable tool for estimating the 10-year probability for incident stroke in stroke-free individuals, while the predictive value of ambulatory blood pressure monitoring (ABPM) for first-ever and recurrent stroke has been well established. We sought to evaluate cross-sectionally the association of ABPM parameters with FSRP score in a large sample of 2343 consecutive stroke-free individuals (mean age: 56.0±12.9, 49.1% male) who underwent 24-hour ABPM. True hypertensives showed significantly higher FSRP (11.2±5.0) compared to the normotensives (8.2±5.0, p<0.001), while subjects with white coat hypertension also had higher FSRP (10.2±4.7) than normotensives (8.2±5.0, p<0.001). Compared to dippers that exhibited the lowest FSRP, non-dippers and reverse-dippers exhibited significantly higher FSRP (9.8±4.8 for dippers vs 10.6±5.2 and 11.5±5.0 for non-dippers and reverse-dippers respectively, p≤0.001 for comparisons). In univariate analyses, the ABPM parameters that had the strongest correlation with FSRP were 24-hour (r=0.440, p<0.001), daytime (r=0.435, p<0.001) and night-time (r=0.423; p<0.001) pulse pressure (PP). The best fitting model for predicting FSRP (R2=24.6%) on multiple linear regression analyses after adjustment for vascular risk factors not included in FSRP comprised the following parameters in descending order: 24-hour PP (β=0.349, p<0.001), daytime SBP variability (β=0.124, p<0.001), 24-hour HR variability (β=-0.091, p<0.001), mean 24-hour HR (β=-0.107, p<0.001), BMI (β=0.081, p<0.001) and dipping percentage (β=-0.063, p=0.001). 24-hour PP and daytime SBP variability are the two ABPM parameters that were more strongly associated with FSRP-score. Reverse dippers had the highest FSRP among all dipping status profiles.
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Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - Maria Pikilidou
- Hypertension Excellence Center, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristeidis H Katsanos
- Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Fotios Michas
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aikaterini Lykka
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Christina Zompola
- Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Angeliki Filippatou
- Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstathios Boviatsis
- Department of Neurosurgery, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Konstantinos Voumvourakis
- Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nikolaos Zakopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Mezue K, Isiguzo G, Madu C, Nwuruku G, Rangaswami J, Baugh D, Madu E. Nocturnal Non-dipping Blood Pressure Profile in Black Normotensives Is Associated with Cardiac Target Organ Damage. Ethn Dis 2016; 26:279-84. [PMID: 27440966 DOI: 10.18865/ed.26.3.279] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE A non-dipping pattern of nocturnal blood pressure in hypertensive patients is an established predictor of cardiovascular risk, especially in Blacks. However, data on non-dipping normotensives and cardiovascular risk in this population is sparse. In this study, we aim to determine if a non-dipping profile in a cohort of Black normotensives is associated with cardiac target organ damage. METHODS We studied ambulatory blood pressure patterns in 43 normotensive Black patients of Caribbean origin and classified their profiles as dippers (DP) and non-dippers (NDP) based on their nocturnal blood pressure profiles. Cardiac target organ damage was estimated from 2-D echocardiogram. RESULTS The mean age of the cohort was 52 years. Both groups were similar with respect to baseline age, sex, weight, height, body mass index and daytime ambulatory BP. There was a statistically significant difference in nocturnal blood pressure between DP and NDP groups (112 ± 7/64 ± 2 mm Hg vs 117 ± 3/69 ± 2 mm Hg, P=.004). The NDP cohort showed evidence of cardiovascular target damage on echocardiography with a significantly increased relative wall thickness (.35 ± .07 cm vs .42 ± .05 cm, P=.001), left ventricular mass index (95 ± 14 vs 105 ± 14 g/m(2), P=.018) and left atrial volume index (26 ± 3.5 vs. 30 ± 3.4, P=.001). Left ventricular geometry in the non-dippers also showed increased concentric remodeling, concentric and eccentric hypertrophy. CONCLUSIONS Our study demonstrates that nocturnal non-dipping of blood pressure in normotensive Blacks of Caribbean origin may be associated with cardiovascular end organ damage thereby providing new surveillance and therapeutic targets.
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Affiliation(s)
- Kenechukwu Mezue
- Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | | | - Chichi Madu
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | | | - Janani Rangaswami
- Delaware Valley Nephrology and Hypertension Associates, Philadelphia; Sidney Kimmel College of Thomas Jefferson University, Philadelphia
| | - Dainia Baugh
- DOCS Heart Center, Enugu, Nigeria; Heart Institute of the Caribbean (HIC), Kingston, Jamaica
| | - Ernest Madu
- DOCS Heart Center, Enugu, Nigeria; Heart Institute of the Caribbean (HIC), Kingston, Jamaica
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Smith W, Malan NT, Schutte AE, Schutte R, MC Mels C, Vilser W, Malan L. Retinal vessel caliber and its relationship with nocturnal blood pressure dipping status: the SABPA study. Hypertens Res 2016; 39:730-736. [DOI: 10.1038/hr.2016.48] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/25/2016] [Accepted: 04/05/2016] [Indexed: 12/19/2022]
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Sargento-Freitas J, Laranjinha I, Galego O, Rebelo-Ferreira A, Moura B, Correia M, Silva F, Machado C, Cordeiro G, Cunha L. Nocturnal blood pressure dipping in acute ischemic stroke. Acta Neurol Scand 2015; 132:323-8. [DOI: 10.1111/ane.12402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - I. Laranjinha
- Stroke Unit; Coimbra University and Hospital Centre; Coimbra Portugal
| | - O. Galego
- Stroke Unit; Coimbra University and Hospital Centre; Coimbra Portugal
| | - A. Rebelo-Ferreira
- Stroke Unit; Coimbra University and Hospital Centre; Coimbra Portugal
- Medical Oncology Department; Santa Maria Hospital - North Lisbon Hospital Centre; Lisbon Portugal
| | - B. Moura
- Stroke Unit; Coimbra University and Hospital Centre; Coimbra Portugal
- Psychiatry and Mental Health Department; Santa Maria Hospital - North Lisbon Hospital Centre; Lisbon Portugal
| | - M. Correia
- Stroke Unit; Coimbra University and Hospital Centre; Coimbra Portugal
- Paediatric Department; Dona Estefânia Hospital; Lisbon Portugal
| | - F. Silva
- Stroke Unit; Coimbra University and Hospital Centre; Coimbra Portugal
| | - C. Machado
- Stroke Unit; Coimbra University and Hospital Centre; Coimbra Portugal
| | - G. Cordeiro
- Stroke Unit; Coimbra University and Hospital Centre; Coimbra Portugal
| | - L. Cunha
- Stroke Unit; Coimbra University and Hospital Centre; Coimbra Portugal
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Seguchi M, Wada H, Sakakura K, Nakagawa T, Ibe T, Ikeda N, Sugawara Y, Ako J, Momomura SI. Circadian Variation of Acute Aortic Dissection. Int Heart J 2015; 56:324-8. [DOI: 10.1536/ihj.14-328] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Tom Nakagawa
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Tatsuro Ibe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Nahoko Ikeda
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yoshitaka Sugawara
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University
| | - Shin-ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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11
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Sun J, Yang W, Zhu Y, Liu X, Wei X, Wang B, Zhong J, Fu Y. The relationship between nocturnal blood pressure and hemorrhagic stroke in Chinese hypertensive patients. J Clin Hypertens (Greenwich) 2014; 16:652-7. [PMID: 25056509 PMCID: PMC8032108 DOI: 10.1111/jch.12369] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 05/27/2014] [Accepted: 06/02/2014] [Indexed: 11/28/2022]
Abstract
To study the relationship between nocturnal blood pressure (BP) variation and spontaneous intracerebral hemorrhage (ICH) among Chinese hypertensive patients and its clinical significance, the authors retrospectively screened 371 patients with primary hypertension (189 patients with ICH, 182 patients without ICH) in Shanghai and analyzed their demographics, clinical information, nocturnal blood pressure variability and medication. Compared with the control group, the levels of blood glucose, triglycerides, and creatinine were significantly increased in the ICH group, along with a marked reduction in nocturnal BP drop (P<.05). Multivariate logistic regression indicated that blood glucose, creatinine, and nocturnal mean arterial pressure were risk factors for ICH, and the magnitude of nocturnal BP drop was negatively related to the risk for ICH. There was no significant difference in the prevalence of reverse dippers between the large hematoma volume group and the small hematoma volume group (χ(2) =2.529, P=.112), nor among the patients taking angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or calcium channel blockers (χ(2) =1.981, P=.371). Reverse dipping is associated with the risk for ICH, suggesting that appropriate antihypertensive drug and chronotherapy might be effective to normalize the rhythm of abnormal circadian variation in hypertensive patients.
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Affiliation(s)
- Jialan Sun
- Department of NeurologyPudong District Gongli HospitalShanghaiChina
| | - Wanlin Yang
- Department of Neurology & Institute of NeurologyRui Jin HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
| | - Yang Zhu
- Department of NeurologyShanghai City Second People's HospitalShanghaiChina
| | - Xiaohong Liu
- Department of NeurologyShanghai Putuo District People's HospitalShanghaiChina
| | - Xin Wei
- Department of NeurologyShanghai Traditional Medical University affiliated Yueyang HospitalShanghaiChina
| | - Baisong Wang
- Department of Pharmacology and BiostatisticsInstitute of Medical SciencesSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
| | - Jiuchang Zhong
- State Key Laboratory of Medical Genomics & Shanghai Institute of HypertensionRui Jin HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
| | - Yi Fu
- Department of Neurology & Institute of NeurologyRui Jin HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghaiChina
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12
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Fan LB, Blumenthal JA, Hinderliter AL, Sherwood A. The effect of job strain on nighttime blood pressure dipping among men and women with high blood pressure. Scand J Work Environ Health 2012; 39:112-9. [PMID: 22460541 DOI: 10.5271/sjweh.3294] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Blunted nighttime blood pressure dipping is an established cardiovascular risk factor. This study examined the effect of job strain on nighttime blood pressure dipping among men and women with high blood pressure. METHODS The sample consisted of 122 blue- and white collar workers (men=72, women=50). The Job Content Questionnaire was used to measure job psychological demands, job control, and social support. The ratio of job demands to job control was used to assess job strain. Nighttime blood pressure dipping was evaluated from 24-hour ambulatory blood pressure monitoring performed on three workdays. RESULTS Men with high job strain had a 5.4 mm Hg higher sleep systolic blood pressure (P=0.03) and 3.5 mm Hg higher sleep pulse pressure (P=0.02) compared to men with low job strain. Men with high job strain had a smaller fall in systolic blood pressure and pulse pressure from awake to sleep state than those with low job strain (P<0.05). Hierarchical analyses showed that job strain was an independent determinant of systolic blood pressure dipping (P=0.03) among men after adjusting for ethnicity, body mass index, anxiety and depression symptoms, current smoking status, and alcohol consumption. Further exploratory analyses indicated that job control was the salient component of job strain associated with blood pressure dipping (P=0.03). CONCLUSIONS High job strain is associated with a blunting of the normal diurnal variation in blood pressure and pulse pressure, which may contribute to the relationship between job strain and cardiovascular disease.
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Affiliation(s)
- Lin-Bo Fan
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA
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13
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Short-term reproducibility of ambulatory blood pressure monitoring in autosomal dominant polycystic kidney disease. Blood Press Monit 2011; 16:47-54. [PMID: 21415814 DOI: 10.1097/mbp.0b013e328344c6f3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Nondipping, defined as a less than 10% decline in Night:Day (N:D) ratio of blood pressure using 24 h ambulatory blood pressure monitoring, is associated with poor cardiovascular outcomes. However, its reproducibility has been questioned in autosomal dominant polycystic kidney disease. MATERIALS AND METHODS Twenty-five of 29 recruited hypertensive or prehypertensive patients with autosomal dominant polycystic kidney disease completed ambulatory blood pressure monitoring on two occasions, 7-15 days apart, on a stable antihypertensive regimen. Daytime and night-time were defined as 6:00-21:59 h and 22:00-5:59 h, respectively. Correlation and concordance coefficients for systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate were determined based on N:D and Asleep:Awake (A:A) ratios. Consistency of dipping was assessed by using Cohen's Kappa statistics. RESULTS Mean (±standard deviation) for age, estimated glomerular filtration rate, differences in daytime and night-time SBP and DBP were 43.12 years (8.55 years), 63.1 ml/min (20.5 ml/min), 11.74 mmHg (8.2 mmHg), and 10.82 mmHg (6.4 mmHg), respectively. Seventeen of 25 (68%) and 18 of 25 (72%) participants maintained the same dipping category based on D:N or A:A separation. Cohen's Kappa was 0.34 for D:N ratio and 0.38 for A:A ratio. Correlation and concordance coefficients were 0.89 and 0.88 for daytime SBP, 0.91 and 0.91 for daytime DBP, 0.79 and 0.78 for night-time SBP, 0.81 and 0.80 for night-time DBP, 0.58 and 0.56 for N:D ratio of SBP, and 0.56 and 0.53 for N:D ratio of DBP. Coefficients for A:A ratio were almost identical to N:D values except for A:A ratios of SBP (0.69 and 0.67) and DBP (0.48 and 0.45). CONCLUSION Repeated measures of SBP and DBP, 7-15 days apart, are highly correlative and concordant in the studied population, but nondipping, even though predominant, was found to be modestly reproducible.
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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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Ma J, Sun J, Zhao J, Wei X, Wang B, Fu Y. Relationship between nocturnal blood pressure variation and silent cerebral infarction in Chinese hypertensive patients. J Neurol Sci 2010; 294:67-9. [DOI: 10.1016/j.jns.2010.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Revised: 03/05/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
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Yilmaz MB, Yalta K, Turgut OO, Yilmaz A, Yucel O, Bektasoglu G, Tandogan I. Sleep quality among relatively younger patients with initial diagnosis of hypertension: Dippers versus non‐dippers. Blood Press 2009; 16:101-5. [PMID: 17612908 DOI: 10.1080/08037050701343225] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sleep is a basic physiological process. Normal sleep yields decrease in sympathetic activity, blood pressure (BP) and heart rate. Those, who do not have expected decrease in their BP are considered "non-dippers". We aimed to determine if there was any association between the non-dipping status and sleep quality, designed a cross-sectional study, and enrolled and evaluated the sleep quality of relatively young patients with an initial diagnosis of hypertension. METHODS Seventy-five consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients had newly diagnosed with stage 1 hypertension. Patients with a prior use of any anti-hypertensive medication were not included. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI), which has an established role in evaluating sleep disturbances. All patients underwent ambulatory BP monitoring. RESULTS There were 42 non-dipper patients (mean age = 47.5+/-11.9 years, 24 male/18 female), as a definition, 31 dipper hypertensive patients (mean age = 48.5+/-12.8 years, 21 male/10 female) and two with white coat hypertension. Daytime systolic and diastolic mean BPs were not significantly different between the two groups. Night-time mean systolic and diastolic BPs were significantly higher in non-dippers compared with dippers. PSQI scores, globally, were significantly higher in non-dippers compared with dippers. Total PSQI score was not correlated with body mass index. It was noticed that, individually, sleep quality, sleep efficiency and sleep disturbance scores were significantly higher in non-dippers. Being a poor sleeper in terms of high PSQI score (total score>5) was associated with 2.955-fold increased risk of being a non-dipper (95% confidence interval 1.127-7.747). CONCLUSION We showed that the risk of having non-dipping hypertension, a risk factor for poor cardiovascular outcomes among hypertensive individuals, was tripled (odds ratios) among poor sleepers. We think that evaluating sleeping status and sleep quality among the hypertensive population may help unmask non-dipper hypertension, enabling physicians to treat appropriately.
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Affiliation(s)
- Mehmet Birhan Yilmaz
- Cumhuriyet University, Faculty of Medicine, Department of Cardiology, Sivas, Turkey.
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Sturgeon JD, Folsom AR, Longstreth WT, Shahar E, Rosamond WD, Cushman M. Hemostatic and inflammatory risk factors for intracerebral hemorrhage in a pooled cohort. Stroke 2008; 39:2268-73. [PMID: 18535282 PMCID: PMC2578823 DOI: 10.1161/strokeaha.107.505800] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to identify novel risk factors for intracerebral hemorrhagic stroke (ICH). METHODS Risk factors were assessed at baseline in a pooled cohort of the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS) involving 21,680 adults aged 45 or over. Over 263,489 person-years of follow-up, we identified 135 incident ICH events. RESULTS In multivariable models, for each SD higher baseline level of fibrinogen, the relative rate of incident ICH increased 35% (95% CI, 17% to 55%). Fibrinogen was more strongly related to ICH in ARIC than in CHS. In multivariable models, those with von Willebrand factor levels above the median were 1.72 (95% CI, 0.97 to 3.03) times more likely to have an incident ICH as those below the median. Factor VIII was significantly positively related to ICH in ARIC (relative rate per standard deviation of 1.31; 95% CI, 1.07 to 1.62), but not in CHS. There was no relation in multivariable models between lipoprotein (a), Factor VII, white blood cell count, or C-reactive protein and ICH. CONCLUSIONS Greater plasma fibrinogen and, to some degree, von Willebrand factor were associated with increased rates of ICH in these prospective studies, whereas Factor VIII was related to ICH in younger ARIC study participants only.
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Affiliation(s)
- Jared D Sturgeon
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 S Second St, Minneapolis, MN 55454-1015, USA
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Liddle's syndrome caused by a novel missense mutation (P617L) of the epithelial sodium channel β subunit. J Hypertens 2008; 26:921-7. [DOI: 10.1097/hjh.0b013e3282f85dfe] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Metoki H, Ohkubo T, Imai Y. Response to Diurnal Blood Pressure Changes in Stroke Subtypes. Hypertension 2006. [DOI: 10.1161/01.hyp.0000219633.51699.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hirohito Metoki
- Departments of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Science and Medicine, Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University 21st Century COE Program, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Science and Medicine, Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University 21st Century COE Program, Sendai, Japan
| | - Yutaka Imai
- Departments of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Science and Medicine, Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University 21st Century COE Program, Sendai, Japan, for the Ohasama Study Group
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Tsivgoulis G, Spengos K, Zakopoulos N. Diurnal blood pressure changes in stroke subtypes. Hypertension 2006; 47:e26; author reply e27. [PMID: 16606802 DOI: 10.1161/01.hyp.0000219699.71559.c2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
The relationship between hypertension and cerebrovascular disease is well established. As blood pressure is a dynamic and continually distributed variable, 24 h ambulatory blood pressure monitoring may be valuable as a risk stratifying tool in determining the "hypertensive load" as assessed by the presence of dipping or non-dipping status of an individual. Indeed, the association between reduced nocturnal blood pressure dipping and increased target organ damage is well established. Raised blood pressures are often seen in those presenting with strokes, although the precise mechanisms are uncertain. The relationship between intracerebral haemorrhage, which accounts for up to 15% of strokes in Caucasians, and blood pressure patterns is not well known. Understanding these inherent diurnal rhythms of blood pressure variation could help us unravel their significance and impact on cerebrovascular disease.
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Affiliation(s)
- Joseph Tomson
- University Department of Medicine, City Hospital, Birmingham B18 7QH, England, UK
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