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Ashraf A, Rimaz S, Seddighinejad A, Karimi A, Hassanzadeh-Rad A, Gholipour M, Motiei M, Yazdanipour MA, Rimaz S. The effect of physical activity level on the severity of diastolic dysfunction. BMC Sports Sci Med Rehabil 2023; 15:74. [PMID: 37391808 DOI: 10.1186/s13102-023-00689-1] [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: 11/18/2022] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Diastolic dysfunction (DD) is a risk factor for cardiovascular events in patients undergoing non-cardiac surgeries. Investigators aimed to assess the effect of physical activity level on the diastolic function of the left ventricle (LV) in patients attending the preoperative visit. METHODS This analytic cross-sectional study was conducted on 228 patients referred to Poursina hospital from November 2021 to March 2022. To define the physical activity level, we used the short form of the International Physical Activity Questionnaire (IPAQ). We categorized patients into inactive, minimally active, and health-enhancing physical activity groups. We also divided participants into three groups based on their daily sitting time. Also, echocardiographic parameters were calculated. The diastolic function of LV was evaluated, and its grading was defined from mild (grade1) to severe (grade 3). RESULTS Results showed that patients with DD had significantly higher age and lower levels of education (P < 0.001 and P = 0.005, respectively). After assessing echocardiographic parameters, we found that E/e', TR Velocity, left atrial volume index, and pulmonary artery pressure had a statistically significant inverse relationship with physical activity level (P < 0.001 for all). Comparing physical activity level of subgroups showed that in HEPA (health-enhancing physical activity), the chance of developing grade 2 or 3 DD was reduced by 97% compared to the inactive group (OR = 0.03, P < 0.001). Still, there was no significant difference between the inactive and minimally active groups (P = 0.223). CONCLUSIONS This study showed an inverse relationship between physical activity level and DD of the LV in a sample of 228 individuals attending the Anesthesia Clinic, independent of potentially confounding variables.Therefore, due to lower rate of DD in patients who are physically active, we can expect lower occurrence rate of cardiovascular events during surgery.
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Affiliation(s)
- Ali Ashraf
- Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Siamak Rimaz
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Seddighinejad
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Amin Karimi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Afagh Hassanzadeh-Rad
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahboobeh Gholipour
- Department of cardiology, Healthy Heart Research Center, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Mahsa Motiei
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | | | - Sheida Rimaz
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Abstract
OBJECTIVE The present study aims to describe a widely held misconception in the literature concerning preoperative hypertension diagnosis. The blood pressure elevation occurring in the operative room is seen commonly even in subjects considered hitherto fully normotensive. As these patients have a condition which - similar to White Coat Hypertension (WCH) - indicates the presence of hypertension, and thus necessitates more frequent intraoperative checks. METHODS We have named a condition 'Diagnosed in Operating Room (DIOR) with Hypertension', following the preoperative stage at which it is detected. RESULT Our observational study evaluated 718 elective noncardiac surgery adult patients, finding 28% of them (n = 204) to be 'DIOR-tensive' and thus at risk for suboptimal intraoperative care. CONCLUSION In addition to recommending a modification to the domain's best practices, we provide a preliminary description of DIOR hypertension patient identifying characteristics (older, higher body weight and BMI, and higher rates of chronic obstructive pulmonary disease, hypothyroidism and obesity), so that DIOR hypertension patients may be more readily identified, and that future research may build on the findings, and that the operating team may remain generally aware that this problem can occur and be dealt with regardless of the patient's medical history.
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Pioli MR, Ritter AM, de Faria AP, Modolo R. White coat syndrome and its variations: differences and clinical impact. Integr Blood Press Control 2018; 11:73-79. [PMID: 30519088 PMCID: PMC6233698 DOI: 10.2147/ibpc.s152761] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hypertension is closely linked to increased cardiovascular risk and development of target organ damage (TOD). Therefore, proper clinical follow-up and treatment of hypertensive subjects are mandatory. A great number of individuals present a variation on blood pressure (BP) levels when they are assessed either in the office or in the out-of-office settings. This phenomenon is defined as white coat syndrome - a change in BP levels due to the presence of a physician or other health professional. In this context, the term "white coat syndrome" may refer to three important and different clinical conditions: 1) white coat hypertension, 2) white coat effect, and 3) masked hypertension. The development of TOD and the increased cardiovascular risk play different roles in these specific subgroups of white coat syndrome. Correct diagnose and clinical guidance are essential to improve the prognosis of these patients. The aim of this review was to elucidate contemporary aspects of these types of white coat syndrome on general and hypertensive population.
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Affiliation(s)
- Mariana R Pioli
- Department of Pharmacology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil,
| | - Alessandra Mv Ritter
- Department of Pharmacology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil,
| | - Ana Paula de Faria
- Department of Pharmacology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil,
| | - Rodrigo Modolo
- Department of Pharmacology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil, .,Laboratory of Cardiac Catheterization, Department of Internal Medicine, Cardiology Division, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil,
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Ryu S, Chang Y, Kang J, Yun KE, Jung HS, Kim CW, Cho J, Lima JA, Sung KC, Shin H, Guallar E. Physical activity and impaired left ventricular relaxation in middle aged adults. Sci Rep 2018; 8:12461. [PMID: 30127508 PMCID: PMC6102302 DOI: 10.1038/s41598-018-31018-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/09/2018] [Indexed: 01/20/2023] Open
Abstract
The aim of this study was to examine the relationship between physical activity level and impaired left ventricular (LV) relaxation in a large sample of apparently healthy men and women. We conducted a cross-sectional study in 57,449 adults who underwent echocardiography as part of a comprehensive health examination between March 2011 and December 2014. Physical activity level was assessed using the Korean version of the International Physical Activity Questionnaire Short Form. The presence of impaired LV relaxation was determined based on echocardiographic findings. Physical activity levels were inversely associated with the prevalence of impaired LV relaxation. The multivariable-adjusted odds ratios (95% confidence interval) for impaired LV relaxation comparing minimally active and health-enhancing physically active groups to the inactive group were 0.84 (0.77–0.91) and 0.64 (0.58–0.72), respectively (P for trend < 0.001). These associations were modified by sex (p for interaction <0.001), with the inverse association observed in men, but not in women. This study demonstrated an inverse linear association between physical activity level and impaired LV relaxation in a large sample of middle-aged Koreans independent of potential confounders. Our findings suggest that increasing physical activity may be independently important in reducing the risk of impaired LV relaxation.
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Affiliation(s)
- Seungho Ryu
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea. .,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
| | - Yoosoo Chang
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Jeonggyu Kang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung Eun Yun
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun-Suk Jung
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chan-Won Kim
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Juhee Cho
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Joao A Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hocheol Shin
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Ryu S, Chang Y, Kang J, Kwon MJ, Yun KE, Jung HS, Kim CW, Shin H, Sung KC. Relationship Between γ-Glutamyltransferase Levels and Left Ventricular Diastolic Dysfunction. Circ J 2017; 81:823-830. [PMID: 28228613 DOI: 10.1253/circj.cj-16-1084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The goal of this study was to examine the association of serum γ-glutamyltransferase (GGT) levels with left ventricular (LV) diastolic dysfunction and LV hypertrophy.Methods and Results:A cross-sectional study of 79,459 Korean men and women who underwent an echocardiography as part of a comprehensive health examination between March 2011 and December 2014. The presence of LV diastolic dysfunction and LV hypertrophy was determined using echocardiography. Of the subjects, 5,447 had LV diastolic dysfunction and 2,070 had LV hypertrophy. Both LV diastolic dysfunction and LV hypertrophy were associated with higher levels of serum GGT. Multivariable-adjusted odds ratios (95% confidence interval) for LV diastolic dysfunction comparing serum GGT quartiles 2-4 with quartile 1 were 1.25 (1.08-1.44), 1.65 (1.43-1.91) and 2.23 (1.92-2.58), respectively (P for trend <0.001). Multivariable-adjusted odds ratios (95% CI) for LV hypertrophy comparing serum GGT quartiles 2-4 with quartile 1 were 1.13 (0.94-1.36), 1.14 (0.93-1.40) and 1.33 (1.07-1.65), respectively (P for trend 0.01). These associations of serum GGT levels with LV diastolic dysfunction and LV hypertrophy were modified by age (P for interaction <0.05). CONCLUSIONS This study demonstrated a positive association between serum GGT levels and LV diastolic dysfunction and LV hypertrophy in a large cohort of middle-aged men and women independent of potential confounders.
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Affiliation(s)
- Seungho Ryu
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine.,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University
| | - Yoosoo Chang
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine.,Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine.,Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University
| | - Jeonggyu Kang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Min-Jung Kwon
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine.,Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Kyung Eun Yun
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Hyun-Suk Jung
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Chan-Won Kim
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Hocheol Shin
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine.,Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
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Ermiş N, Afşin A, Cuğlan B, Açikgöz N, Cansel M, Yağmur J, Hidayet Ş, Colak MC, Selçuk EB. Left atrial volume and function in patients with white-coat hypertension assessed by real-time three-dimensional echocardiography. Blood Press Monit 2016; 21:231-7. [DOI: 10.1097/mbp.0000000000000188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jang SY, Kim S, Lee CK, Cho EJ, Cho SJ, Lee SC. Prehypertension and Left Ventricular Diastolic Dysfunction in Middle-Aged Koreans. Korean Circ J 2016; 46:536-41. [PMID: 27482263 PMCID: PMC4965433 DOI: 10.4070/kcj.2016.46.4.536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/13/2015] [Accepted: 11/26/2015] [Indexed: 01/19/2023] Open
Abstract
Background and Objectives Left ventricular diastolic dysfunction is known to be a marker of myocardial damage, in particular myocardial fibrosis resulting from hypertension (HT). However, few studies have shown an association between the grade of diastolic dysfunction and blood pressure classification. We investigated the association between diastolic dysfunction and prehypertension (preHT) in apparently healthy adults who underwent routine health examinations. Subjects and Methods The study sample included 4261 Koreans, 45 to 64 years of age with no previous history of HT, diabetes mellitus, malignancy, proven coronary artery disease, or valvular heart disease based on echocardiography, who underwent routine health examinations including echocardiography. The subjects were classified into three groups based on resting blood pressure: prehypertensive, hypertensive, and normotensive. Results The prevalence of preHT in our study was 42.1%. After adjusting for age, gender, smoking status, alcohol consumption, fasting blood sugar, serum lipid profile, and body mass index, left ventricular diastolic dysfunction grades 1 and 2 were significantly more frequent in subjects with preHT (odds ratio [OR] 1.66 [95% confidence interval {CI} 1.40-1.96] and 1.37 [95% CI 0.95-1.97], respectively). When analyzed according to gender, the increased OR was especially notable in males. Conclusion Left ventricular diastolic dysfunction appears to be significantly associated with preHT in Korean middle-aged males.
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Affiliation(s)
- Shin Yi Jang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sujin Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Eun Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Cardiology Clinic, National Cancer Center, Goyang, Korea
| | - Soo Jin Cho
- Health Promotion Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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White-coat hypertension, as defined by ambulatory blood pressure monitoring, and subclinical cardiac organ damage: a meta-analysis. J Hypertens 2016; 33:24-32. [PMID: 25380162 DOI: 10.1097/hjh.0000000000000416] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM : The clinical and prognostic relevance of white-coat hypertension (WCH) has not been fully elucidated; in particular, the association of this blood pressure phenotype with suclinical organ damage remains unclear. We performed a systematic meta-analysis in order to provide a comprehensive information on cardiac structural and functional changes in WCH, as defined by ambulatory blood pressure monitoring. DESIGN Studies were identified by the following search terms: 'white-coat hypertension', 'isolated clinic hypertension', 'cardiac organ damage', 'target organ damage', 'left ventricle', 'left ventricular hypertrophy', 'cardiac hypertrophy', 'ventricular dysfunction', and 'echocardiography'. RESULTS A total of 7382 untreated adult patients (2493 normotensive, 1705 WCH, and 3184 hypertensive individuals) included in 25 studies were considered. Left ventricular mass index was higher in WCH than in normotensive patients [standardized difference in mean (SDM) 0.50, P < 0.01]; mitral E/A ratio was lower (SDM -0.27, P < 0.01) and left atrium larger (SDM 0.29, P < 0.05) in WCH than in the normotensive counterparts. Hypertensive patients showed a greater left ventricular mass index (SDM 0.42, P < 0.01), reduced E/A (SDM -0.15, P < 0.01), and larger left atrium diameter (SDM 0.27, P < 0.01) than WCH patients. CONCLUSIONS Our meta-analysis shows that alterations in cardiac structure and function in WCH patients, as defined by ambulatory blood pressure monitoring, are intermediate between sustained hypertensive patients and normotensive controls. The study supports the view that WCH should not be further considered a fully benign entity.
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Tadic M, Cuspidi C, Ivanovic B, Ilic I, Celic V, Kocijancic V. Influence of White-Coat Hypertension on Left Ventricular Deformation 2- and 3-Dimensional Speckle Tracking Study. Hypertension 2016; 67:592-6. [DOI: 10.1161/hypertensionaha.115.06822] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 12/09/2015] [Indexed: 01/09/2023]
Abstract
We sought to compare left ventricular deformation in subjects with white-coat hypertension to normotensive and sustained hypertensive patients. This cross-sectional study included 139 untreated subjects who underwent 24-hour ambulatory blood pressure monitoring and completed 2- and 3-dimensional examination. Two-dimensional left ventricular multilayer strain analysis was also performed. White-coat hypertension was diagnosed if clinical blood pressure was elevated and 24-hour blood pressure was normal. Our results showed that left ventricular longitudinal and circumferential strains gradually decreased from normotensive controls across subjects with white-coat hypertension to sustained hypertensive group. Two- and 3-dimensional left ventricular radial strain, as well as 3-dimensional area strain, was not different between groups. Two-dimensional left ventricular longitudinal and circumferential strains of subendocardial and mid-myocardial layers gradually decreased from normotensive control to sustained hypertensive group. Longitudinal and circumferential strains of subepicardial layer did not differ between the observed groups. We concluded that white-coat hypertension significantly affects left ventricular deformation assessed by 2-dimensional traditional strain, multilayer strain, and 3-dimensional strain.
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Affiliation(s)
- Marijana Tadic
- From the Cardiology Department, University Clinical Hospital Center “Dr Dragisa Misovic-Dedinje”, Belgrade, Serbia (M.T., I.I., V.C., V.K.); Department of Cardiology, Faculty of Medicine, Belgrade, Serbia (M.T., B.I., V.C.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.)
| | - Cesare Cuspidi
- From the Cardiology Department, University Clinical Hospital Center “Dr Dragisa Misovic-Dedinje”, Belgrade, Serbia (M.T., I.I., V.C., V.K.); Department of Cardiology, Faculty of Medicine, Belgrade, Serbia (M.T., B.I., V.C.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.)
| | - Branislava Ivanovic
- From the Cardiology Department, University Clinical Hospital Center “Dr Dragisa Misovic-Dedinje”, Belgrade, Serbia (M.T., I.I., V.C., V.K.); Department of Cardiology, Faculty of Medicine, Belgrade, Serbia (M.T., B.I., V.C.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.)
| | - Irena Ilic
- From the Cardiology Department, University Clinical Hospital Center “Dr Dragisa Misovic-Dedinje”, Belgrade, Serbia (M.T., I.I., V.C., V.K.); Department of Cardiology, Faculty of Medicine, Belgrade, Serbia (M.T., B.I., V.C.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.)
| | - Vera Celic
- From the Cardiology Department, University Clinical Hospital Center “Dr Dragisa Misovic-Dedinje”, Belgrade, Serbia (M.T., I.I., V.C., V.K.); Department of Cardiology, Faculty of Medicine, Belgrade, Serbia (M.T., B.I., V.C.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.)
| | - Vesna Kocijancic
- From the Cardiology Department, University Clinical Hospital Center “Dr Dragisa Misovic-Dedinje”, Belgrade, Serbia (M.T., I.I., V.C., V.K.); Department of Cardiology, Faculty of Medicine, Belgrade, Serbia (M.T., B.I., V.C.); and Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy (C.C.)
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Martin CA, McGrath BP. White-coat hypertension. Clin Exp Pharmacol Physiol 2014; 41:22-9. [PMID: 23682974 DOI: 10.1111/1440-1681.12114] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 04/28/2013] [Accepted: 05/12/2013] [Indexed: 01/19/2023]
Abstract
1. Numerous studies have examined whether white-coat hypertension (WCHT) is associated with increased cardiovascular risk, but with definitions of WCHT that were not sufficiently robust, results have been inconsistent. The aim of the present review was to standardize the evidence by only including studies that used a definition of WCHT consistent with international guidelines. 2. Published studies were reviewed for data on vascular dysfunction, target organ damage, risk of future sustained hypertension and cardiovascular events. 3. White-coat hypertension has a population prevalence of approximately 15% and is associated with non-smoking and slightly elevated clinic blood pressure. Compared with normotensives, subjects with WCHT are at increased cardiovascular risk due to a higher prevalence of glucose dysregulation, increased left ventricular mass index and increased risk of future diabetes and hypertension. 4. In conclusion, management of a patient with WCHT should focus on cardiovascular risk factors, particularly glucose intolerance, not blood pressure alone.
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Affiliation(s)
- Catherine A Martin
- Monash University, Melbourne, Vic., Australia; Monash Health, Melbourne, Vic., Australia; Australian Catholic University, Melbourne, Vic., Australia
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11
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Combined effects of office and 24-h blood pressure on aortic stiffness in human hypertension. J Hypertens 2011; 29:869-75. [DOI: 10.1097/hjh.0b013e328344da49] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martin C, Cameron J, McGrath B. Mechanical and circulating biomarkers in isolated clinic hypertension. Clin Exp Pharmacol Physiol 2008; 35:402-8. [PMID: 18307729 DOI: 10.1111/j.1440-1681.2008.04886.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
1. This review examines the current evidence for altered mechanical and circulating biomarkers in isolated clinic hypertension and their potential significance. 2. Arterial stiffness, as assessed by central pulse wave velocity, is influenced by multiple cardiovascular risk factors; however, an independent association with isolated clinic hypertension (ICHT) has not been convincingly shown in four small studies. 3. Endothelial dysfunction, as assessed by brachial artery flow-mediated vasodilation, circulating levels of endothelial markers (e.g. nitrite/nitrate, von Willebrand factor, endothelin-1) and/or circulating levels of inhibitors of vascular nitric oxide (plasma asymmetric dimethylarginine, homocysteine), has been shown to be present in established hypertension and to a variable and inconsistent extent in subjects with ICHT. 4. Evidence of increased oxidative stress in ICHT versus normotensive subjects was found in two of three studies. 5. Circulating inflammatory markers C-reactive protein and plasminogen activator inhibitor-1 were significantly increased in two of three and two of two studies, respectively, in ICHT compared with normotensive subjects. 6. Urinary albumin excretion is a marker of both arterial and renal disease. The consensus from seven studies in patients with ICHT is that albuminuria is not an independent marker for ICHT. 7. Studies to date assessing biomarkers in ICHT have been small and cross-sectional. Larger, long-term longitudinal studies of arterial functional and circulating biomarkers are required to assess the potential vascular impact of ICHT.
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Affiliation(s)
- Catherine Martin
- Centre for Vascular Health, Monash University and Department of Vascular Sciences and Medicine, Dandenong Hospital, Southern Health, Melbourne, Victoria, Australia
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The white coat phenomenon is benign in referred treated patients: a 14-year ambulatory blood pressure mortality study. J Hypertens 2008; 26:699-705. [DOI: 10.1097/hjh.0b013e3282f4b3bf] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Erdogan D, Caliskan M, Yildirim I, Gullu H, Baycan S, Ciftci O, Yildirir A, Muderrisoglu H. Effects of normal blood pressure, prehypertension and hypertension on left ventricular diastolic function and aortic elastic properties. Blood Press 2007; 16:114-21. [PMID: 17612910 DOI: 10.1080/08037050701395910] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (BP) provides guideline for the new category of BP levels as normal, prehypertension (PHT), and hypertension. Although PHT is associated with a markedly increased risk of developing hypertension within 4 years, its prognostic significance and predisposition to target-organ damage is unknown. Accordingly, we evaluated the effects of normal BP, PHT and hypertension on left ventricular (LV) diastolic function and aortic elasticity, which are sensitive indicators of target-organ damage. METHODS We evaluated LV diastolic function and aortic elastic properties of 60 subjects with PHT, 70 patients with hypertension and 50 normotensive healthy volunteers using transthoracic echocardiography. None of the subjects had any systemic disease. RESULTS LV diastolic function was more significantly impaired in the hypertension group than in the PHT group compared with controls, but it was not strongly different between the PHT and control group. Aortic distensibility was significantly lower, and aortic stiffness index was significantly higher in both the hypertension and the PHT group than those in the control group. However, aortic elastic properties did not significantly differ between the PHT and hypertension groups. Furthermore, we found that the presence of the PHT was significant predictor of impaired aortic elasticity in a multivariable model that adjusted for other variables. CONCLUSIONS Aortic elastic properties are significantly and LV diastolic function is slightly impaired in subjects with PHT, and impairment of aortic elasticity is as severe as that in hypertension.
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Affiliation(s)
- Dogan Erdogan
- Suleyman Demirel University, Medical Faculty, Cardiology Department, Isparta, Turkey.
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