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Habas E, Errayes A, Habas E, Alfitori G, Habas A, Farfar K, Rayani A, Habas A, Elzouki AN. Masked phenomenon: renal and cardiovascular complications; review and updates. Blood Press 2024; 33:2383234. [PMID: 39056371 DOI: 10.1080/08037051.2024.2383234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/10/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND In the in-clinic blood pressure (BP) recording setting, a sizable number of individuals with normal BP and approximately 30% of patients with chronic renal disease (CKD) exhibit elevated outpatient BP records. These individuals are known as masked hypertension (MHTN), and when they are on antihypertensive medications, but their BP is not controlled, they are called masked uncontrolled hypertension (MUHTN). The masked phenomenon (MP) (MHTN and MUHTN) increases susceptibility to end-organ damage (a two-fold greater risk for cardiovascular events and kidney dysfunction). The potential extension of the observed benefits of MP therapy, including a reduction in end-organ damage, remains questionable. AIM AND METHODS This review aims to study the diagnostic methodology, epidemiology, pathophysiology, and significance of MP management in end-organs, especially the kidneys, cardiovascular system, and outcomes. To achieve the purposes of this non-systematic comprehensive review, PubMed, Google, and Google Scholar were searched using keywords, texts, and phrases such as masked phenomenon, CKD and HTN, HTN types, HTN definition, CKD progression, masked HTN, MHTN, masked uncontrolled HTN, CKD onset, and cardiovascular system and MHTN. We restricted the search process to the last ten years to search for the latest updates. CONCLUSION MHTN is a variant of HTN that can be missed if medical professionals are unaware of it. Early detection by ambulatory or home BP recording in susceptible individuals reduces end-organ damage and progresses to sustained HTN. Adherence to the available recommendations when dealing with masked phenomena is justifiable; however, further studies and recommendation updates are required.
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Affiliation(s)
- Elmukhtar Habas
- Medical Department, Hamad General Hospital, Qatar University, Doha, Qatar
| | - Almehdi Errayes
- Medical Department, Hamad General Hospital, Qatar University, Doha, Qatar
| | - Eshrak Habas
- Internal Medicine, Medical Department, Tripoli Central Hospital, University of Tripoli, Tripoli, Libya
| | - Gamal Alfitori
- Medical Department, Hamad General Hospital, Qatar University, Doha, Qatar
| | - Ala Habas
- Medical Department, Alwakra General Hospital, Qatar University, Alwakra, Qatar
| | - Kalifa Farfar
- Medical Department, Alwakra General Hospital, Qatar University, Alwakra, Qatar
| | - Amnna Rayani
- Tripoli Children Hospital, University of Tripoli, Tripoli, Libya
| | - Aml Habas
- Tripoli Children Hospital, University of Tripoli, Tripoli, Libya
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Lin L, Jiang X, Liu L, Wu J, Yu T, Wei Y, Li M, Peng H, Wang C. Prognostic Effect of Masked Morning Hypertension in Chinese Inpatients With Non-dialysis Chronic Kidney Disease: A Multicenter Retrospective Study. Am J Hypertens 2024; 37:621-630. [PMID: 38625716 PMCID: PMC11247133 DOI: 10.1093/ajh/hpae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/09/2023] [Accepted: 04/09/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND This study aimed to elucidate the prognostic role of Masked Morning Hypertension (MMH) in non-dialysis-dependent chronic kidney disease (NDD-CKD). METHODS 2,130 NDD-CKD patients of the inpatient department were categorized into four blood pressure (BP) groups: clinical normotension (CH-), clinical hypertension (CH+) with morning hypertension (MH+), and without MH+ (MH-) respectively. The correlation between these four BP types and the primary (all-cause mortality) and secondary endpoints (cardio-cerebrovascular disease [CVD] and end-stage kidney disease [ESKD]) was analyzed. RESULTS The prevalence of MH and MMH were 47.4% and 14.98%, respectively. Morning hypertension independently increased the risk of all-cause mortality (P = 0.004) and CVD (P < 0.001) but not ESKD (P = 0.092). Masked morning hypertension was associated with heightened all-cause mortality (HR = 4.22, 95% CI = 1.31-13.59; P = 0.02) and CVD events (HR = 5.14, 95% CI = 1.37-19.23; P = 0.02), with no significant association with ESKD (HR = 1.18, 95% CI = 0.65-2.15; P = 0.60). When considering non-CVD deaths as a competing risk factor, a high cumulative incidence of CVD events was observed in the MMH group (HR = 5.16, 95% CI = 1.39-19.08). CONCLUSIONS MMH is an independent risk factor for all-cause mortality and combined cardiovascular and cerebrovascular events in NDD-CKD patients, underscoring its prognostic significance. This highlights the need for comprehensive management of MH in this population.
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Affiliation(s)
- Lin Lin
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, 52 Meihua East Road, Zhuhai 519000, Guangdong, China
| | - Xinying Jiang
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, 52 Meihua East Road, Zhuhai 519000, Guangdong, China
| | - Lingling Liu
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, 52 Meihua East Road, Zhuhai 519000, Guangdong, China
| | - Jingcan Wu
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, 52 Meihua East Road, Zhuhai 519000, Guangdong, China
| | - Tiantian Yu
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, 52 Meihua East Road, Zhuhai 519000, Guangdong, China
| | - Yuting Wei
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, 52 Meihua East Road, Zhuhai 519000, Guangdong, China
| | - Man Li
- Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
| | - Hui Peng
- Division of Nephrology, Department of Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Cheng Wang
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, 52 Meihua East Road, Zhuhai 519000, Guangdong, China
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Liu L, Lin L, Ke J, Chen B, Xia Y, Wang C. Higher Nocturnal Blood Pressure and Blunted Nocturnal Dipping Are Associated With Decreased Daytime Urinary Sodium and Potassium Excretion in Patients With CKD. Kidney Int Rep 2024; 9:73-86. [PMID: 38312777 PMCID: PMC10831351 DOI: 10.1016/j.ekir.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/26/2023] [Accepted: 10/16/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Sodium homeostasis is intimately associated with blood pressure (BP) rhythm, and potassium excretion is closely associated with sodium excretion in the general population. However, the association between circadian sodium and potassium pattern excretion and nocturnal BP in patients with chronic kidney disease (CKD) is not elucidated. Methods We evaluated the correlation between the day-to-night ratio of urinary sodium and potassium excretion rate, nocturnal blood pressure, and nocturnal BP dipping in a CKD cohort. Results A total of 3152 (56.76% males, mean age 47.63 years) individuals with CKD were included in the study. Patients in quartile 1 (with the lowest ratio) exhibited a 12 mmHg or 9 mmHg higher nocturnal systolic blood pressure (SBP) and blunted SBP dipping than those in quartile 4 when urinary sodium or potassium excretion rate was divided into day-to-night ratios (both P < 0.001). In multivariate analyses, lower day-to-night ratio of urinary sodium was independently linked to higher nocturnal SBP and blunted SBP dipping (linear regression coefficient (95% confidence interval [CI]): -6.89 (-9.48 to -4.31), and -3.64 (-5.48 to -1.80), respectively; both P < 0.001). Similarly, compared with the highest quartile of day-to-night ratio of urinary potassium excretion rate, linear regression coefficient (95% CI) for the lowest quartile was -5.60 (-8.13 to -3.07) for nocturnal SBP, and -2.47 (-4.28 to -0.67) for SBP dipping (both P < 0.001). Moreover, urine flow rate and concentrates of sodium or potassium in the urine were positively associated with urinary sodium or potassium excretion during daytime (P < 0.001). Conclusion A higher nocturnal BP and a blunted nocturnal BP dipping were both independently linked to a lower excretion of sodium or potassium during the day in patients with CKD. Furthermore, a decreased urine flow rate and a diminished capacity to concentrate sodium or potassium in the urine appear to be the key contributors to a low day-to-night ratio of urinary sodium excretion or potassium rate.
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Affiliation(s)
- Lingling Liu
- Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China
| | - Lin Lin
- Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China
| | - Jianting Ke
- Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China
| | - Binhuan Chen
- Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China
| | - Yu Xia
- Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China
| | - Cheng Wang
- Department of Nephrology, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, China
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Jiang X, Li X, Peng H, Li M, Wang C. Prognostic Value of Nighttime Double Product in Nondialysis Chronic Kidney Disease With Hypertension. J Am Heart Assoc 2023; 12:e031627. [PMID: 38108241 PMCID: PMC10863753 DOI: 10.1161/jaha.123.031627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Both nighttime systolic blood pressure and pulse rate are associated with adverse outcomes in patients with chronic kidney disease (CKD). However, nighttime double product (DP), which is the product of nighttime systolic blood pressure and pulse rate, has not yet been investigated in this context. The present study aimed to explore the prognostic value of nighttime DP for adverse outcomes in patients with CKD and hypertension. METHODS AND RESULTS This retrospective cohort study included a total of 1434 patients with nondialysis CKD complicated by hypertension. The patients were enrolled in Zhuhai and Guangzhou, China, with a median follow-up of 23.8 months. Patient enrollment for the high or low nighttime DP group was performed on the basis of the cutoff value determined by time-dependent receiver operator characteristic curve analysis. The primary end point was a composite of major cardiovascular and cerebrovascular events, and the secondary end point was all-cause death and composite renal end point. The 24-hour circadian DP rhythm was established via multiple-component cosinor analysis. Cox regression was used to explore the association between nighttime DP and adverse outcomes. The DP of nondialysis patients with CKD and hypertension showed a diurnal rhythm, which varied with renal function. After adjustment, high nighttime DP was associated with a higher risk for major cardiovascular and cerebrovascular events (hazard ratio [HR], 5.823 [95% CI, 2.382-14.233]), all-cause death (HR, 4.978 [95% CI, 2.205-11.240]), and composite renal event (HR, 1.661 [95% CI, 1.128-2.447]), compared with low nighttime DP. These associations were independent of nighttime systolic blood pressure and PR. CONCLUSIONS The present cohort study demonstrated that DP had diurnal fluctuations and nighttime DP was an important prognostic factor in nondialysis patients with CKD and hypertension, outperforming traditional risk factors, including systolic blood pressure and pulse rate.
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Affiliation(s)
- Xinying Jiang
- Division of Nephrology, Department of MedicineThe Fifth Affiliated Hospital Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Xuehong Li
- Division of Nephrology, Department of MedicineThe Fifth Affiliated Hospital Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Hui Peng
- Division of Nephrology, Department of MedicineThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouGuangdongChina
| | - Man Li
- Guangdong Provincial Key Laboratory of Biomedical ImagingThe Fifth Affiliated Hospital Sun Yat‐Sen UniversityZhuhaiGuangdongChina
| | - Cheng Wang
- Division of Nephrology, Department of MedicineThe Fifth Affiliated Hospital Sun Yat‐Sen UniversityZhuhaiGuangdongChina
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Liu X, Li F, Zheng Z, Li G, Zhou H, Zhang T, Tang Y, Qin W. Association of morning hypertension with chronic kidney disease progression and cardiovascular events in patients with chronic kidney disease and hypertension. Nutr Metab Cardiovasc Dis 2022; 32:965-972. [PMID: 35172934 DOI: 10.1016/j.numecd.2021.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/11/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIM Associations of morning hypertension with chronic kidney disease are rarely investigated in prospective studies. We aim to investigate the predictive value of uncontrolled morning hypertension (UMH) to chronic kidney disease (CKD) progression and cardiovascular (CV) events in patients with CKD and hypertension. METHODS AND RESULTS In this prospective two-center observational study, 304 hypertensive patients with CKD were enrolled. Time to total mortality, CKD progression and CV events was recorded; Kaplan-Meier survival function estimates and Multivariable Cox proportional hazard model were used to investigate associations between UMH and outcomes. The study protocol was approved by the Institutional Review Board (http://www.thaiclinicaltrials.org; TCTR20180313004). After a follow-up for median 30 months, 23 (7.6%) patients died, 34 (11.2%) had CKD progression, and 95 (31.3%) occurred new-onset CV events, respectively. UMH was shown to be a strong predictor of CKD progression [hazard ratio (HR) 2.46, 95% confidence interval (CI) 1.22-4.94] and CV events (HR 1.69, 95% CI 1.12-2.53). When morning hypertension was analyzed as a continuous variable, morning systolic blood pressure (per 10 mmHg) was also shown to be predictive to CKD progression (HR 1.28, 95% CI 1.07-1.53, P < 0.01) and CV events (HR 1.15, 95% CI 1.03-1.28, P < 0.01). CONCLUSIONS UMH is strongly associated with CKD progression and CV events in patients with CKD and hypertension. UMH in CKD patients deserves further attentions.
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Affiliation(s)
- Xiang Liu
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; West China school of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Fangming Li
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Division of Nephrology, Department of Medicine, Chengdu 7th People's Hospital
| | - Zhiyao Zheng
- West China school of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Gen Li
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huan Zhou
- West China school of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Ting Zhang
- West China school of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yi Tang
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Wei Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Liu X, Li F, Zhang T, Zheng Z, Zhou H, Qin A, Tang Y, Qin W. The Association of Morning Hypertension With Target Organ Damage in Patients With Chronic Kidney Disease and Hypertension. Front Cardiovasc Med 2021; 8:715491. [PMID: 34513954 PMCID: PMC8427187 DOI: 10.3389/fcvm.2021.715491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/20/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: To determine the association between morning hypertension and target organ damage (TOD) in patients with chronic kidney disease (CKD) and hypertension. Methods: In this cross-sectional study, 447 patients with CKD and hypertension from two centers were enrolled. Ambulatory blood pressure monitoring was conducted in all patients. Linear regression and logistic regression analysis were used to determine the association between morning hypertension and TOD in patients with CKD and hypertension, including assessments of estimated glomerular filtration rate (eGFR), left ventricular mass index (LVMI), urine protein/creatinine ratio (UPCR), and left ventricular hypertrophy (LVH). Results: Overall, 194 (43.4%) participants had morning hypertension. Morning hypertension was strongly correlated with LVH [odds ratio (OR), 2.14; 95% confidence interval (CI), 1.3–3.51; p < 0.01], lower level of eGFR (β = −0.51; 95%CI, −0.95–−0.08; p < 0.05), higher LVMI (β = 0.06; 95%CI, 0.04–0.08, p < 0.001), and UPCR (β = 0.22; 95%CI, 0.06–0.38, p < 0.01), independent of nocturnal hypertension and elevated morning blood pressure surge. As a continuous variable, both morning systolic blood pressure (SBP) and diastolic blood pressure (DBP) were found to be associated with LVH and higher level of UPCR and LVMI (p < 0.05), whereas only morning SBP was negatively correlated with eGFR (p < 0.01). Conclusion: Morning hypertension was strongly correlated with cardiac damage and impaired kidney function in CKD patients with hypertension, independent of nocturnal hypertension and morning surge in blood pressure. Morning hypertension in CKD patients warrants further attention.
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Affiliation(s)
- Xiang Liu
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Fangming Li
- Division of Nephrology, Department of Medicine, Chengdu Seventh People's Hospital, Chengdu, China
| | - Ting Zhang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhiyao Zheng
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Huan Zhou
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Aiya Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Yi Tang
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
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Liu X, Zhang T, Qin A, Li F, Zheng Z, Zhou H, Tang Y, Qin W. Association of morning blood pressure surge with chronic kidney disease progression in patients with chronic kidney disease and hypertension. J Clin Hypertens (Greenwich) 2021; 23:1879-1886. [PMID: 34498804 PMCID: PMC8678764 DOI: 10.1111/jch.14366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/20/2021] [Accepted: 08/31/2021] [Indexed: 02/05/2023]
Abstract
Blood pressure (BP) usually rise from being asleep to awake, which is named the morning blood pressure surge (MBPS). Researches have reported that elevated MBPS was related with CV events, incident CKD in hypertensive patients. However, there have been no studies that have investigated the association between MBPS and renal or heart outcomes in patients with CKD and hypertension, in these patients, the MBPS is much lower because of high prevalence of night hypertension and reduced BP dipping. In this prospective two-center observational study, we enrolled patients with CKD and hypertension and the 24 h ambulatory blood pressure monitoring (ABPM) was conducted in all patients. Time to total mortality, CKD progression and CV events was recorded; Finally, a total of 304 patients were enrolled and 94 (30.9%) of them had elevated MBPS. After a follow-up for median 30 months, 23 (7.6%), 34 (11.2%), and 95 (31.3%) patients occurred death, CKD progression and new-onset CV events, respectively. The Cox regression analysis suggested the elevated MBPS was a strong predictor of CKD progression (HR 2.35, 95%CI 1.2 -4.63, p = .013), independent of morning BP, while no associations were found between elevated MBPS and CV events (HR 1.02, 95%CI 0.66 -1.57), as well as death (HR 1.08, 95%CI 0.46 -2.55). In conclusion, we provided the first evidence that elevated MBPS was an important risk factor of CKD progression in patients with CKD and hypertension. Appropriate evaluation and management of MBPS may be helpful to postpone CKD progression.
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Affiliation(s)
- Xiang Liu
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Ting Zhang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Aiya Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Fangming Li
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Division of Nephrology, Department of Medicine, Chengdu Seventh People's Hospital, Chengdu, Sichuan, China
| | - Zhiyao Zheng
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Huan Zhou
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Yi Tang
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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The Association of Morning Surge and Night-Time Dipping Blood Pressure with Significant and Complex Coronary Artery Lesions. High Blood Press Cardiovasc Prev 2021; 28:467-474. [PMID: 34057691 DOI: 10.1007/s40292-021-00463-9] [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: 03/12/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Hypertension responsible for more than 10 million deaths annually worldwide and abnormal diurnal blood pressure (BP) variation is associated with cardiovascular events. AIM This study aimed to investigate the association between the 24-h ambulatory night BP dipping and morning BP surge (MS) with characteristic of coronary artery lesions that may contribute cardiovascular events and mortality burden. METHODS A cross sectional study over 1-year, collected 263 cases of hypertensive (80%) and non-hypertensive patients, aged 61 ± 10 years, who undergoing invasive coronary angiography (CAG) and 24-h ambulatory BP monitoring admitted to cardiology department complain of chest pain. The night-time/day-time dip and sleep-trough MS were calculated. Non-dipper status was considered when night-time/day-time dip < 10%, and significant coronary lesion (SCL) when ≥ 50 % stenosis in 1.5 mm vessels. The SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score was used to quantify the complexity of SCL. RESULT The mean morning systolic BP (SBP) surge was higher in the high SYNTAX Score subgroup than low and intermediate subgroups (25 ± 11 vs 17 ± 13 and 10 ± 10 mmHg, p < 0.010). Non-dipper SBP status was more frequently in patients with SCL than non-SCL (p < 0.019). In ordinal regression, hypertension was independent predictor of SCL (odd ratio: 0.40, p < 0.003), the night-time/day-time BP dip was independent predictor of being in a higher SYNTAX score subgroup (systolic odd ratio: 0.88, diastolic odd ratio: 1.14 p < 0.05). CONCLUSION Hypertension is associated with SCL and the night-time/day-time BP dip as a continuous variable is associated with complex coronary lesion. Non-dipping as categorical variable and morning BP surge were not independent predictors of significant or complex coronary lesions.
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Hao Y, Li X, Zhu Y, Ke J, Lou T, Li M, Wang C. Effect of age and isolated systolic or diastolic hypertension on target organ damage in non-dialysis patients with chronic kidney disease. Aging (Albany NY) 2021; 13:6144-6155. [PMID: 33619233 PMCID: PMC7950225 DOI: 10.18632/aging.202609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/21/2021] [Indexed: 01/11/2023]
Abstract
The aim of this study was to investigate associations between age-dependent variations in isolated systolic/diastolic hypertension (ISH/IDH) with target organ damage in chronic kidney disease (CKD). A cross-sectional study was conducted among 2,459 CKD patients with ambulatory blood pressure monitoring. Blood pressure was categorized into four groups: normotension, ISH, IDH, and systolic-diastolic hypertension. The outcome measurements were left ventricular mass index (LVMI), estimated glomerular filtration rate(eGFR), and urinary albumin creatinine ratio (ACR). Older patients (≥60-years-old) had a higher prevalence of ISH and a lower prevalence of IDH than younger patients (<60-years-old). In multivariate analysis, compared with the normotension group, younger patients with ISH were associated with higher LVMI (+14.4 g/m2), lower eGFR (−0.2 log units), and higher ACR (+0.5 log units); but younger patients with IDH were only associated with lower eGFR (−0.2 log units) and higher ACR (+0.4 log units). Among older patients, ISH was correlated with higher LVMI (+8.8 g/m2), lower eGFR (−0.2 log units), and higher ACR (+1.0 log units), whereas IDH was not associated with these renal/cardiovascular parameters. In conclusion, ISH was associated with a relatively high risk of target organ damage irrespective of age, whereas IDH was only correlated with renal injury in younger CKD patients.
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Affiliation(s)
- Yu Hao
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, Guangdong, China
| | - Xue Li
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, Guangdong, China
| | - Ye Zhu
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, Guangdong, China
| | - Jianting Ke
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, Guangdong, China
| | - Tanqi Lou
- Division of Nephrology, Department of Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
| | - Man Li
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, Guangdong, China
| | - Cheng Wang
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital Sun Yat-Sen University, Zhuhai 519000, Guangdong, China.,Division of Nephrology, Department of Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
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Wen RW, Chen XQ, Zhu Y, Ke JT, Du Y, Wang C, Lou TQ. Ambulatory blood pressure is better associated with target organ damage than clinic blood pressure in patients with primary glomerular disease. BMC Nephrol 2020; 21:541. [PMID: 33308181 PMCID: PMC7731761 DOI: 10.1186/s12882-020-02200-1] [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: 12/12/2019] [Accepted: 12/02/2020] [Indexed: 12/14/2022] Open
Abstract
Background Blood pressure is an important and modifiable cardiovascular risk factor. Ambulatory blood pressure monitoring (ABPM) provides valuable prognostic information in patients with chronic kidney disease (CKD), yet little is known about the association of various types of BP measurements with target organ damage (TOD) in patients with primary glomerular disease. The goal of this study was to investigate whether ambulatory blood pressure is better associated with TOD than clinic blood pressure in patients with primary glomerular disease. Methods 1178 patients with primary glomerular disease were recruited in this cross-sectional study. TOD were assessed by the following 4 parameters: left ventricular mass index (LVMI or LVH, left ventricular hypertrophy), estimated glomerular filtration rate (eGFR< 60 ml/min/1.73m2), albumin-to-creatinine ratio (ACR ≥ 30 mg/g) and carotid intima-media thickness (cIMT) or plaque. Receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were used to evaluate the relationship between ambulatory or clinic systolic blood pressure (SBP) indexes and TOD. Results Among 1178 patients (mean age, 39 years,54% men), 116, 458, 1031 and 251 patients had LVH, eGFR < 60 ml/min/1.73m2, ACR ≥ 30 mg/g and cIMT≥0.9 mm or plaque respectively. Area under ROC curves for TOD in ambulatory SBP, especially nighttime SBP, was greater than that in clinic SBP (P < 0.05). Multivariate logistic regression analyses showed that 24 h SBP, daytime SBP and nighttime SBP were significantly associated with LVH, eGFR< 60 ml/min/1.73m2 and ACR ≥ 30 mg/g after adjustment for clinic SBP, while the association of clinic SBP was attenuated after further adjustment for nighttime SBP. Conclusions Ambulatory blood pressure, especially nighttime blood pressure, is probably superior to clinic blood pressure and has a significant association with TOD in primary glomerular disease patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-020-02200-1.
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Affiliation(s)
- Ruo-Wei Wen
- Division of Nephrology, Department of Medicine, the Fifth affiliated hospital Sun Yat-Sen University, ZhuHai, 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth affiliated hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Xiao-Qiu Chen
- Division of Nephrology, Department of Medicine, the Fifth affiliated hospital Sun Yat-Sen University, ZhuHai, 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth affiliated hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Ye Zhu
- Division of Nephrology, Department of Medicine, the Fifth affiliated hospital Sun Yat-Sen University, ZhuHai, 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth affiliated hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Jian-Ting Ke
- Division of Nephrology, Department of Medicine, the Fifth affiliated hospital Sun Yat-Sen University, ZhuHai, 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth affiliated hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Yi Du
- Division of Nephrology, Department of Medicine, the Fifth affiliated hospital Sun Yat-Sen University, ZhuHai, 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth affiliated hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Cheng Wang
- Division of Nephrology, Department of Medicine, the Fifth affiliated hospital Sun Yat-Sen University, ZhuHai, 519000, Guangdong, China. .,Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth affiliated hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
| | - Tan-Qi Lou
- Division of Nephrology, Department of Medicine, the Third affiliated hospital Sun Yat-Sen University, GuangZhou, 510000, Guangdong, China
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