1
|
McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Canavan MD, Ceconi C, Christodorescu RM, Daskalopoulou SS, Ferro CJ, Gerdts E, Hanssen H, Harris J, Lauder L, McManus RJ, Molloy GJ, Rahimi K, Regitz-Zagrosek V, Rossi GP, Sandset EC, Scheenaerts B, Staessen JA, Uchmanowicz I, Volterrani M, Touyz RM. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J 2024; 45:3912-4018. [PMID: 39210715 DOI: 10.1093/eurheartj/ehae178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
|
2
|
Venishetty N, Berry JD, de Lemos JA, Wu E, Lee M, Drawz PE, Nambi V, Ballantyne CM, Killeen AA, Ix JH, Shlipak MG, Ascher SB. Associations of Ambulatory Blood Pressure Measurements With High-Sensitivity Troponin and Natriuretic Peptide Levels in SPRINT. Am J Hypertens 2024; 37:571-579. [PMID: 38554284 PMCID: PMC11247134 DOI: 10.1093/ajh/hpae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Nighttime blood pressure (BP) has greater prognostic importance for cardiovascular disease (CVD) than daytime BP, but less is known about nighttime and daytime BP associations with measures of subclinical CVD. METHODS Among 897 Systolic Blood Pressure Intervention Trial Study (SPRINT) participants with 24-hour ambulatory BP monitoring obtained near the 27-month study visit, 849 (95%) had N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) measured at the 24-month study visit. Multivariable linear regression analyses were performed to evaluate the associations of nighttime and daytime BP with cardiac biomarker levels. RESULTS The mean age was 69 ± 12 years, 28% were African American, and mean nighttime and daytime SBP were 121 ± 16 mm Hg and 132 ± 14 mm Hg, respectively. In multivariable models, compared with the lowest tertile of nighttime systolic BP, the highest tertile was associated with 48% higher NT-proBNP levels (adjusted geometric mean ratio [GMR] = 1.48, 95% CI: 1.22, 1.79), and 19% higher hs-cTnT levels (adjusted GMR = 1.19, 95% CI: 1.07, 1.32). In contrast, the highest vs. lowest tertile of daytime systolic BP was not associated with NT-proBNP (adjusted GMR = 1.09, 95% CI: 0.88, 1.34), but was associated with 16% higher hs-cTnT levels (adjusted GMR = 1.16, 95% CI: 1.04, 1.30). Similar results were observed using diastolic BP. CONCLUSIONS In SPRINT, both higher nighttime and daytime BP were independently associated with higher hs-cTnT levels, but only higher nighttime BP was associated with higher NT-proBNP levels.
Collapse
Affiliation(s)
- Nikit Venishetty
- Department of Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Jarett D Berry
- Department of Medicine, University of Texas at Tyler Health Science Center, Tyler, Texas, USA
| | - James A de Lemos
- Division of Cardiology, Department of Cardiology, the University of Texas at Southwestern Medical School, Dallas, Texas, USA
| | - Elaine Wu
- Division of Cardiology, Department of Cardiology, the University of Texas at Southwestern Medical School, Dallas, Texas, USA
| | - MinJae Lee
- Department of Biostatistics, Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Paul E Drawz
- Division of Nephrology and Hypertension, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Vijay Nambi
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Christie M Ballantyne
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, Texas, USA
| | - Anthony A Killeen
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Joachim H Ix
- Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California, USA
- Division of Nephrology-Hypertension, University of California San Diego, San Diego, California, USA
| | - Michael G Shlipak
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco, California, USA
| | - Simon B Ascher
- Department of Medicine, Kidney Health Research Collaborative, San Francisco Veterans Affairs Health Care System and University of California San Francisco, San Francisco, California, USA
- Division of Hospital Medicine, University of California Davis, Sacramento, California, USA
| |
Collapse
|
3
|
Nolde JM, Atkins E, Marschner S, Hillis GS, Chalmers J, Billiot L, Nelson MR, Reid CM, Hay P, Burke M, Jansen S, Usherwood T, Rodgers A, Chow CK, Schlaich MP. Ambulatory blood pressure after 12 weeks of quadruple combination of quarter doses of blood pressure medication vs. standard medication. J Hypertens 2024; 42:1009-1018. [PMID: 38501351 DOI: 10.1097/hjh.0000000000003683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND A combination of four ultra-low-dose blood pressure (BP) medications lowered office BP more effectively than initial monotherapy in the QUARTET trial. The effects on average ambulatory BP changes at 12 weeks have not yet been reported in detail. METHODS Adults with hypertension who were untreated or on monotherapy were eligible for participation. Overall, 591 participants were randomized to either the quadpill (irbesartan 37.5 mg, amlodipine 1.25 mg, indapamide 0.625 mg, and bisoprolol 2.5 mg) or monotherapy control (irbesartan 150 mg). The difference in 24-h, daytime, and night-time systolic and diastolic ambulatory BP at 12 weeks along further metrics were predefined secondary outcomes. RESULTS Of 576 participants, 289 were randomized to the quadpill group and 287 to the monotherapy group. At 12 weeks, mean 24-h ambulatory SBP and DBP were 7.7 [95% confidence interval (95% CI) 9.6-5.8] and 5.3 (95% CI: 6.5-4.1) mmHg lower in the quadpill vs. monotherapy group ( P < 0.001 for both). Similar reductions in the quadpill group were observed for daytime (8.1/5.7 mmHg lower) and night-time (6.3/4.0 mmHg lower) BP at 12 weeks (all P < 0.001) compared to monotherapy. The rate of BP control (24-h average BP < 130/80 mmHg) at 12 weeks was higher in the quadpill group (77 vs. 50%; P < 0.001). The reduction in BP load was also more pronounced with the quadpill. CONCLUSION A quadruple quarter-dose combination compared with monotherapy resulted in greater ambulatory BP lowering across the entire 24-h period with higher ambulatory BP control rates and reduced BP variability at 12 weeks. These findings further substantiate the efficacy of an ultra-low-dose quadpill-based BP lowering strategy.
Collapse
Affiliation(s)
- Janis M Nolde
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, The University of Western Australia, Perth, Western Australia
| | - Emily Atkins
- The George Institute for Global Health, University of New South Wales
- Westmead Applied Research Centre, University of Sydney
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales
| | - Simone Marschner
- Westmead Applied Research Centre, University of Sydney
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales
| | - Graham S Hillis
- Department of Cardiology, Royal Perth Hospital
- School of Medicine, The University of Western Australia, Perth, Western Australia
| | - John Chalmers
- The George Institute for Global Health, University of New South Wales
| | - Laurent Billiot
- The George Institute for Global Health, University of New South Wales
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania
| | - Christopher M Reid
- School of Public Health & Preventive Medicine Monash University, School of Population Health, Curtin University, Perth, Western Australia
| | | | - Michael Burke
- School of Medicine, Western Sydney University, Sydney, New South Wales
| | | | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales
- Westmead Applied Research Centre, University of Sydney
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales
| | - Clara K Chow
- The George Institute for Global Health, University of New South Wales
- Westmead Applied Research Centre, University of Sydney
- Department of Cardiology, Westmead Hospital, Sydney, New South Wales
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, The University of Western Australia, Perth, Western Australia
- Department of Cardiology, Royal Perth Hospital
- School of Medicine, The University of Western Australia, Perth, Western Australia
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Kario K, Tomitani N, Hoshide S, Nishizawa M, Yoshida T, Kabutoya T, Fujiwara T, Mizuno H, Okawara Y, Kanegae H. Different Home Blood Pressure Thresholds to Predict Perfect 24-Hour Ambulatory Blood Pressure Control in Treated Hypertension Based on an "All-in-One" Device. Hypertension 2023; 80:2464-2472. [PMID: 37671575 DOI: 10.1161/hypertensionaha.123.21578] [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: 05/30/2023] [Accepted: 08/11/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Home blood pressure (BP) is an important component of digital strategies for hypertension management. However, no studies have used the same device to investigate 24-hour BP control status in relation to different home BP control thresholds. METHODS Participants in the general practitioner-based, multicenter HI-JAMP study (Home-Activity Information and Communication Technology-Based Japan Ambulatory Blood Pressure Monitoring Prospective) underwent office BP measurement, then 24-hour ambulatory BP monitoring, then home BP monitoring for 5 days. A validated all-in-one BP monitoring device was used to measure office, home, and ambulatory BP. Baseline data were used to investigate ambulatory BP control status in individuals with well-controlled home BP based on the different guideline thresholds (125/75 mm Hg, 130/80 mm Hg, and 135/85 mm Hg). RESULTS Data from 2269 patients were analyzed. For individuals with well-controlled home BP <135/85 mm Hg (59.5% of the total population), the prevalence of uncontrolled 24-hour (≥130/80 mm Hg), daytime (≥135/85 mm Hg), and nighttime ambulatory BP (≥120/70 mm Hg) was 19.9%, 18.5%, and 33.6%, respectively. Corresponding prevalence rates in the 42.7% of participants with well-controlled home BP <130/80 mm Hg were 13.4%, 12.9%, and 26.0%, and when well-controlled home BP was strictly defined as <125/75 mm Hg (23.9% of the population), prevalence of rates of uncontrolled 24-hour, daytime, and nighttime ambulatory BP were 7.0%, 9.0%, and 15.3%, respectively. CONCLUSIONS Home BP control status defined using different thresholds could predict 24-hour ambulatory BP control status in treated hypertension. One-third of individuals still had uncontrolled nocturnal hypertension when home BP was controlled to <135/85 mm Hg, but ambulatory BP was quite well controlled when home BP was <125/75 mm Hg.
Collapse
Affiliation(s)
- Kazuomi Kario
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Naoko Tomitani
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Satoshi Hoshide
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | | | - Tetsuro Yoshida
- Onga Nakama Medical Association Onga Hospital, Fukuoka, Japan (T.Y.)
| | - Tomoyuki Kabutoya
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Takeshi Fujiwara
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Hiroyuki Mizuno
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Yukie Okawara
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| | - Hiroshi Kanegae
- Department of Medicine, Division of Cardiovascular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K., N.T., S.H., T.K., T.F., H.M., Y.O., H.K.)
| |
Collapse
|
5
|
Filippone EJ, Foy AJ, Naccarelli GV. Controversies in Hypertension III: Dipping, Nocturnal Hypertension, and the Morning Surge. Am J Med 2023:S0002-9343(23)00160-2. [PMID: 36893831 DOI: 10.1016/j.amjmed.2023.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
A comprehensive approach to hypertension requires out-of-office determinations by home and/or ambulatory monitoring. The 4 phenotypes comparing office and out-of-office pressures in treated and untreated patients include normotension, hypertension, white-coat phenomena, and masked phenomena. Components of out-of-office pressure may be equally as important as mean values. Nighttime pressures are normally 10 - 20% lower than daytime (normal "dipping"). Abnormalities include dipping more than 20% (extreme dippers), less than 10 % (non-dippers), or rising above daytime (risers) and have been associated with elevated cardiovascular risk. Nighttime pressure may be elevated (nocturnal hypertension) in isolation or together with daytime hypertension. Isolated nocturnal hypertension theoretically changes white-coat hypertension to true hypertension and normotension to masked hypertension. Pressure normally peaks in the morning hours ("morning surge") when cardiovascular events are most common. Morning hypertension may result from residual nocturnal hypertension or an exaggerated surge and has been associated with enhanced cardiovascular risk, especially in Asian populations. Randomized trials are needed to determine whether altering therapy based solely on either abnormal dipping, isolated nocturnal hypertension, and/or an abnormal surge is justified.
Collapse
Affiliation(s)
- Edward J Filippone
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
| | - Andrew J Foy
- Department of Medicine, Penn State University Heart and Vascular Institute; Penn State M.S Hershey Medical Center and College of Medicine, Hershey, Pennsylvania, USA
| | - Gerald V Naccarelli
- Department of Medicine, Penn State University Heart and Vascular Institute; Penn State M.S Hershey Medical Center and College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
6
|
Nolde JM, Hillis GS, Atkins E, Von Huben A, Marschner S, Chan J, Reid CM, Nelson MR, Figtree G, Chalmers J, Usherwood T, Rodgers A, Chow CK, Schlaich MP. Impact of various night-time period definitions on nocturnal ambulatory blood pressure. J Hypertens 2022; 40:2271-2279. [PMID: 35983855 DOI: 10.1097/hjh.0000000000003255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several definitions of night-time BP exist for the calculation of nocturnal blood pressure (BP) based on 24-h BP measurements. How much these methods differ regarding the resulting nocturnal blood pressure values, under which circumstances these differences become clinically meaningful, and under which circumstances diary-adjusted measurements should be used preferentially remains uncertain. METHODS Data of 512 24-h BP recordings were analysed regarding differences in nocturnal BP based on three alternative definitions of night-time: 2300-0700 h, 0100-0500 h, and diary-adjusted measures. RESULTS Mean systolic nocturnal BP between 2300-0700 h was 2.5 mmHg higher than between 0100 and 0500 h and 1.6 mmHg higher than diary adjusted estimates. Up to 38.3% of individuals showed BP differences of more than 5 mmHg when comparing temporal definitions of night-time, resulting in significant proportions of individuals being re-classified as hypertensive. When diary-derived sleeping patterns differed by less than 2 h from the 2300 to 0700 h fixed time definition, mean BP discrepancies remained below 3 mmHg. Absolute time discrepancies between diary and 2300-0700 h fixed time definition of 2-4, 4-8 or at least 8 h led to SBP/DBP differences of 4.1/3.1, 6.8/6.1, and 14.5/9.1mmHg, respectively. CONCLUSION Average differences of nocturnal BP between varying definitions in study/cohort data are small and would be of limited relevance in many settings. However, substantial differences can be observed in individual cases, which may affect clinical decision-making in specific patients. In patients whose sleeping patterns differs by more than 2 h from defined fixed night-times, diaries should be used for adjustment.
Collapse
Affiliation(s)
- Janis M Nolde
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, The University of Western Australia
| | | | - Emily Atkins
- The George Institute for Global Health, University of New South Wales
- Westmead Applied Research Centre, University of Sydney, Sydney and Department of Cardiology, Westmead Hospital, Sydney
| | - Amy Von Huben
- Westmead Applied Research Centre, University of Sydney, Sydney and Department of Cardiology, Westmead Hospital, Sydney
| | - Simone Marschner
- Westmead Applied Research Centre, University of Sydney, Sydney and Department of Cardiology, Westmead Hospital, Sydney
| | - Justine Chan
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, The University of Western Australia
| | - Christopher M Reid
- School of Public Health & Preventive Medicine Monash University, Melbourne, Victoria
- School of Population Health, Curtin University, Perth
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart
| | - Gemma Figtree
- Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney
| | - John Chalmers
- Westmead Applied Research Centre, University of Sydney, Sydney and Department of Cardiology, Westmead Hospital, Sydney
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales
- Westmead Applied Research Centre, University of Sydney, Sydney and Department of Cardiology, Westmead Hospital, Sydney
| | - Anthony Rodgers
- The George Institute for Global Health, University of New South Wales
| | - Clara K Chow
- The George Institute for Global Health, University of New South Wales
- Westmead Applied Research Centre, University of Sydney, Sydney and Department of Cardiology, Westmead Hospital, Sydney
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, The University of Western Australia
- Department of Cardiology, Royal Perth Hospital, Perth
- Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| |
Collapse
|
7
|
Kim SH, Shin C, Kim S, Kim JS, Lim SY, Seo HS, Lim HE, Sung KC, Cho GY, Lee SK, Kim YH. Prevalence of Isolated Nocturnal Hypertension and Development of Arterial Stiffness, Left Ventricular Hypertrophy, and Silent Cerebrovascular Lesions: The KoGES (Korean Genome and Epidemiology Study). J Am Heart Assoc 2022; 11:e025641. [PMID: 36193933 DOI: 10.1161/jaha.122.025641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Apart from nondippers' impact on cardiovascular events, the prevalence of isolated nocturnal hypertension (INH) and its consequences on both the heart and brain were not clearly investigated in the general population. Methods and Results The participants underwent ambulatory blood pressure monitoring evaluations for arterial stiffness, echocardiography, and brain magnetic resonance imaging. They were grouped into normotension, INH, and overt diurnal hypertension, based on ambulatory blood pressure monitoring and history of antihypertensive treatment. White matter hyperintensity, arterial stiffness, and echocardiographic parameters were compared. Of the 1734 participants, there were 475 (27.4%) subjects with normotension, 314 with INH (18.1%), and 945 with overt diurnal hypertension (54.5%). Prevalence of INH was not different between sex or age. Of INH, 71.3% (n=224) was caused by elevated diastolic blood pressure. After multivariable adjustment, INH showed higher pulse wave velocity (P<0.001) and central systolic blood pressure (P<0.001), left ventricular mass index (P=0.026), and worse left ventricular diastolic function (early diastolic mitral annular velocity) (P<0.001) than normotension. Mean white matter hyperintensity scores of INH were not different from normotension (P=0.321), but the odds for white matter hyperintensity presence were higher in INH than normotension (odds ratio, 1.504 [95% CI, 1.097-2.062]; P=0.011). Conclusions INH was common in the general population and associated with increased arterial stiffness, left ventricular hypertrophy, and diastolic dysfunction. White matter hyperintensity was more likely to be present in the INH group than in the normotension group. The use of ambulatory blood pressure monitoring should be encouraged to identify masked INH and prevent the occurrence of cardiovascular events.
Collapse
Affiliation(s)
- Seong Hwan Kim
- Division of Cardiology, Department of Internal Medicine Korea University Ansan Hospital Ansan Republic of Korea
| | - Chol Shin
- Institute of Human Genomic Study, Department of Radiology Korea University Ansan Hospital Ansan Republic of Korea
| | - Sunwon Kim
- Division of Cardiology, Department of Internal Medicine Korea University Ansan Hospital Ansan Republic of Korea
| | - Jin-Seok Kim
- Division of Cardiology, Department of Internal Medicine Korea University Ansan Hospital Ansan Republic of Korea
| | - Sang Yup Lim
- Division of Cardiology, Department of Internal Medicine Korea University Ansan Hospital Ansan Republic of Korea
| | - Hyeong-Seok Seo
- Institute of Human Genomic Study, Department of Radiology Korea University Ansan Hospital Ansan Republic of Korea
| | - Hong Euy Lim
- Division of Cardiology, Department of Internal Medicine Hallym University Sacred Heart Hospital Anyang Republic of Korea
| | - Ki-Chul Sung
- Division of Cardiology, Department of Internal Medicine Kangbuk Samsung Medical Center Seoul Republic of Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine Seoul National University Bundang Hospital Seongnam Republic of Korea
| | - Seung Ku Lee
- Institute of Human Genomic Study, Department of Radiology Korea University Ansan Hospital Ansan Republic of Korea
| | - Yong-Hyun Kim
- Division of Cardiology, Department of Internal Medicine Korea University Ansan Hospital Ansan Republic of Korea
| |
Collapse
|
8
|
Nolde JM, Lugo-Gavidia LM, Kannenkeril D, Chan J, Robinson S, Jose A, Joyson A, Schlaich L, Carnagarin R, Azzam O, Kiuchi MG, Schlaich MP. Simultaneously measured inter-arm blood pressure difference is not associated with pulse wave velocity in a clinical dataset of at-risk hypertensive patients. J Hum Hypertens 2022; 36:811-818. [PMID: 34354250 DOI: 10.1038/s41371-021-00588-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/09/2022]
Abstract
Recent analysis of systolic inter-arm differences in blood pressure from the INTERPRESS-IPD Collaboration suggest an association with increased all-cause mortality, cardiovascular mortality and cardiovascular events. Previous studies have demonstrated associations with other risk parameters. We aimed to reproduce these associations in a cohort of 199 treated, at-risk hypertensive patients with pulse wave velocity (PWV) as a surrogate marker of cardiovascular (CV) damage. Simultaneously measured inter-arm blood pressure (BP) differences, 24 hour ambulatory BP and PWV were measured in 199 treated patients from a tertiary hospital hypertension outpatient clinic. Associations between systolic inter-arm BP difference and PWV were analyzed with uni- and multi-variate regression models. Out of 199 participants, 90 showed an inter-arm BP difference of more than 5 mmHg. The inter-arm difference was not associated with PWV. Furthermore, neither observed single BP measurements nor 24 hour ambulatory BP was associated with inter-arm BP differences. In our clinical patient cohort we failed to observe an association between inter-arm BP differences and PWV. Mode of assessment, study design and the sample characteristics of this treated, hypertensive cohort may have contributed to the negative findings. The limited sample size of the study poses a challenge to the detection of smaller effects in our study.
Collapse
Affiliation(s)
- Janis M Nolde
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Leslie Marisol Lugo-Gavidia
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Dennis Kannenkeril
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia.,Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Justine Chan
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Sandi Robinson
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Ancy Jose
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Anu Joyson
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Luca Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Omar Azzam
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Márcio Galindo Kiuchi
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine-Royal Perth Hospital Research Foundation, Faculty of Medicine, Dentistry & Health Sciences, The University of Western Australia, Perth, WA, Australia. .,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia. .,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
| |
Collapse
|
9
|
Liu J, Su X, Nie Y, Zeng Z, Chen H. Nocturnal blood pressure rather than night-to-day blood pressure ratio is related to arterial stiffening in untreated young and middle-aged adults with non-dipper hypertension. J Clin Hypertens (Greenwich) 2022; 24:1044-1050. [PMID: 35894760 PMCID: PMC9380157 DOI: 10.1111/jch.14546] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/18/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022]
Abstract
Little is known about nocturnal blood pressure (BP) or night-to-day BP ratio, which is a more specific determinant of arterial stiffness in subjects with non-dipper hypertension? This study aims to investigate the correlation of nocturnal BP and brachial-ankle pulse wave velocity (ba PWV), an index of arterial stiffness in untreated young and middle-aged adults with non-dipper hypertension. A cross-sectional analysis of baseline parameters of the NARRAS trial was performed. Twenty-four hour ambulatory BP measurements, ba PWV and routine clinical data collection were performed in all patients. The relationship of 24-h ambulatory BP profiles, biochemical measures as well as demographic parameters and ba PWV were analyzed using Pearson's correlation and multiple stepwise regression analysis. A total of 77 patients (mean age 47.0 ± 11.7 years) with non-dipper hypertension were included. Age, height, weight and nocturnal systolic BP were related to ba PWV in Pearson's correlation analysis. In stepwise regression analysis, age (β = 10.57, 95% confidence interval (CI): 6.099-15.042, p < 0.001) and weight (β = -3.835, 95% CI: -7.658--0.013, p = 0.049) are related to ba PWV. Nocturnal systolic BP (β = 8.662, 95% CI: 2.511-14.814, p = 0.006) was the independent predictors of ba PWV, even after night-to-day systolic BP ratio or 24-h ambulatory BP profile were taken into account. Nocturnal systolic BP rather than night-to-day systolic BP ratio appears to be a more specific determinant for arterial stiffness, as assessed by ba PWV in young and middle-aged adults with non-dipper hypertension. 24-h ambulatory BP measurements are essential for cardiovascular risk evaluation.
Collapse
Affiliation(s)
- Jing Liu
- Department of HypertensionPeking University People's HospitalBeijingChina
| | - Xiaofeng Su
- Department of HypertensionPeking University People's HospitalBeijingChina
| | - Ying Nie
- Department of Internal MedicineBeijing Jiaotong University HospitalBeijingChina
| | - Zhihuan Zeng
- Department of CardiologyThe First Affiliated Hospital of Guangdong Pharmaceutical UniversityGuangzhouChina
| | - Hongyan Chen
- Deparment of Internal MedicineNorth China Electric Power University HospitalBeijingChina
| | | |
Collapse
|
10
|
Lugo-Gavidia LM, Carnagarin R, Burger D, Nolde JM, Chan J, Robinson S, Bosio E, Matthews VB, Schlaich MP. Circulating platelet-derived extracellular vesicles correlate with night-time blood pressure and vascular organ damage and may represent an integrative biomarker of vascular health. J Clin Hypertens (Greenwich) 2022; 24:738-749. [PMID: 35502649 PMCID: PMC9180329 DOI: 10.1111/jch.14479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 12/11/2022]
Abstract
Elevated office blood pressure (BP) has previously been associated with increased levels of circulating extracellular vesicles (EVs). The present study aimed to assess the relationship between levels of platelet derived EVs, ambulatory BP parameters, and pulse wave velocity as a marker of macrovascular organ damage. A total of 96 participants were included in the study. Platelet-derived extracellular vesicles (pEVs) were evaluated by flow cytometry (CD41+/Annexin v+). BP evaluation included unobserved automated office BP and ambulatory BP monitoring. Carotid-femoral pulse wave velocity (PWV) was measured as a marker of macrovascular damage. pEVs correlated with nocturnal systolic BP (r = 0.31; p = .003) and nocturnal dipping (r = -0.29; p = .01) in univariable analysis. Multivariable regression models confirmed robustness of the association of EVs and nocturnal blood pressure (p = .02). In contrast, systolic office, 24h- and daytime-BP did not show significant associations with pEVs. No correlations were found with diastolic BP. Circulating pEVs correlated with pulse wave velocity (r = 0.25; p = .02). When comparing different hypertensive phenotypes, higher levels of EVs and PWV were evident in patients with sustained hypertension compared to patients with white coat HTN and healthy persons. Circulating platelet derived EVs were associated with nocturnal BP, dipping, and PWV. Given that average nocturnal BP is the strongest predictor of CV events, platelet derived EVs may serve as an integrative marker of vascular health, a proposition that requires testing in prospective clinical trials.
Collapse
Affiliation(s)
- Leslie Marisol Lugo-Gavidia
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, RPH Research Foundation, The University of Western Australia, Perth, Australia
| | - Revathy Carnagarin
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, RPH Research Foundation, The University of Western Australia, Perth, Australia
| | - Dylan Burger
- Kidney Research Centre, The Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Janis M Nolde
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, RPH Research Foundation, The University of Western Australia, Perth, Australia
| | - Justine Chan
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, RPH Research Foundation, The University of Western Australia, Perth, Australia
| | - Sandi Robinson
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, RPH Research Foundation, The University of Western Australia, Perth, Australia
| | - Erika Bosio
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, RPH Research Foundation, The University of Western Australia, Perth, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit, RPH Research Foundation, The University of Western Australia, Perth, Australia.,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Dabetes Institute, Melbourne, Victoria, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, Australia
| |
Collapse
|
11
|
Ren B, Chen M. Effect of sodium-glucose cotransporter-2 inhibitors on patients with essential hypertension and pre-hypertension: a meta-analysis. Ther Adv Endocrinol Metab 2022; 13:20420188221142450. [PMID: 36533186 PMCID: PMC9747874 DOI: 10.1177/20420188221142450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 11/13/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sodium-glucose cotransporter-2 (SGLT2) inhibitors are novel, hypoglycemic drugs exhibiting cardiovascular protective activities. If SGLT2 inhibitors can be successfully used as antihypertensive drugs, they can be administered to patients with both hypertension and type 2 diabetes, thus diminishing the risk of polypharmacy-related complications. AIM The aim of this review was to evaluate the hypotensive efficacy of SGLT2 inhibitors in patients with hypertension and pre-hypertension. DATA SOURCES AND METHODS We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials comparing SGLT2 inhibitors and a placebo in patients with essential hypertension and pre-hypertension. Our main outcome was the mean change in office blood pressure (BP) and body weight. We assessed the pooled data using a fixed-effects model. RESULTS After screening 968 articles, nine trials were eligible (n = 2450 participants). Compared to the mean changes in systolic and diastolic BP in patients who were given a placebo, those in patients who used SGLT2 inhibitors were -5.04 mmHg and -1.67 mmHg, respectively. An intensive dose of SGLT2 inhibitors resulted in a stronger BP-lowering effect than the regular dose. Compared to that in the placebo group, the mean change in mean body weight was -1.74 kg in the SGLT2 inhibitor group. There was no significant difference between the two groups regarding the risk of overall adverse events. The pooled effect estimates remained similar across all residual studies and their subgroups in the leave-one-out sensitivity analysis. CONCLUSION SGLT2 inhibitors had a statistically significant BP-lowering effect on hypertension and pre-hypertension, which was further enhanced with increased drug dosage. SGLT2 inhibitors have the potential to be used as antihypertensive agents in patients with hypertension complicated by type 2 diabetes.
Collapse
Affiliation(s)
- Bangjiaxin Ren
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Graduate School, Chongqing Medical University, Chongqing, China
| | | |
Collapse
|
12
|
Capillary vascular density in the retina of hypertensive patients is associated with a non-dipping pattern independent of mean ambulatory blood pressure. J Hypertens 2021; 39:1826-1834. [PMID: 34397628 DOI: 10.1097/hjh.0000000000002863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND A nocturnal non-dipping pattern has been associated with hypertension-mediated organ damage (HMOD), morbidity and mortality. Retinal imaging through application of modern technologies including optical coherence tomography angiography (OCT-A) can provide detailed insights into early vascular damage. In this observational study, we investigated the relationship of microscopic vascular density in the retina measured with OCT-A and nocturnal blood pressure (BP) dipping. METHODS Retinal OCT-A and ambulatory BP monitoring (ABPM) data prospectively obtained from 142 patients referred to a tertiary hypertension clinic were analysed with regression models for associations between BP night-time dipping and retinal capillary vascular density in three different zones around the fovea. RESULTS More pronounced nocturnal SBP and DBP dipping was significantly associated with increased vascular density in the central foveal area of the retina. These associations were robust to adjustment for other available risk factors including mean daytime BP. Parafoveal and whole image vascular density did not show equivalent significant associations with nocturnal BP dipping. The results were reproducible when assessed in a subgroup of patients who had concomitant type 2 diabetes. CONCLUSION Foveal vascular density was associated with the nocturnal BP dipping pattern in hypertensive patients. These associations were robust to adjustment of relevant factors such as daytime BP. Our findings highlight the importance of nocturnal BP features reflected in ambulatory BP monitoring in the assessment of HMOD. Whether routine assessment of retinal damage markers may improve risk management of hypertensive patients remains to be determined.
Collapse
|