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Kim Y, Esquivel JH, Mattos MK, Davis EM, Logan J. The impact of forced awakening on morning blood pressure surge. Heart Lung 2024; 68:92-97. [PMID: 38941772 DOI: 10.1016/j.hrtlng.2024.06.011] [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: 02/12/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Poor sleep quality can cause an increase in morning blood pressure surge (MBPS), an independent risk factor of cardiovascular disease (CVD) events. Awakening induced by external factors such as alarm clocks, may also contribute to increased MBPS. OBJECTIVES To (1) compare the MBPS and sleep quality parameters between natural and forced awakenings and (2) examine the potential impact of forced awakening on MBPS, independent of sleep quality. METHODS Thirty-two healthy adults participated in this pilot study, which included one night of natural awakening and one night of forced awakening (i.e., sleep was interrupted by an alarm after five hours). Objective and self-reported sleep quality parameters were measured using a multisensory wristband and sleep diaries, respectively, and beat-to-beat blood pressure variability was assessed using a continuous blood pressure monitor. Analyses included a paired t-test (objective 1) and linear mixed models (objective 2). RESULTS Participants predominantly consisted of young, healthy, and highly educated Asian adults. During the night of sleep with forced awakening, significantly higher MBPS, lower objective wakefulness after sleep onset, and lower self-reported sleep latency were observed, compared to the night with natural awakening. Forced awakening was significantly associated with increased MBPS after controlling for age, sex, mean arterial pressure, and sleep quality. CONCLUSIONS Forced awakening may significantly increase MBPS, consequently heightening the risk of CVD events. Study findings should be validated in a larger sample. Further research is also warranted to examine the impact of forced awakening on MBPS in individuals with CVD.
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Affiliation(s)
- Yeonsu Kim
- University of Virginia School of Nursing, 225 Jeanette Lancaster Way, Charlottesville, VA, United States, 22903.
| | - Jill Howie Esquivel
- University of California San Francisco School of Nursing, 2 Koret Way, San Francisco, CA, United States, 94143
| | - Meghan Kathleen Mattos
- University of Virginia School of Nursing, 5012 McLeod Hall, 202 Jeanette Lancaster Way, Charlottesville, VA, United States, 22903
| | - Eric M Davis
- Department of Medicine, University of Virginia, 1222 Jefferson Park Ave, Charlottesville, VA, United States, 22903
| | - Jeongok Logan
- University of Virginia School of Nursing, 4011 McLeod Hall, 202 Jeanette Lancaster Way, Charlottesville, VA, United States, 22903
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2
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Jiang Y, Song X, Hou D, Zhao X, Chen W, Li R, Zheng Z, Sang Z, Wu J. Morning blood pressure surge and intracranial atherosclerotic plaque characteristics: a high-resolution magnetic resonance vessel wall imaging study. Br J Radiol 2024; 97:210-220. [PMID: 38263837 PMCID: PMC11027336 DOI: 10.1093/bjr/tqad011] [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: 07/20/2023] [Revised: 10/01/2023] [Accepted: 10/16/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE To investigate the relationship between morning blood pressure surge (MBPS) and intracranial atherosclerotic plaque burden and vulnerability. METHODS A total of 267 ischaemic stroke patients were retrospectively analysed. Sleep-trough and prewaking MBPS were calculated from ambulatory blood pressure monitoring (ABPM). Plaque characteristics, including intraplaque haemorrhage (IPH), maximum wall thickness (max WT), and stenosis degree, were obtained from high-resolution MR vessel wall imaging (HR-vwMRI). Linear and logistic regression were used to detect the association. RESULTS Subjects with the top tertile of sleep-trough MBPS (≥15.1 mmHg) had a lower prevalence (9.1% vs. 19.6%, P = .029) of severe stenosis (≥70%) than others. Subjects within the top tertile of prewaking MBPS (≥7.6 mmHg) had a lower percentage of IPH (27.3% vs. 40.4%, P = .035) than others. After adjusting for stroke risk factors (age, sex, diabetes, hyperlipidaemia, hyperhomocysteinaemia, smoking, and family stroke history) and 24-h mean systolic blood pressure, 10 mmHg sleep-trough MBPS increment was associated with 0.07mm max WT reduction, and the top tertile MBPS group was associated with a lower chance of severe stenosis (odd ratio = 0.407, 95% CI, 0.175-0.950). Additionally, an increased prewaking MBPS is associated with a lower incidence of IPH, with OR = 0.531 (95% CI, 0.296-0.952). Subgroup analysis demonstrated that the positive findings could only be seen in non-diabetic subjects. CONCLUSION Increment of MBPS is negatively associated with intracranial atherosclerotic plaque burden and vulnerability, and this relationship remains significant in the non-diabetic subgroup. ADVANCES IN KNOWLEDGE This study provided evidence that MBPS was associated with the intracranial atherosclerotic plaque burden and vulnerability on HR-vwMRI.
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Affiliation(s)
- Yuhan Jiang
- School of Medicine, Tsinghua University, Beijing 100084, China
| | - Xiaowei Song
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Duoduo Hou
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084, China
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Wenwen Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084, China
| | - Zhuozhao Zheng
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Zhenhua Sang
- Department of Information Technology Service, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Jian Wu
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
- IDG/McGovern Institute for Brain Research at Tsinghua University, Beijing 100084, China
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3
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Chen R, Yang J, Liu C, Sun M, Ke J, Yang Y, Shen Y, Yuan F, He C, Cheng R, Lv H, Tan H, Gao X, Zhang J, Huang L. Sex-Dependent Association Between Early Morning Ambulatory Blood Pressure Variations and Acute Mountain Sickness. Front Physiol 2021; 12:649211. [PMID: 33815152 PMCID: PMC8012890 DOI: 10.3389/fphys.2021.649211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/01/2021] [Indexed: 01/14/2023] Open
Abstract
Background Acute high altitude (HA) exposure elicits blood pressure (BP) responses in most subjects, and some of them suffer from acute mountain sickness (AMS). However, a 24-h ambulatory BP (ABP) change and the correlation with the occurrence of AMS in different sexes are still unclear. Objectives This prospective study aimed to investigate HA induced BP responses in males and females and the relationship between AMS and 24-h ABP. Methods Forty-six subjects were matched according to demographic parameters by propensity score matching with a ratio of 1:1. All the subjects were monitored by a 24-h ABP device; the measurement was one period of 24 h BP. 2018 Lake Louise questionnaire was used to evaluate AMS. Results Both the incidence of AMS (14 [60.9%] vs. 5 [21.7%], P = 0.007) and headache (18 [78.3%] vs. 8 [34.8%], P = 0.003) were higher in females than in males. All subjects showed an elevated BP in the early morning [morning systolic BP (SBP), 114.72 ± 13.57 vs. 120.67 ± 11.10, P = 0.013]. The elevation of morning SBP variation was more significant in females than in males (11.95 ± 13.19 vs. −0.05 ± 14.49, P = 0.005), and a higher morning BP surge increase (4.69 ± 18.09 vs. −9.66 ± 16.96, P = 0.005) was observed after acute HA exposure in the female group. The increase of morning SBP was associated with AMS occurrence (R = 0.662, P < 0.001) and AMS score (R = 0.664, P = 0.001). Among the AMS symptoms, we further revealed that the incidence (R = 0.786, P < 0.001) and the severity of headache (R = 0.864, P < 0.001) are closely correlated to morning SBP. Conclusions Our study demonstrates that females are more likely to suffer from AMS than males. AMS is closely associated with elevated BP in the early morning period, which may be correlated to higher headache incidence in subjects with higher morning SBP.
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Affiliation(s)
- Renzheng Chen
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jie Yang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chuan Liu
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Mengjia Sun
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jingbin Ke
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yuanqi Yang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yang Shen
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Fangzhengyuan Yuan
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Chunyan He
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ran Cheng
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hailin Lv
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hu Tan
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xubin Gao
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jihang Zhang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lan Huang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.,Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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4
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Yetton BD, McDevitt EA, Cellini N, Shelton C, Mednick SC. Quantifying sleep architecture dynamics and individual differences using big data and Bayesian networks. PLoS One 2018; 13:e0194604. [PMID: 29641599 PMCID: PMC5894981 DOI: 10.1371/journal.pone.0194604] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/06/2018] [Indexed: 01/19/2023] Open
Abstract
The pattern of sleep stages across a night (sleep architecture) is influenced by biological, behavioral, and clinical variables. However, traditional measures of sleep architecture such as stage proportions, fail to capture sleep dynamics. Here we quantify the impact of individual differences on the dynamics of sleep architecture and determine which factors or set of factors best predict the next sleep stage from current stage information. We investigated the influence of age, sex, body mass index, time of day, and sleep time on static (e.g. minutes in stage, sleep efficiency) and dynamic measures of sleep architecture (e.g. transition probabilities and stage duration distributions) using a large dataset of 3202 nights from a non-clinical population. Multi-level regressions show that sex effects duration of all Non-Rapid Eye Movement (NREM) stages, and age has a curvilinear relationship for Wake After Sleep Onset (WASO) and slow wave sleep (SWS) minutes. Bayesian network modeling reveals sleep architecture depends on time of day, total sleep time, age and sex, but not BMI. Older adults, and particularly males, have shorter bouts (more fragmentation) of Stage 2, SWS, and they transition less frequently to these stages. Additionally, we showed that the next sleep stage and its duration can be optimally predicted by the prior 2 stages and age. Our results demonstrate the potential benefit of big data and Bayesian network approaches in quantifying static and dynamic architecture of normal sleep.
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Affiliation(s)
- Benjamin D. Yetton
- Department of Psychology, University of California, Irvine, Irvine, California, United States of America
| | - Elizabeth A. McDevitt
- Princeton Neuroscience Institute, Princeton University, Princeton, New Jersey, United States of America
| | - Nicola Cellini
- Department of Psychology, University of California, Irvine, Irvine, California, United States of America
- Department of General Psychology, University of Padova, Padova, Italy
| | - Christian Shelton
- Department of Computer Science, University of California, Riverside, Riverside, California, United States of America
| | - Sara C. Mednick
- Department of Psychology, University of California, Irvine, Irvine, California, United States of America
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5
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Kario K, Bhatt DL, Brar S, Bakris GL. Differences in Dynamic Diurnal Blood Pressure Variability Between Japanese and American Treatment-Resistant Hypertensive Populations. Circ J 2017; 81:1337-1345. [PMID: 28458378 DOI: 10.1253/circj.cj-16-1237] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Dynamic diurnal changes in 24-h ambulatory systolic blood pressure (SBP) are associated with increased cardiovascular risk. We compared ambulatory BP dynamics in Japanese and American black and white populations with treatment-resistant hypertension.Methods and Results:Both HTN-Japan (n=41) and SYMPLICITY HTN-3 (n=384 white and n=140 black patients) enrolled patients with office SBP ≥160 mmHg and 24-h ambulatory SBP ≥135 mmHg while on ≥3 antihypertensive medications. Indices of circadian variation in ambulatory BP, including morning and nighttime dynamic surges, were retrospectively compared. All 3 cohorts had similar baseline office SBP. The Japanese cohort had significantly lower body mass index, less obstructive sleep apnea, and less hypercholesterolemia than the black and white cohorts, but significantly greater morning SBP levels, including moving peak morning SBP (183 vs. 169 vs. 169 mmHg, P<0.001), morning dynamic surge (37.9 vs. 28.6 vs. 24.2 mmHg, P<0.001) and nighttime dynamic surge (24.9 vs. 8.3 vs. 7.7 mmHg, P<0.001). These racial differences in SBP surge parameters persisted despite adjustment for baseline demographic population differences through multivariate regression. CONCLUSIONS Greater diurnal BP variability, including dynamic surges, in Japanese compared with black and white patients may indicate ethnic differences in the underlying BP regulatory mechanism of resistant hypertension. These differences may be important to take into consideration for more specific drug and device-based therapy strategies based on ethnicity.
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Affiliation(s)
- Kazuomi Kario
- Department of Cardiovascular Medicine, Jichi Medical University School of Medicine
| | - Deepak L Bhatt
- Division of Cardiovascular Disease, Brigham and Women's Hospital Heart & Vascular Center, and Harvard Medical School
| | | | - George L Bakris
- ASH Comprehensive Hypertension Center, The University of Chicago Medicine
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6
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Morning pressor surge, blood pressure variability, and arterial stiffness in essential hypertension. J Hypertens 2017; 35:272-278. [DOI: 10.1097/hjh.0000000000001153] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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7
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Turak O, Afsar B, Siriopol D, Ozcan F, Cagli K, Yayla C, Oksuz F, Mendi MA, Kario K, Covic A, Kanbay M. Morning Blood Pressure Surge as a Predictor of Development of Chronic Kidney Disease. J Clin Hypertens (Greenwich) 2016; 18:444-448. [PMID: 26530334 PMCID: PMC8031569 DOI: 10.1111/jch.12707] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/06/2015] [Accepted: 08/10/2015] [Indexed: 08/16/2023]
Abstract
Blood pressure (BP) usually increases upon awakening--a physiological mechanism called morning BP surge (MBPS). BP values above the MBPS threshold are associated with target organ damage, including left ventricular hypertrophy and proteinuria. Despite these data, there have been no studies that have investigated the association between elevated MBPS and the development of incident chronic kidney disease (CKD). In this study, patients with essential hypertension were included and underwent ambulatory BP measurements and MBPS. Patients were followed for a median of 3.33 years. In total, 622 patients were enrolled. The mean age of patients was 57.6±12.4 years, 54.0% were men, 16.7% had diabetes, and 10.6% had prevalent cardiovascular disease. During follow-up, 32 patients developed CKD. Higher MBPS, analyzed both as continuous and categorical variables, was associated with incident CKD in all models. Elevated MBPS is associated with kidney function deterioration and the development of CKD. Studies are needed to further examine underlying mechanisms regarding MBPS and these renal outcomes.
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Affiliation(s)
- Osman Turak
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Baris Afsar
- Department of NephrologyNumune State HospitalKonyaTurkey
| | - Dimitrie Siriopol
- Nephrology ClinicDialysis and Renal Transplant Center“C.I. PARHON” University Hospital, and “Grigore T. Popa” University of MedicineIasiRomania
| | - Firat Ozcan
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Kumral Cagli
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Cagri Yayla
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Fatih Oksuz
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Mehmet Ali Mendi
- Department of CardiologyYuksek Ihtisas Training and Research HospitalAnkaraTurkey
| | - Kazuomi Kario
- Department of Sleep and Circadian CardiologyJichi Medical University School of MedicineTochigiJapan
| | - Adrian Covic
- Nephrology ClinicDialysis and Renal Transplant Center“C.I. PARHON” University Hospital, and “Grigore T. Popa” University of MedicineIasiRomania
| | - Mehmet Kanbay
- Division of NephrologyDepartment of MedicineKoc University School of MedicineIstanbulTurkey
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8
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McMullan CJ, Yano Y, Bakris GL, Kario K, Phillips RA, Forman JP. Racial impact of diurnal variations in blood pressure on cardiovascular events in chronic kidney disease. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2015; 9:299-306. [PMID: 25891362 DOI: 10.1016/j.jash.2015.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 10/24/2022]
Abstract
Ambulatory blood pressure parameters, nocturnal dipping and morning surge, are associated with cardiovascular outcomes in several populations. While significant variation exists between racial groups in ambulatory blood pressure measurements and the incidence of cardiovascular disease, the effect of race on the associations of dipping and morning surge with cardiovascular outcomes is unknown. In a prospective analysis of 197 African American and 197 Japanese individuals with non-diabetic chronic kidney disease matched by age and renal function, we analyzed the associations of dipping and morning surge with cardiovascular events for both races and assessed whether these relations differed by race. Higher sleep-trough morning surge was independently associated with cardiovascular events in Japanese (hazard ratio, 1.93 per 10 mm Hg; 95% confidence interval, 1.20-3.10) but not in African American participants, with race an effect modifier (P-value <.01). Dipping was not associated with cardiovascular events in either racial group. In individuals with chronic kidney disease, the association between morning surge and cardiovascular events appears to be dependent upon race, with higher morning surge a risk factors in Japanese but not in African Americans.
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Affiliation(s)
- Ciaran J McMullan
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Yuichiro Yano
- Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL, USA; Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Yakushiji, Shimotsuke, Tochigi, Japan
| | - George L Bakris
- Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, Chicago, IL, USA
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Yakushiji, Shimotsuke, Tochigi, Japan
| | - Robert A Phillips
- Department of Medicine, Houston Methodist and Weill Cornell College of Medicine, Houston, TX, USA
| | - John P Forman
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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9
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Dalfó-Pibernat A. Relación entre el descanso y el pico matutino de presión arterial: factores favorecedores y recomendaciones para su control. ENFERMERIA CLINICA 2015; 25:40-1. [DOI: 10.1016/j.enfcli.2014.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 04/30/2014] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
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10
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Elsurer R, Afsar B. Morning blood pressure surge is associated with serum gamma-glutamyltransferase activity in essential hypertensive patients. J Hum Hypertens 2014; 29:331-6. [PMID: 25355010 DOI: 10.1038/jhh.2014.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/18/2014] [Accepted: 07/10/2014] [Indexed: 01/14/2023]
Abstract
The phenomenon that blood pressure rises sharply in the morning is called 'Morning Blood Pressure Surge' (MBPS). Serum gamma-glutamyltransferase (GGT) is a proinflammatory marker involved in the pathogenesis of cardiovascular diseases. Although both are novel cardiovascular risk factors associated with inflammation and atherosclerosis, the specific relationship between MBPS and serum GGT is unknown. This study investigates the relationship between MBPS and serum GGT activity in essential hypertensive patients. Totally, 320 hypertensive patients were recruited. Mean MBPS was 17.0 ± 12.9 mm Hg. MBPS was positively correlated with age (r = +0.222, P < 0.0001), body mass index (r = +0.132, P = 0.018), GGT (r = +0.271, P < 0.0001), daytime augmentation index adjusted for heart rate (AIx@75) (r = +0.140, P=0.014), 24-h pulse wave velocity (PWV) (r = +0.143, P = 0.014) and daytime PWV (r = +0.158, P = 0.007). From the 25th to 75th quartile of serum GGT, MBPS increased significantly (Ptrend < 0.0001). In multivariate linear regression analysis, MBPS was independently associated with age (P = 0.002), dipping status (P < 0.0001) and logGGT (P < 0.0001). In conclusion, MBPS is independently associated serum GGT activity in essential hypertensive patients. This is the first study in the literature to demonstrate an independent and a dose-response relationship between the two novel cardiovascular risk factors, MBPS and serum GGT, in this patient population.
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Affiliation(s)
- R Elsurer
- Department of Nephrology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - B Afsar
- Department of Nephrology, Konya Numune Hospital, Konya, Turkey
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11
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Turak O, Afsar B, Ozcan F, Canpolat U, Grbovic E, Mendi MA, Oksuz F, Siriopol D, Covic A, Caliskan M, McFann K, Johnson RJ, Kanbay M. Relationship between elevated morning blood pressure surge, uric acid, and cardiovascular outcomes in hypertensive patients. J Clin Hypertens (Greenwich) 2014; 16:530-5. [PMID: 24919769 DOI: 10.1111/jch.12359] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 05/01/2014] [Accepted: 05/08/2014] [Indexed: 01/19/2023]
Abstract
Early morning blood pressure surge (MBPS) is a risk factor for cardiovascular events (CVEs), but the relationship with uric acid is not well understood. The authors aimed to determine the association between MBPS and increased uric acid and the effect of elevated MBPS and uric acid combination on CVEs. A total of 921 patients underwent 24-hour ambulatory blood pressure monitoring and were followed for a median of 40 months. During this period, 103 (11.2%) CVEs occurred. There was a significant relationship between increasing quartiles of serum uric acid level and increasing values of MBPS (P<.0001). Patients in the highest quartile stratified by elevated MBPS and serum uric acid level had a 3.55 odds of major CVE compared with patients in the lowest quartile. Serum uric acid is associated with MBPS and development of new CVEs.
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Affiliation(s)
- Osman Turak
- Department of Cardiology, Türkiye Yüksek Ihtisas Education and Research Hospital, Ankara, Turkey
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12
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Afsar B, Elsurer R. The relationship between central hemodynamics, morning blood pressure surge, glycemic control and sodium intake in patients with type 2 diabetes and essential hypertension. Diabetes Res Clin Pract 2014; 104:420-6. [PMID: 24780746 DOI: 10.1016/j.diabres.2014.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/25/2014] [Accepted: 03/20/2014] [Indexed: 12/11/2022]
Abstract
AIMS The current study aimed to investigate the relationship between morning blood pressure surge (MBPS), hemodynamic parameters, glycemic control and 24-h urinary sodium excretion (USE) in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS MBPS and central hemodynamic parameters were assessed from ambulatory blood pressure measurements. In addition to routine biochemistry, 24h urine collection was performed to measure protein, albumin and sodium excretion. RESULTS There were 146 (38%) patients with T2DM and 238 (72%) patients without T2DM (control group). Patients with T2DM had statistically higher MBPS compared with patients without T2DM (P<0.0001). In patients with T2DM, MBPS was correlated with HbA1c (rho=0.311, P<0.0001), 24h urinary sodium excretion (USE) (rho=0.292, P=0.004) and various hemodynamic parameters. Additionally, regression analysis showed that being male (P=0.006), the presence of coronary artery disease (P=0.023), HbA1c (P=0.012), and 24h USE (P=0.001) were independently related with log MBPS in T2DM patients. CONCLUSION This study demonstrated that T2DM was an independent risk factor for increased MBPS and MBPS was associated with central hemodynamic parameters. Additionally poor glycemic control and sodium intake were associated with worse MBPS in T2DM.
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Affiliation(s)
- Baris Afsar
- Konya Numune State Hospital, Department of Nephrology, Turkey.
| | - Rengin Elsurer
- Selcuklu Faculty of Medicine, Selcuk University, Department of Nephrology, Turkey
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