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Condoleo V, Maio R, Cassano V, Bonfrate L, Pelaia C, Armentaro G, Miceli S, Fiorentino TV, Perticone M, Succurro E, Andreozzi F, Sesti G, Sciacqua A. Association between non-dipping blood pressure pattern and different glucometabolic profile during oral glucose tolerance test. Intern Emerg Med 2024; 19:81-89. [PMID: 37801209 PMCID: PMC10827950 DOI: 10.1007/s11739-023-03442-1] [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: 05/22/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
It is known that, a not physiological blood pressure (BP) circadian pattern has been associated with increased risk of organ damage and cardiovascular (CV) event. The aim of this study was to assess the association between circadian BP pattern and glucometabolic phenotypes occurring after oral glucose tolerance test (OGTT). We recruited 810 hypertensive Caucasian patients. All participants underwent to OGTT, laboratory test and 24-h ambulatory BP monitoring (ABPM). The analysis of collected data allowed classifying patients based on nocturnal BP profiles into four categories: dippers, non-dippers, extreme dippers, and reverse dippers. Considering the dipping pattern, the proportion of non-dippers in normal glucose tolerance patients with 1-h glucose ≥ 155 mg/dL (NGT ≥ 155) (36.4%) was higher than NGT < 155 (29.6%) and impaired glucose tolerance (IGT) (34.8%), but lower than type 2 diabetes group (T2DM) (52.6%) (p = 0.001). The proportion of dippers was lower in NGT ≥ 155 (47%) and T2DM (34.6%), when compared with NGT < 155 (53.8%) and IGT (51.2%) (p = 0.017). From logistic regression analysis, 1-h glucose ≥ 155 increased the risk of a pathological nocturnal drop in BP by 74%, (OR = 1.740, 95% CI 1.254-2.415, p < 0.0001). In addition, the improvement in 1 unit of Matsuda was responsible for a 3.5% risk decrease (OR = 0.965, 95% CI 0.958-0.971, p < 0.0001), while e-GFR determined a 0.9% risk reduction of nocturnal BP drop (OR = 0.991, 95% CI 0.984-0.999, p = 0.020). Our data demonstrated the existence, in newly diagnosed hypertensive patients, of an association between circadian BP profile and altered glycemic response during OGTT, in particular NGT ≥ 155 subjects are associated with a non-dipper BP pattern, this is clinically relevant because may explain, at least in part, the increased CV risk in this setting of patients.
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Affiliation(s)
- Valentino Condoleo
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa-Località Germaneto, 88100, Catanzaro, Italy
| | - Raffaele Maio
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa-Località Germaneto, 88100, Catanzaro, Italy
| | - Velia Cassano
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa-Località Germaneto, 88100, Catanzaro, Italy.
| | - Leonilde Bonfrate
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa-Località Germaneto, 88100, Catanzaro, Italy
| | - Giuseppe Armentaro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa-Località Germaneto, 88100, Catanzaro, Italy
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa-Località Germaneto, 88100, Catanzaro, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa-Località Germaneto, 88100, Catanzaro, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa-Località Germaneto, 88100, Catanzaro, Italy
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa-Località Germaneto, 88100, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Græcia, 88100, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa-Località Germaneto, 88100, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Græcia, 88100, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario "S. Venuta", Viale Europa-Località Germaneto, 88100, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Græcia, 88100, Catanzaro, Italy
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Ding X, Zhou Y, Pan Y, Xu J, Yan H, Zhao X, Wang Y, Wang Y. Dipping Pattern and 1-year stroke functional outcome in ischemic stroke or transient ischemic attack. Clin Exp Hypertens 2023; 45:2139384. [DOI: 10.1080/10641963.2022.2139384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Xia Ding
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilun Zhou
- Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jie Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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Karakayali M, Omar T, Artac I, Rencuzogullari İ, Karabag Y, Demir O. The relationship between the systemic immune-inflammation index and reverse-dipper circadian pattern in newly diagnosed hypertensive patients. J Clin Hypertens (Greenwich) 2023; 25:700-707. [PMID: 37464585 PMCID: PMC10423764 DOI: 10.1111/jch.14688] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/20/2023]
Abstract
Although hypertension is considered high intravascular pressure, impairing circadian blood pressure (BP) has been shown to potentially contribute to poor clinical outcomes. Systemic immune-inflammation index (SII), based on platelet, neutrophil, and lymphocyte counts, has been established as a strong prognostic marker in cardiovascular disease. The role of inflammation in the pathogenesis of hypertension is a well-known issue and inflammatory markers are associated with BP variability. We aimed to investigate whether there is a relationship between circadian BP changes and SII in newly diagnosed hypertensive patients. The study population consisted of 196 newly diagnosed hypertensive patients without LVH. In total, 76 (38%) patients had a dipper BP pattern, 60 (31%) patients had a non-dipper BP pattern, and 60 (31%) patients had a reverse-dipper BP pattern. SII was calculated according to Multivariate logistic regression analysis revealed SII and HDL-C as an independent predictors of reverse-dipper circadian pattern in newly diagnosed hypertensive patients. The cut-off value of the SII for reverse-dipper hypertension in a ROC curve analysis was >639.73 with 63.3% sensitivity and 84.2% specificity. Our study showed that the SII level was higher in the reverse-dipper hypertension patient group than in the dipper and non-dipper hypertension groups. Furthermore, SII was an independent predictor of newly diagnosed reverse-dipper hypertensive patients. The high SII value in newly diagnosed hypertensive patients can be used as an early warning parameter to identify reverse-dipper hypertension patients.
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Affiliation(s)
| | - Timor Omar
- Department of CardiologyKafkas University School of MedicineKarsTurkey
| | - Inanç Artac
- Department of CardiologyKafkas University School of MedicineKarsTurkey
| | | | - Yavuz Karabag
- Department of CardiologyKafkas University School of MedicineKarsTurkey
| | - Ozturk Demir
- Department of CardiologyKafkas University School of MedicineKarsTurkey
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Karakayali M, Artac I, Omar T, Rencuzogullari İ, Karabag Y, Cinar T, Altunova M, Hamideyin S. The association between frontal QRS-T angle and reverse dipper status in newly diagnosed hypertensive patients. Blood Press Monit 2023; 28:96-102. [PMID: 36916470 DOI: 10.1097/mbp.0000000000000637] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
The frontal QRS-T angle (fQRS-T angle) in ECG is a new measure of myocardial repolarization, in which a higher fQRS-T angle is linked with worse cardiac outcomes. Reverse dipper hypertension is also linked to poor cardiac outcomes. The purpose of this study was to investigate the association between the fQRS-T angle and reverse dipper status in individuals newly diagnosed with hypertension who did not have left ventricular hypertrophy (LVH). The investigation recruited 171 hypertensive individuals without LVH who underwent 24-h ambulatory blood pressure monitoring (ABPM). On the basis of the findings of 24-h ABPM, the study population was categorized into the following three groups: patients with dipper hypertension, non-dipper hypertension, and reverse dipper hypertension. LVH was defined by echocardiography. The fQRS-T angle was measured using the 12-lead ECG. The fQRS-T angle in individuals with reverse dipper hypertension was substantially greater than in patients with and without dipper hypertension (51° ± 28° vs. 28° ± 22° vs. 39° ± 25°, respectively, P < 0.001). The fQRS-T angle (odds ratio: 1.040, 95% confidence interval: 1.016-1.066; P = 0.001) was independently associated with reverse dipper hypertension according to multivariate analysis. In receiver operating characteristic curve analysis, the fQRS-T angle to predict reverse dipper hypertension was 33.5° with 76% sensitivity and 71% specificity. This study showed that an increased fQRS-T angle was associated with reverse dipper hypertension in newly diagnosed hypertensive patients without LVH.
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Affiliation(s)
| | - Inanç Artac
- Department of Cardiology, Kafkas University School of Medicine, Kars
| | - Timor Omar
- Department of Cardiology, Kafkas University School of Medicine, Kars
| | | | - Yavuz Karabag
- Department of Cardiology, Kafkas University School of Medicine, Kars
| | - Tufan Cinar
- Department of Cardiology, Sultan 2. Abdulhamid Khan Educational and Research Hospital
| | - Mehmet Altunova
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Research and Education Hospital, İstanbul, Turkey
| | - Serif Hamideyin
- Department of Cardiology, Kafkas University School of Medicine, Kars
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Melgarejo JD, Vernooij MW, Ikram MA, Zhang ZY, Bos D. Intracranial Carotid Arteriosclerosis Mediates the Association Between Blood Pressure and Cerebral Small Vessel Disease. Hypertension 2023; 80:618-628. [PMID: 36458543 PMCID: PMC9944388 DOI: 10.1161/hypertensionaha.122.20434] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Intracranial arteriosclerosis could explain the association between blood pressure (BP) and cerebral small vessel disease (CSVD). Therefore, we tested whether intracranial carotid artery calcification (ICAC) mediates the association between BP and CSVD and determined pathophysiological mechanisms based on ICAC subtypes. METHODS One thousand four hundred fifty-eight stroke-free participants from the Rotterdam Study (mean age, 68 years; 52% women) underwent nonenhanced computed tomography scans to quantify ICAC volume (mm3) between 2003 and 2015. ICAC was categorized into intimal and internal elastic lamina calcifications. CSVD included white matter hyperintensities volume, the presence of lacunes, and cerebral microbleeds visualized on magnetic resonance imaging. Office BP included systolic BP, diastolic BP, pulse pressure, and mean arterial pressure. Mediation analysis included a 2-way decomposition to determine the direct association between BP and CSVD and the indirect or mediated effect (negative or positive mediations expressed in %) of log-ICAC volume on such association. RESULTS BP and log-ICAC were correlated and were also associated with CSVD. In all participants, total log-ICAC volume mediated the association of diastolic BP (-14.5%) and pulse pressure (16.5%) with log-white matter hyperintensities. Internal elastic lamina log-ICAC volume mediated -19.5% of the association between diastolic BP and log-white matter hyperintensities; intimal log-ICAC volume did not mediate associations. For lacunes, total and internal elastic lamina log-ICAC volume mediated the association of diastolic BP (-40% and -45.8%) and pulse pressure (26.9% and 18.2%). We did not observe mediations for cerebral microbleeds. CONCLUSIONS Intracranial arteriosclerosis mediates the association between BP and CSVD. Internal elastic lamina calcification, considered a proxy of arterial stiffness, is the leading mechanism explaining the link between BP and CSVD.
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Affiliation(s)
- Jesus D Melgarejo
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (J.D.M., M.W.V., M.A.I., D.B.).,Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.D.M., Z.-Y.Z., D.B.).,Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela (J.D.M.)
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (J.D.M., M.W.V., M.A.I., D.B.).,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (M.W.V., D.B.)
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (J.D.M., M.W.V., M.A.I., D.B.)
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.D.M., Z.-Y.Z., D.B.)
| | - Daniel Bos
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands (J.D.M., M.W.V., M.A.I., D.B.).,Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.D.M., Z.-Y.Z., D.B.).,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands (M.W.V., D.B.)
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6
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Hou T, Chacon AN, Su W, Katsumata Y, Guo Z, Gong MC. Role of sympathetic pathway in light-phase time-restricted feeding-induced blood pressure circadian rhythm alteration. Front Nutr 2022; 9:969345. [PMID: 36159491 PMCID: PMC9493072 DOI: 10.3389/fnut.2022.969345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
Disruption of blood pressure (BP) circadian rhythm, independent of hypertension, is emerging as an index for future target organ damage and is associated with a higher risk of cardiovascular events. Previous studies showed that changing food availability time alters BP rhythm in several mammalian species. However, the underlying mechanisms remain largely unknown. To address this, the current study specifically investigates (1) the relationship between rhythms of food intake and BP in wild-type mice; (2) effects of light-phase time-restricted feeding (TRF, food only available during light-phase) on BP circadian rhythm in wild-type and diabetic db/db mice; (3) the roles of the autonomic system and clock gene in light-phase TRF induced changes in BP circadian rhythm. Food intake and BP of C57BL/6J and db/db mice were simultaneously and continuously recorded using BioDAQ and telemetry systems under ad libitum or light-phase TRF. Per2 protein daily oscillation was recorded in vivo by IVIS spectrum in mPer2 Luc mice. Autonomic nerve activity was evaluated by heart rate variability, baroreflex, urinary norepinephrine (NE) and epinephrine (Epi) excretion, and mRNA expressions of catecholamines biosynthetic and catabolic enzymes, and alpha-adrenergic receptors in mesenteric resistance arteries. We found that in wild-type mice, the BP level was correlated with the food intake temporally across the 24 h. Reversing the feeding time by imposing light-phase TRF resulted in reverse or inverted BP dipping. Interestingly, the net changes in food intake were correlated with the net alteration in BP temporally under light-phase TRF. In db/db mice, light-phase TRF worsened the existing non-dipping BP. The food intake and BP circadian rhythm changes were associated with alterations in Per2 protein daily oscillation and the time-of-day variations in heart rate variability, baroreflex, and urinary excretion of NE and Epi, and increased mRNA expression of Slc6a2 (encoding NE transporter) and Adra1d (encoding alpha-adrenergic receptor 1d) in the mesenteric resistance arteries, indicating the sympathetic nervous system (SNS) was modulated after light-phase TRF. Collectively, our results demonstrated that light-phase TRF results in reverse dipping of BP in wild-type and diabetic db/db mice and revealed the potential role of the sympathetic pathway in light-phase TRF-induced BP circadian rhythm alteration.
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Affiliation(s)
- Tianfei Hou
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Aaron N. Chacon
- Department of Pharmacology and Nutritional Sciences, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Wen Su
- Department of Pharmacology and Nutritional Sciences, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Yuriko Katsumata
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Zhenheng Guo
- Department of Pharmacology and Nutritional Sciences, College of Medicine, University of Kentucky, Lexington, KY, United States
- Research and Development, Lexington Veterans Affairs Medical Center, Lexington, KY, United States
| | - Ming C. Gong
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY, United States
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Nie J, Hou L, Tan B. Correlation between Carotid Stenosis Degree and Blood Pressure Variability in Patients with Carotid Stenosis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4305015. [PMID: 35637843 PMCID: PMC9148253 DOI: 10.1155/2022/4305015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/22/2022] [Indexed: 11/25/2022]
Abstract
Background Carotid artery stenosis is one of the most serious diseases that endanger human health in contemporary times. It is a frequently occurring and common disease of the middle-aged and elderly people. Its incidence is increasing year by year, bringing a heavy economic burden to society and families. Whether there is a relationship between the degree of carotid artery stenosis and blood pressure variability is less studied. Aims To investigate the correlation between the degree of carotid stenosis and blood pressure variability in patients with carotid stenosis. Materials and Methods A total of 200 patients with carotid artery stenosis who were treated in our hospital from January 2017 to January 2020 were selected as the subjects of prospective study and were divided into mild stenosis according to the degree of carotid stenosis (carotid artery stenosis rate was 0-50%), moderate stenosis (carotid artery stenosis rate was between 50% and 70%), severe stenosis (carotid artery stenosis rate≧70%), and the control group with 50 cases each. The correlations between the hemodynamics, the degree of carotid artery stenosis, and blood pressure variability in patients with carotid artery stenosis were analyzed. Results The levels of 24hSSD, 24hDSD, dSSD, dDSD, and nSSD in the mild stenosis group and moderate stenosis group were significantly higher than those in the control group. In the stenosis group, the levels of 24hSSD, 24hDSD, dSSD, dDSD, and nSSD in the severe stenosis group were significantly higher than those in the moderate stenosis group, with statistical significance (P < 0.05). The levels of PSV, EDV, and MV in the mild stenosis group and moderate stenosis group were lower than those in the control group, while the PI and RI indexes were higher than those in the control group. PI and RI levels were significantly higher than those in the mild stenosis group and moderate stenosis group (P < 0.05). Logistic analysis showed that EDV (P = 0.001, OR = 2.245, 95%CI = 1.638 ~ 3.078), SSD (P = 0.014, OR = 0.725, 95%CI = 0.528 ~ 0.996), and PSV (P = 0.001, OR = 1.970, 95%CI = 1.300 ~ 2.990) were closely related to the degree of carotid artery stenosis. Conclusion Hemodynamics and blood pressure variability are related to the severity of carotid stenosis, which provides a reference and basis for clinical treatment of carotid stenosis.
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Affiliation(s)
- Junli Nie
- Department of Cardiology, General Hospital of the Yangtze River Shipping, China
| | - Liang Hou
- Department of Cardiology, General Hospital of the Yangtze River Shipping, China
| | - Baozhen Tan
- Department of Cardiology, General Hospital of the Yangtze River Shipping, China
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Abstract
OBJECTIVE We examined the associations among the circadian rhythms of blood pressure (BP), heart rate (HR) and left atrial function in essential hypertensive patients. METHODS The study included 237 essential hypertensive patients who completed 24-h ambulatory BP, HR monitoring and two-dimensional speckle tracking echocardiography (2DSTE). The strain and strain rate images were studied, and the following parameters were measured: left atrial reservoir strain and strain rate (LAS-S and LASR-S), left atrial conduit strain and strain rate (LAS-E and LASR-E), and left atrial booster strain and strain rate (LAS-A and LASR-A). The left atrial stiffness index (LASI) was identified as the ratio of E/e' to LAS-S. All participants were divided into three groups according to the percentage of nocturnal BP dipping (dippers, nondippers and reverse dippers). RESULTS The LASI was significantly higher in BP reverse dippers than in dippers and nondippers. LAS-S, LAS-E and LASR-E were significantly lower in BP reverse dippers than dippers and nondippers. Multivariate logistic regression analysis demonstrated that age, night-time mean SBP and the percentage of nocturnal HR decline were independently related to an increased LASI. CONCLUSION Impairment of the left atrial reservoir and conduit functions was correlated with abnormal BP and HR circadian rhythms in hypertension. Increased left atrial stiffness was associated with night-time SBP and the percentage of nocturnal HR decline.
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Abstract
PURPOSE OF REVIEW This review provides a contemporary review of sleep apnea with emphasis on definitions, epidemiology, and consequences. RECENT FINDINGS Amyloid β-42 is one of the main peptides forming amyloid plaques in the brains of Alzheimer patients. Poorer sleep quality and shorter sleep duration have been associated with a higher amyloid burden. Decreased sleep time in the elderly is a precipitating factor in amyloid retention. Studies have shown that the dysregulation of the homeostatic balance of the major inhibitory and excitatory amino acid neurotransmitter systems of gamma-aminobutyric acid (GABA) and glutamate play a role in sleep disordered breathing (SDB). SUMMARY Untreated sleep disordered breathing (obstructive sleep apnea and/or central sleep apnea) are an important cause of medical mortality and morbidity. OSA is characterized by recurrent episodes of partial or complete collapse of the upper airway during sleep followed by hypoxia and sympathetic activation. Apneic events are terminated by arousal, followed by increases in pulse and blood pressure, and re-oxygenation and the release of inflammatory factors. Individuals with OSA have an increased risk of developing atrial fibrillation. Hypoxemia and poor sleep quality because of OSA increase the risk of cognitive decline in the elderly.
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Chokesuwattanaskul A, Cheungpasitporn W, Thongprayoon C, Vallabhajosyula S, Bathini T, Mao MA, Cato LD, Chokesuwattanaskul R. Impact of Circadian Blood Pressure Pattern on Silent Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e016299. [PMID: 32476573 PMCID: PMC7429026 DOI: 10.1161/jaha.119.016299] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Abnormal circadian blood pressure (BP) variations during sleep, specifically the non‐dipping (<10% fall in nocturnal BP) and reverse‐dipping patterns (rise in nocturnal BP), have been associated with an increased risk of cardiovascular events and target organ damage. However, the relationship between abnormal sleep BP variations and cerebral small vessel disease markers is poorly established. This study aims to assess the association between non‐dipping and reverse‐dipping BP patterns with markers of silent cerebral small vessel disease. Methods and Results MEDLINE, Embase, and Cochrane Databases were searched from inception through November 2019. Studies that reported the odds ratios (ORs) for cerebral small vessel disease markers in patients with non‐dipping or reverse‐dipping BP patterns were included. Effect estimates from the individual studies were extracted and combined using the random‐effect, generic inverse variance method of DerSimonian and Laird. Twelve observational studies composed of 3497 patients were included in this analysis. The reverse‐dipping compared with normal dipping BP pattern was associated with a higher prevalence of white matter hyperintensity with a pooled adjusted OR of 2.00 (95% CI, 1.13–2.37; I2=36%). Non‐dipping BP pattern compared with normal dipping BP pattern was associated with higher prevalence of white matter hyperintensity and asymptomatic lacunar infarction, with pooled ORs of 1.38 (95% CI, 0.95–2.02; I2=52%) and 2.33 (95% CI, 1.30–4.18; I2=73%), respectively. Limiting to only studies with confounder‐adjusted analysis resulted in a pooled OR of 1.38 (95% CI, 0.95–2.02; I2=52%) for white matter hyperintensity and 1.44 (95% CI, 0.97–2.13; I2=0%) for asymptomatic lacunar infarction. Conclusions The non‐dipping and reverse‐dipping BP patterns are associated with neuroimaging cerebral small vessel disease markers.
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Affiliation(s)
- Anthipa Chokesuwattanaskul
- Division of Neurology Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand.,King Chulalongkorn Memorial Hospital Thai Red Cross Society Bangkok Thailand
| | | | | | | | - Tarun Bathini
- Department of Internal Medicine University of Arizona Tucson AZ
| | - Michael A Mao
- Department of Internal Medicine Mayo Clinic Jacksonville FL
| | - Liam D Cato
- University Hospitals Birmingham NHS Foundation Trust Birmingham United Kingdom
| | - Ronpichai Chokesuwattanaskul
- King Chulalongkorn Memorial Hospital Thai Red Cross Society Bangkok Thailand.,Department of Medicine Faculty of Medicine Chulalongkorn University and King Chulalongkorn Memorial Hospital Bangkok Thailand
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Kong Q, Ma X, Wang C, Du X, Ren Y, Wan Y. Total Atherosclerosis Burden of Baroreceptor-Resident Arteries Independently Predicts Blood Pressure Dipping in Patients With Ischemic Stroke. Hypertension 2020; 75:1505-1512. [PMID: 32336234 PMCID: PMC7682798 DOI: 10.1161/hypertensionaha.120.15036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Supplemental Digital Content is available in the text. Nighttime blood pressure (BP) generally dips by 10% to 20% of the daytime values, and abnormal BP dipping may affect vascular health independently of BP level. The regulation of BP dipping involves arterial baroreflex, whose receptors mainly reside in carotid sinuses and aortic arch. Atherosclerosis in these baroreceptor-resident arteries (BRAs) is frequent among patients with ischemic stroke (IS) and might impair their BP-regulating capacity. We aimed to examine associations between atherosclerosis of BRA and BP dipping in patients with IS. BP dipping ratio was measured by 24-hour ambulatory blood pressure monitoring on the sixth day after IS. With computed tomography angiography, atherosclerosis conditions in 10 segments of carotid sinuses and aortic arch were scored and summed as total atherosclerosis burden of BRA. Among the 245 patients with IS, 78.0% had atherosclerosis in BRA. The total AS burden of BRA was negatively correlated with systolic BP dipping ratio (r=−0.331; P<0.001) and diastolic BP dipping ratio (r=−0.225; P<0.001). After adjusting for age, sex, vascular risk factors, 24-hour BP means, cervical and intracranial atherosclerosis scores, the negative correlations still existed (adjusted β, −0.259 [95% CI, −0.416 to −0.102] and adjusted β, −0.178 [95% CI, −0.346 to −0.010], respectively). In conclusion, higher total atherosclerosis burden of BRA was independently indicative of more blunted dipping of systolic BP and diastolic BP in IS. The total atherosclerosis burden of BRA might be important for predicting and managing BP dipping in patients with IS.
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Affiliation(s)
- Qi Kong
- From the Department of Neurology (Q.K., X.M., Y.R.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Ma
- From the Department of Neurology (Q.K., X.M., Y.R.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chen Wang
- Department of Radiology (C.W., X.D.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiangying Du
- Department of Radiology (C.W., X.D.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yi Ren
- From the Department of Neurology (Q.K., X.M., Y.R.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yungao Wan
- Department of Cardiology (Y.W.), Xuanwu Hospital, Capital Medical University, Beijing, China
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Thoonkuzhy C, Rahman M. New Insights on Chronotherapy in Hypertension: Is Timing Everything? Curr Hypertens Rep 2020; 22:32. [DOI: 10.1007/s11906-020-1032-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Li J, Li R, Gao Y, Zhang J, Zhao Y, Zhang X, Wang G. Nocturnal Mean Arterial Pressure Rising Is Associated With Mortality in the Intensive Care Unit: A Retrospective Cohort Study. J Am Heart Assoc 2019; 8:e012388. [PMID: 31566067 PMCID: PMC6806033 DOI: 10.1161/jaha.119.012388] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Disrupted circadian rhythm of blood pressure is commonly observed in patients in the intensive care unit (ICU). This study assessed the association of nocturnal mean arterial pressure rising (NMAPR) with short‐ and long‐term mortality in critically ill adult patients. Methods and Results Adult patients with a complete record of mean arterial pressure monitoring during the first 24 hours of ICU stay in the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC‐II) database were included in this retrospective cohort study. All patients were divided into the non‐NMAPR group (≤1) or the NMAPR group (>1), according to the value of mean nighttime divided by daytime mean arterial pressure. The associations of NMAPR with ICU, hospital, 28‐day, and 1‐year mortality were assessed using multivariable logistic regression or a Cox proportional hazards model. Interaction and subgroup analyses were performed for those patients who had a first Sequential Organ Failure Assessment (SOFA) score of ≥8 or <8. The overall cohort comprised 5185 patients. The patients with NMAPR (n=1865) had higher ICU, hospital, 28‐day, and 1‐year mortality than the non‐NMAPR group (n=3320). After adjusting for covariates, the analysis showed that NMAPR was significantly associated with mortality in the ICU (odds ratio: 1.34; 95% CI, 1.10–1.65), in the hospital (odds ratio: 1.35; 95% CI, 1.12–1.63), at 28 days (hazard ratio: 1.27; 95% CI, 1.10–1.48), and at 1 year (hazard ratio: 1.24; 95% CI, 1.10–1.40). All results of the interaction analysis had no statistical significance, and similar results persisted in the patients with different SOFA scores. Conclusions NMAPR may aid in the early identification of critically ill patients at high risk of ICU, hospital, 28‐day, or 1‐year mortality.
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Affiliation(s)
- Jiamei Li
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Ruohan Li
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Ya Gao
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Jingjing Zhang
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Yujie Zhao
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Xiaoling Zhang
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Gang Wang
- Department of Critical Care MedicineThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
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Impact of Mean Arterial Pressure Fluctuation on Mortality in Critically Ill Patients. Crit Care Med 2019; 46:e1167-e1174. [PMID: 30247271 DOI: 10.1097/ccm.0000000000003435] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the association between mean arterial pressure fluctuations and mortality in critically ill patients admitted to the ICU. DESIGN Retrospective cohort. SETTING All adult ICUs at a tertiary care hospital. PATIENTS All adult patients with complete mean arterial pressure records were selected for analysis in the Multiparameter Intelligent Monitoring in Intensive Care II database. Patients in the external cohort were newly recruited adult patients in the Medical Information Mart for Intensive Care III database. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The records of 8,242 patients were extracted. Mean arterial pressure fluctuation was calculated as follows: (mean nighttime mean arterial pressure - mean daytime mean arterial pressure)/mean arterial pressure. Patients were divided into two groups according to the degree of mean arterial pressure fluctuation: group A (between -5% and 5%) and group B (<-5% and >5%). The endpoints of this study were ICU and hospital mortality. Patients in group A (n = 4,793) had higher ICU and hospital mortality than those in group B (n = 3,449; 11.1% vs 8.1%, p < 0.001 and 13.8% vs 10.1%, p < 0.001, respectively). After adjusting for other covariates, the mean arterial pressure fluctuations between -5% and 5% were significantly correlated with ICU mortality (odds ratio, 1.296; 95% CI, 1.103-1.521; p = 0.002) and hospital mortality (odds ratio, 1.323; 95% CI, 1.142-1.531; p < 0.001). This relationship remained remarkable in patients with low or high Sequential Organ Failure Assessment scores in the sensitive analysis. Furthermore, external validation on a total of 4,502 individuals revealed that patients in group A still had significantly higher ICU (p < 0.001) and hospital mortality (p < 0.001) than those in group B. CONCLUSIONS The reduced mean arterial pressure fluctuation (within -5% and 5%) may be associated with ICU and hospital mortality in critically ill patients.
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Park JS, Shin JH, Park JB, Choi DJ, Youn HJ, Park CG, Kwan J, Ahn Y, Kim DW, Rim SJ, Park SW, Sung J, Bae JH. Relationship between arterial stiffness and circadian pattern of blood pressure. Medicine (Baltimore) 2019; 98:e14953. [PMID: 30896666 PMCID: PMC6709131 DOI: 10.1097/md.0000000000014953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Arterial stiffness is a risk factor for cardiovascular morbidity and mortality. The relationship between the arterial stiffness and the circadian pattern of blood pressure (BP) has been controversial. The objective of the present study was to investigate the relationship between arterial stiffness by pulse wave analysis (PWA) and variables of 24-hour ambulatory BP monitoring (ABPM) in patients with high normal BP or hypertension (HTN).Five hundred forty-eight patients (304 males, 48 ± 12-year-old) with high normal BP or HTN were enrolled. BP was measured at the outpatient clinic and 24-hour ABPM was performed. Using radial applanation tonometry, PWA was performed for evaluation of systemic arterial stiffness. Patients were classified into four groups according to the dipping patterns: a nocturnal dipping group, an isolated systolic non-dipping group, an isolated diastolic non-dipping group and a both systolic and diastolic non-dipping group. For adjustment of age, population was divided to 2 groups: old group ≥55 year-old (n = 158, 75 males), young group <55 year-old (n = 390, 229 males).According to the dipping patterns, augmentation pressure (AP), augmentation index (AI) and heart rate (75 bpm) adjusted AI (AI@HR75) showed statistically significant difference (P = .011, .009, and .018, respectively). Multivariate analysis showed that isolated diastolic non-dipping was correlated with arterial stiffness expressed as AI and AI@HR 75, only in young group (β-coefficient = 12.6, P = .04 and β-coefficient = 7.503, P = .028, respectively).Arterial stiffness might be closely related with the pattern of non-dipping in young patients with HTN and high normal BP.
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Affiliation(s)
- Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon
| | - Joon-Han Shin
- Department of Cardiology, Ajou University School of Medicine, Suwon
| | | | - Dong-Ju Choi
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam
| | - Ho-Joong Youn
- Cardiovascular Center and Cardiology Division, College of Medicine, The Catholic University of Korea, Seoul
| | - Chang-Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul
| | - Jun Kwan
- Department of Cardiology, Inha University College of Medicine, Incheon
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju
| | - Dong-Woon Kim
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital and Chungbuk National University College of Medicine, Cheongju
| | - Se-Joong Rim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College Medicine, Seoul
| | - Seung-Woo Park
- Division of Cardiology, Heart Vascular and Stroke Institute, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Jidong Sung
- Division of Cardiology, Heart Vascular and Stroke Institute, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Jang-Ho Bae
- Department of Cardiology, Heart Center, College of Medicine, Konyang University, Deajeon, Republic of Korea
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Somuncu MU, Karakurt ST, Karakurt H, Serbest NG, Cetin MS, Bulut U. The additive effects of OSA and nondipping status on early markers of subclinical atherosclerosis in normotensive patients: a cross-sectional study. Hypertens Res 2018; 42:195-203. [PMID: 30504820 DOI: 10.1038/s41440-018-0143-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/26/2018] [Accepted: 06/06/2018] [Indexed: 11/09/2022]
Abstract
The additive effect of hypertension on carotid atherosclerosis in patients with obstructive sleep apnea (OSA) is well-established; however, the effect of the nondipping pattern has not yet been evaluated. In this study, we aim to assess the effect of the nondipping pattern on carotid atherosclerosis, which is quantified as carotid intima-media thickness (CIMT), and on the high-risk carotid profile in normotensive patients with OSA. We included 189 patients with OSA in this cross-sectional study. We followed a 2 × 2 factorial design to create groups according to the presence of OSA and nondipping pattern. All patients underwent carotid ultrasonography to quantify their CIMT and presence of plaques. Patients who had CIMT ≥ 0.9 mm and/or carotid plaques were classified as having a high-risk carotid profile. Patients in the OSA/nondipper group had a 26% higher CIMT and five times the prevalence of a high-risk carotid profile compared to patients in the non-OSA/dipper group. CIMT was correlated with age, the apnea-hypopnea index (AHI), minimum oxygen saturation, and nighttime systolic blood pressure (SBP). Independent of age, diabetes, and AHI, a one mmHg increase in nighttime SBP was associated with a 0.22 mm increase in CIMT and a 4% increase in odds for the high-risk carotid profile. Similarly, independent of age and diabetes, being in the OSA/nondipper group was associated with 6.7 times increased odds for a high-risk carotid profile than being in the non-OSA/dipper group. Modeling with both the nondipping status and presence of OSA produced an 8% higher discriminative value than modeling with neither of these parameters. We found an additive effect of the nondipping pattern on carotid atherosclerosis in normotensive patients with OSA. Our findings suggested that in addition to having established hypertension, a nondipping pattern in normotensive patients with OSA may aggravate atherosclerosis.
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Affiliation(s)
- Mustafa Umut Somuncu
- Department of Cardiology, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey.
| | - Seda Tukenmez Karakurt
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | - Huseyin Karakurt
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
| | | | - Mehmet Serkan Cetin
- Department of Cardiology, Bulent Ecevit University Faculty of Medicine, Zonguldak, Turkey
| | - Umit Bulut
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Istanbul, Turkey
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Abstract
PURPOSE OF REVIEW Given the emerging knowledge that circadian rhythmicity exists in every cell and all organ systems, there is increasing interest in the possible benefits of chronotherapy for many diseases. There is a well-documented 24-h pattern of blood pressure with a morning surge that may contribute to the observed morning increase in adverse cardiovascular events. Historically, antihypertensive therapy involves morning doses, usually aimed at reducing daytime blood pressure surges, but an absence of nocturnal dipping blood pressure is also associated with increased cardiovascular risk. RECENT FINDINGS To more effectively reduce nocturnal blood pressure and still counteract the morning surge in blood pressure, a number of studies have examined moving one or more antihypertensives from morning to bedtime dosing. More recently, such studies of chronotherapy have studied comorbid populations including obstructive sleep apnea, chronic kidney disease, or diabetes. Here, we summarize major findings from recent research in this area (2013-2017). In general, nighttime administration of antihypertensives improved overall 24-h blood pressure profiles regardless of disease comorbidity. However, inconsistencies between studies suggest a need for more prospective randomized controlled trials with sufficient statistical power. In addition, experimental studies to ascertain mechanisms by which chronotherapy is beneficial could aid drug design and guidelines for timed administration.
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18
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Gunawan F, Ng HY, Gilfillan C, Anpalahan M. Ambulatory Blood Pressure Monitoring in Type 2 Diabetes Mellitus: A Cross-sectional Study. Curr Hypertens Rev 2018; 15:135-143. [PMID: 29875006 PMCID: PMC6635654 DOI: 10.2174/1573402114666180607090205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/29/2018] [Accepted: 06/03/2018] [Indexed: 01/19/2023]
Abstract
Background: Ambulatory blood pressure (ABP) monitoring in type 2 diabetes (T2DM) is not yet routine in clini-cal practice. Objectives: To quantify abnormal ABP patterns and their associations with diabetic complications, and to assess the reliabil-ity of office blood pressure (OBP) for assessing BP in T2DM. Methods: In a cross-sectional study, eligible patients with T2DM underwent OBP and 24- hour ABP measurements under standardized conditions and screening for diabetic complications. Results: 56 patients (mean age 67 + 10 years, males 50%) completed assessment. 43(73%) had a known history of hyper-tension. Non-dipping and nocturnal systolic hypertension (SHT) were prevalent in 31(55%) and 32(57%) patients, respec-tively. 16(29%) demonstrated masked phenomenon, but only three (7%) demonstrated white coat effect. Nocturnal SHT had a significant association with composite microvascular complications independent of daytime systolic BP control (adjusted odds ratio (OR) 1.72(CI 1.41-4.25). There was no association between other abnormal ABP patterns and diabetic complica-tions. The sensitivity and specificity of OBP for diagnosing HT or assessing BP control was 59% and 68% respectively. The positive and negative predictive values were 74% and 52% respectively. Conclusion: Non-dipping, reverse dipping, nocturnal SHT and masked phenomenon are highly prevalent in patients with T2DM with or without a known history of hypertension. Compared with non-dipping, nocturnal SHT may be a stronger predictor of end organ damage. The reliability of OBP for assessing BP in T2DM is only modest. Patients with T2DM are likely to benefit from routine ABP monitoring.
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Affiliation(s)
- Florence Gunawan
- Department of Endocrinology, Eastern Health, Victoria, Australia
| | - Hui Yi Ng
- Department of General Medicine, Eastern Health, Victoria, Australia
| | - Christopher Gilfillan
- Department of Endocrinology, Eastern Health, Victoria, Australia.,Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Mahesan Anpalahan
- Department of General Medicine, Eastern Health, Victoria, Australia.,Eastern Health Clinical School, Monash University, Victoria, Australia.,North West Academic Centre, The University of Melbourne, Victoria, Australia
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Su D, Song A, Yan B, Guo Q, Gao Y, Zhou Y, Zhou F, Yang G, Zhang C. Circadian Blood Pressure Variations in Postmenopausal Females with Hypertension. Int Heart J 2018; 59:361-366. [PMID: 29479015 DOI: 10.1536/ihj.17-206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The abnormalities of blood pressure (BP) nocturnal decline have been found to be predictive for carotid plaque and lacunar infarction in patients with hypertension. In this study, BP dipping patterns in postmenopausal females with hypertension were investigated. The nocturnal decline of systolic BP (SBP) was evaluated using 24-hour ambulatory BP monitoring (ABPM). A total of 163 postmenopausal females were eventually included in our study. The prevalence of reverse-dipper BP pattern was 32.3% in females with menopause age in their 40s and 40% in their 50s. However, after multivariate logistic regression analysis, menopause age was shown to be an independent risk factor for BP reverse dipping (Odds ratio [OR] 1.148; 95%CI 1.020 - 1.292; P = 0.020). Moreover, menopause age was negatively correlated with the decline rate of nocturnal SBP (r = -0.159; P < 0.05) and diastolic BP (r = -0.161; P < 0.05). Our study suggested that the menopause age might serve as a risk factor for reverse-dipper BP pattern in postmenopausal females with hypertension.
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Affiliation(s)
- Dan Su
- Department of Cardiology, the Second Affiliated Hospital, Xi'an Jiaotong University
| | - Anqi Song
- Department of Cardiology, the Second Affiliated Hospital, Xi'an Jiaotong University
| | - Bin Yan
- Department of Clinical Research Center, the First Affiliated Hospital, Xi'an Jiaotong University
| | - Qi Guo
- Department of Cardiology, the Second Affiliated Hospital, Xi'an Jiaotong University
| | - Ya Gao
- Department of Emergency Medicine, the Second Affiliated Hospital, Xi'an Jiaotong University
| | - Yanhua Zhou
- Department of Cardiology, Xianyang People's Hospital
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital, Wuhan University
| | - Guang Yang
- Department of Cardiology, Shaanxi Provincial People's Hospital
| | - Chaoying Zhang
- Department of Cardiology, the Second Affiliated Hospital, Xi'an Jiaotong University
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The underlying risks of circadian blood pressure variation for carotid plaque in treated hypertensive patients with normal blood pressure. Blood Press Monit 2018; 22:191-195. [PMID: 28257292 DOI: 10.1097/mbp.0000000000000253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between 24 h variation of blood pressure (BP) and carotid plaque in essential hypertensive patients with normal BP under anti-hypertensive treatment. PARTICIPANTS AND METHODS A total of 322 hypertensive patients with systolic BP (SBP) and diastolic BP (DBP) within the normal range after routine treatment were continuously recruited and evaluated by ambulatory BP monitoring from 1 January 2014 to 31 July 2015. The exclusion criteria included participants younger than 18 or older than 90 years of age, pregnancy, night-work employment, and suffering from secondary hypertension. The prevalence of carotid plaque between different circadian BP pattern groups was analyzed using a χ-test. Logistic regression was applied to analyze the relationship between carotid plaque and ambulatory BP monitoring variables. RESULTS All the individuals were divided into a 'carotid plaque' group (n=197) and a 'non-plaque' group (n=125) on the basis of whether the thickness of each plaque was at least 0.5 mm under the carotid ultrasound. In addition, patients were grouped into a dipper (10-20% nocturnal fall of BP in SBP) group and a nondipper (<10% nocturnal fall of BP in SBP) group on the basis of individual SBP variation. In the nondipper group, the number of patients with carotid plaque was higher than the patients without plaque (P=0.017). Logistic analysis showed that the nondipper pattern of BP was significantly associated with the formation of carotid plaque (odds ratio=1.731, P=0.041). CONCLUSION A nondipper pattern of BP may serve as a risk factor for carotid plaque in treated hypertensive individuals with normal BP.
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Cuspidi C, Sala C, Tadic M, Gherbesi E, De Giorgi A, Grassi G, Mancia G. Clinical and prognostic significance of a reverse dipping pattern on ambulatory monitoring: An updated review. J Clin Hypertens (Greenwich) 2017; 19:713-721. [PMID: 28692165 PMCID: PMC8031119 DOI: 10.1111/jch.13023] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/15/2017] [Accepted: 03/26/2017] [Indexed: 11/28/2022]
Abstract
Reverse or inverted dipping (ie, the phenomenon characterized by higher nighttime compared with daytime blood pressure values) is an alteration of circadian blood pressure rhythm frequently documented in hypertension, type 2 diabetes mellitus, chronic kidney disease, and sleep apnea syndrome, and generally regarded as a harmful condition. Available literature on the clinical and prognostic implications of reverse dipping is scanty. The present article will review a number of relevant issues concerning reverse dipping, in particular: (1) its possible mechanisms; (2) prevalence and clinical correlates, (3) concomitant cardiac and extracardiac subclinical organ damage; (4) association with acute and chronic cardiovascular diseases; (5) prognostic value in predicting cardiovascular events and mortality; and (6) therapeutic interventions aimed at reverting this abnormal circadian blood pressure rhythm.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Istituto Auxologico ItalianoMilanoItaly
| | - Carla Sala
- Department of Clinical Sciences and Community HealthUniversity of Milano and Fondazione IRCCS Policlinico di MilanoMilanoItaly
| | - Marijana Tadic
- University Clinical Hospital Centre “Dragisa Misovic”BelgradeSerbia
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community HealthUniversity of Milano and Fondazione IRCCS Policlinico di MilanoMilanoItaly
| | | | - Guido Grassi
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
- Istituto di Ricerche a Carattere Scientifico MultimedicaSesto San GiovanniMilanItaly
| | - Giuseppe Mancia
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanoItaly
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23
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Abstract
Background orthostatic hypotension (OH) is a common disabling condition associated with increased morbidity and mortality. Much of the evidence available is derived from younger populations with chronic neurological disease leading to uncertainty for the diagnosis and management of older people. Objective to provide an overview of recent and emerging evidence for the diagnosis, management and prognosis of OH in older persons. Methods a narrative review of recent studies, emerging therapies and relevant regulatory updates. Findings revisions to the diagnostic criteria for OH include the duration of the blood pressure drop, specific criteria for initial and delayed OH and OH with hypertension. Non-drug therapies remain the first-line treatment option and Comprehensive Geriatric Assessment appears to result in lower rates of OH. Recent evidence concerning withdrawal of causative medication is inconsistent. Midodrine has recently become the only licenced medication for OH in the UK. Other emerging treatments include atomoxetine and droxidopa but these require further evaluation. Many other agents may be used but are not supported by high-quality evidence. The increase in mortality associated with OH is less apparent in older people. Summary OH remains common in older people, the new diagnostic criteria address some of the previous uncertainty but evidence concerning withdrawal of antihypertensives is conflicting. Midodrine is now the only licenced medication for OH in the UK, but non-drug therapies remain first line and fludrocortisone may be considered before midodrine. We may see other agents such as droxidopa becoming increasingly used over the coming years.
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Affiliation(s)
- James Frith
- Newcastle University-Institute of Cellular Medicine, Newcastle upon Tyne NE1 7RU, United Kingdom of Great Britain and Northern Ireland
- The Newcastle upon Tyne Hospitals NHS Foundation Trust-Falls and Syncope Service, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Steve W Parry
- Newcastle University-Institute of Cellular Medicine, Newcastle upon Tyne NE1 7RU, United Kingdom of Great Britain and Northern Ireland
- The Newcastle upon Tyne Hospitals NHS Foundation Trust-Falls and Syncope Service, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
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Çimen T, Bilgin M, Akyel A, Felekoğlu MA, Nallbani A, Özdemir Ş, Erden G, Öztürk A, Doğan M, Yeter E. Endocan and Non-Dipping Circadian Pattern in Newly Diagnosed Essential Hypertension. Korean Circ J 2016; 46:827-833. [PMID: 27826342 PMCID: PMC5099339 DOI: 10.4070/kcj.2016.46.6.827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/27/2016] [Accepted: 04/05/2016] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives Non-dipper hypertension is frequently accompanied by endothelial dysfunction and activation. Previous studies suggested that endocan may be a novel endothelial dysfunction marker. This study aims to investigate the association between circadian blood pressure (BP) pattern and plasma endocan levels together with high-sensitivity C-reactive protein (hsCRP) in patients with newly diagnosed untreated hypertension. Subjects and Methods Twenty-four hour ambulatory blood pressure monitoring was recorded in 35 dipper, 35 non-dipper hypertensives and 35 healthy controls. Endocan levels were measured by enzyme-linked immunosorbent assay. Serum levels of hsCRP were also recorded. Results Despite similar daytime and 24-hour average BP values between dippers and non-dippers, statistically significant high nocturnal BP was accompanied by a non-dipping pattern (Systolic BP: 132±9 vs. 147±11 mmHg; Distolic BP: 80±7 vs. 91±9 mmHg, respectively, p<0.001 for both). Non-dipper patients demonstrated higher endocan levels compared to dippers and normotensives (367 (193-844) pg/mL, 254 (182-512) pg/mL and 237 (141-314) pg/ml, respectively, p<0.001). HsCRP levels were significantly higher in non-dippers than the other groups (p=0.013). In a multivariate logistic regression analysis, endocan (p=0.021) and hsCRP (p=0.044) were independently associated with a non-dipping pattern. Conclusion Elevated endocan levels were found in non-dipper groups. Endocan and hsCRP were found to be independently associated with a non-dipping pattern. We suggest that elevated levels of endocan in non-dipper hypertensive patients might be associated with a longer duration of exposure to high BP. These results point to the possible future role of endocan in selection of hypertensive patients at higher risk or target organ damage.
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Affiliation(s)
- Tolga Çimen
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Murat Bilgin
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ahmet Akyel
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mehmet Ali Felekoğlu
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ali Nallbani
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Şeyda Özdemir
- Department of Clinical Biochemistry, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Gönül Erden
- Department of Clinical Biochemistry, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Alpaslan Öztürk
- Department of Clinical Biochemistry, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mehmet Doğan
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ekrem Yeter
- Department of Cardiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Wada M, Takeshima T, Nakamura Y, Nagasaka S, Kamesaki T, Kajii E. Carotid plaque is a new risk factor for peripheral vestibular disorder: a retrospective cohort study. Medicine (Baltimore) 2016; 95:e4510. [PMID: 27495105 PMCID: PMC4979859 DOI: 10.1097/md.0000000000004510] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Many chronic diseases are associated with dizziness or vertigo, as is peripheral vestibular disorder (PVD). Although carotid plaque development is linked to atherosclerosis, it is unclear whether such plaques can lead to the development of PVD. We therefore conducted this study to investigate the presence of an association between carotid plaque and new PVD events.In this retrospective study, we consecutively enrolled 393 patients ≥20 years old who had been treated for chronic diseases such as hypertension, dyslipidemia, and diabetes mellitus for ≥6 months at a primary care clinic (Oki Clinic, Japan) between November 2011 and March 2013. Carotid plaque presence was measured with high-resolution ultrasonography for all patients. During a 1-year follow-up period, an otorhinolaryngologist diagnosed and reported any new PVD events (the main end point). Hazard ratios (HRs) and 95% confidence intervals (CIs) for new PVD occurrence were estimated using the Cox proportional hazard regression model.The mean age of the participants was 65.5 years; 33.8% were men, and 12.7%, 82.4%, and 93.1% had diabetes mellitus, hypertension, and dyslipidemia, respectively. There were 76 new PVD events; patients with carotid plaque had a greater risk of such events (crude HR: 3.25; 95% CI: 1.62-6.52) compared to those without carotid plaque. This risk was even higher after adjusting for traditional risk factors for atherosclerosis (adjusted HR: 4.41; 95% CI: 1.75-11.14).Carotid plaques are associated with an increased risk of new PVD events.
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Affiliation(s)
- Masaoki Wada
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Tochigi
- Oki Clinic, Ibaraki
- Correspondence: Masaoki Wada, Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan (e-mail: )
| | - Taro Takeshima
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Tochigi
| | | | - Shoichiro Nagasaka
- Division of Diabetes, Metabolism and Endocrinology, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Toyomi Kamesaki
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Tochigi
| | - Eiji Kajii
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Tochigi
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Blood pressure reverse dipping may associate with stable coronary artery disease in patients with essential hypertension: a cross-sectional study. Sci Rep 2016; 6:25410. [PMID: 27139821 PMCID: PMC4853743 DOI: 10.1038/srep25410] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 04/18/2016] [Indexed: 12/20/2022] Open
Abstract
The dipping variations of circadian blood pressure (BP) correlate closely with target-organ damages and cardiovascular events. The aim of this study was to investigate the relationship between BP reverse dipping and the prevalence of stable coronary artery disease (sCAD) in hypertensive patients. Clinical data and the results of 24-hour ambulatory BP monitoring (ABPM) were obtained from 718 hypertensive patients (390 males, mean age 59.6 ± 13.8 years) in a single centre in Northern China. Reverse dipping pattern was defined as nocturnal systolic BP (SBP) was higher than daytime SBP. A logistic regression model was applied to explore the independent risk factors of sCAD. The patients with BP reverse dipping accounted for 31.5% in sCAD group and 19.5% in control group (P < 0.05). In multivariate analysis, BP reverse dipping remained significantly associated with the prevalence of sCAD (Odds ratio [OR], 1.772; p = 0.027). Furthermore, the circadian decline rate of SBP was independently associated with sCAD (OR, 0.975; p = 0.043). The hypertensive patients with reverse BP dipping were found to be more frequently suffering from sCAD. BP reverse dipping examined with 24-hour ABPM may indicate sCAD.
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Sun L, Yan B, Gao Y, Su D, Peng L, Jiao Y, Wang Y, Han D, Wang G. Relationship between blood pressure reverse dipping and type 2 diabetes in hypertensive patients. Sci Rep 2016; 6:25053. [PMID: 27109832 PMCID: PMC4842986 DOI: 10.1038/srep25053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/08/2016] [Indexed: 01/14/2023] Open
Abstract
Recent studies suggested that nocturnal variations of blood pressure (BP) were closely related to type 2 diabetes. However, little information has been revealed about the relationship between reverse-dipper pattern of BP and type 2 diabetes. In this cross-sectional study, BP variations of 531 hypertensive patients were evaluated with ambulatory BP monitoring (ABPM). Diagnosis of diabetes in Chinese adults was made according to diabetes diagnostic criteria of 2015. Multivariate logistic regression was used to examine the relationships between type 2 diabetes and ABPM results. In the study, patients with reverse-dipper pattern (32.3%) had the highest prevalence of type 2 diabetes compared with dippers (21.4%) and nondippers (23.3%). After multivariate logistic regression, reverse-dipper BP pattern (OR 2.067, P = 0.024) and nondipper BP pattern (OR 1.637, P = 0.039) were found to be correlated with type 2 diabetes compared with dipper pattern. The results of our study also suggested that type 2 diabetes might contribute to the reverse-dipper pattern of BP (OR 1.691, P = 0.023). In addition, fasting glucose was negatively correlated with the decline rate of nocturnal SBP (r = -0.095, P = 0.029). Reverse-dipper pattern of BP in ABPM may be independently associated with type 2 diabetes in patients with hypertension.
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Affiliation(s)
- Lu Sun
- Department of Ultrasound, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Bin Yan
- Department of Emergency Medicine, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Ya Gao
- Department of Emergency Medicine, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Dan Su
- Department of Cardiology, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Liyuan Peng
- Department of Emergency Medicine, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yang Jiao
- Department of Endocrinology, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yuhuan Wang
- Department of Endocrinology, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Donggang Han
- Department of Ultrasound, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Gang Wang
- Department of Emergency Medicine, the Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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Su D, Guo Q, Gao Y, Han J, Yan B, Peng L, Song A, Zhou F, Wang G. The relationship between red blood cell distribution width and blood pressure abnormal dipping in patients with essential hypertension: a cross-sectional study. BMJ Open 2016; 6:e010456. [PMID: 26908530 PMCID: PMC4769385 DOI: 10.1136/bmjopen-2015-010456] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To investigate whether red blood cell distribution width (RDW) is associated with the blood pressure (BP) reverse-dipper pattern in patients with hypertension. DESIGN Cross-sectional study. SETTING Single centre. PARTICIPANTS Patients with essential hypertension were included in our study (n=708). The exclusion criteria included age <18 or >90 years, incomplete clinical data, night workers, diagnosis of secondary hypertension, under antihypertensive treatment, intolerance for the 24 h ambulatory BP monitoring (ABPM) and BP reading success rate <70%. MEASUREMENT Physical examination and ABPM were performed for all patients in our study. The value of RDW was measured using an automated haematology analyser. STATISTICAL METHODS The distribution of RDW in patients with hypertension among different circadian BP pattern groups was analyzed using analysis of variance (ANOVA). Multinomial logistic regression was applied to explore the associations of RDW and other relevant variables with ABPM results. RESULTS There was significantly increased RDW in reverse dippers (13.52 ± 1.05) than dippers (13.25 ± 0.85) of hypertension (p=0.012). Moreover, multinomial logistic regression analysis showed that RDW (OR 1.325, 95% CI 1.037 to 1.692, p=0.024) and diabetes mellitus (OR 2.286, 95% CI 1.380 to 3.788, p=0.001) were significantly different when comparing the reverse-dipper BP pattern with the dipper pattern. However, there was no difference of RDW between the non-dipper pattern and the reverse-dipper pattern (OR 1.036, 95% CI 0.867 to 1.238, p=0.693). In addition to this, RDW was negatively correlated with the decline rate of nocturnal systolic BP (r=-0.113; p=0.003) and diastolic BP (r=-0.101; p=0.007). CONCLUSIONS Our results suggested that RDW might associate with the abnormal dipper BP patterns of either reverse dipping or non-dipping homogeneously examined with 24 h ABPM.
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Affiliation(s)
- Dan Su
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Qi Guo
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Ya Gao
- Department of Emergency Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Jin Han
- Department of Nephrology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Bin Yan
- Department of Emergency Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Liyuan Peng
- Department of Emergency Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Anqi Song
- Department of Cardiology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Fuling Zhou
- Department of Hematology, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Gang Wang
- Department of Emergency Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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Yan B, Yan H, Sun L, Yan X, Peng L, Wang Y, Wang G. Novel Association Between the Reverse-Dipper Pattern of Ambulatory Blood Pressure Monitoring and Metabolic Syndrome in Men But Not in Women. Medicine (Baltimore) 2015; 94:e2115. [PMID: 26632731 PMCID: PMC5059000 DOI: 10.1097/md.0000000000002115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The aim of this study was to investigate the relationships between nocturnal variations in blood pressure (BP) and metabolic syndrome (MetS) in different gender.This cross-sectional study involved 509 hypertensive patients (254 males and 255 females, 45 to 75 years old) from September 2013 to March 2014. BP values were acquired from ambulatory BP monitoring (ABPM). The dipper pattern of BP was defined as 10% to 20% reduction of the mean systolic BP (SBP) values at night compared with the daytime values. The diagnosis of MetS was made according to NCEP ATP-III definition. Multivariate logistic regression analyses were used to explore the relationships between ABPM results and MetS.In our study, MetS were observed in 29.1% of male and 18.4% of female participants. The prevalence of MetS was higher in the patients with reverse-dipper pattern than in others. After multivariate logistic regression analysis, the reverse-dipper pattern of BP (odds ratio 2.298; P = 0.006) and 24-SBP (odds ratio 1.063; P = 0.021) were independently correlated with MetS in males. However, there was no association between MetS and BP reverse dipping in females.Our cross-sectional study showed that the reverse-dipper pattern of BP is associated with MetS in male, while the underlying mechanism deserves further investigation.
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Affiliation(s)
- Bin Yan
- From the Department of Emergency Medicine (BY, GW); Department of Endocrinology (HY, YW); Department of Ultrasound (LS); the Second Affiliated Hospital, Xi'an Jiaotong University; Xi'an Jiaotong University Health Science Center, Xi'an (XY); and School of Medicine, Tianjin Medical University, Tianjin, China (LP)
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