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Baek MS, Song WK, Kim KE, Lee A, Lee JY, Shin JW, Kook MS. Morning Blood Pressure Surge and Glaucomatous Visual Field Progression in Normal-Tension Glaucoma Patients With Systemic Hypertension. Am J Ophthalmol 2023; 254:161-176. [PMID: 37352910 DOI: 10.1016/j.ajo.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE To investigate the impact of a morning blood pressure surge (MBPS) at baseline on subsequent visual field (VF) progression in hypertensive, normal-tension glaucoma (NTG) patients receiving oral anti-hypertensive treatment. DESIGN Retrospective cohort study. METHODS A total of 127 eyes from 127 newly diagnosed NTG patients treated for systemic hypertension and followed up for at least 2 years were analyzed. All patients underwent baseline 24-hour ambulatory blood pressure monitoring (ABPM) and at least 5 serial VF examinations during the follow-up period. VF progression was defined according to the Early Manifest Glaucoma Trial criteria. The associations of VF progression with 24-hour ABPM-based blood pressure (BP) parameters (including MBPS) and other clinical variables were analyzed using Cox regression analyses. Kaplan-Meier survival analysis was used to compare VF survival estimates in patients with and without MBPS. RESULTS VF progression was detected in 38 eyes (29.9%) over a 5.2-year mean follow-up. In the multivariate Cox regression model, a greater MBPS (hazard ratio [HR] = 1.033; P = .024) and lower nighttime mean arterial pressure (MAP) trough (HR = 0.965; P = .031) at baseline were significant independent predictors of subsequent VF progression. The likelihood of VF progression was significantly greater in patients with higher MBPS (P = .021) at baseline according to Kaplan-Meier survival analysis. CONCLUSIONS An increased MBPS at baseline is a significant independent predictor of subsequent VF progression in NTG patients with systemic hypertension. This may be another relevant BP parameter associated with VF progression in hypertensive NTG patients receiving oral anti-hypertensive treatment.
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Affiliation(s)
- Min Su Baek
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Woo Keun Song
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ko Eun Kim
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Anna Lee
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jin Yeong Lee
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joong Won Shin
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Michael S Kook
- From the Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Omboni S. Ethnic disparities in the morning surge: Which utility for typifying the hypertensive patient? J Clin Hypertens (Greenwich) 2019; 22:29-31. [PMID: 31769150 DOI: 10.1111/jch.13739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy.,Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Moscow, Russia
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Morning blood pressure surge in young black and white adults: The African-PREDICT Study. J Hum Hypertens 2018; 33:22-33. [DOI: 10.1038/s41371-018-0089-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/09/2022]
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Muntner P, Lewis CE, Diaz KM, Carson AP, Kim Y, Calhoun D, Yano Y, Viera AJ, Shimbo D. Racial differences in abnormal ambulatory blood pressure monitoring measures: Results from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Am J Hypertens 2015; 28:640-8. [PMID: 25376639 PMCID: PMC4415060 DOI: 10.1093/ajh/hpu193] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/03/2014] [Accepted: 09/05/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Several ambulatory blood pressure monitoring (ABPM) measures have been associated with increased cardiovascular disease risk independent of clinic blood pressure (BP). African Americans have higher clinic BP compared with Whites but few data are available on racial differences in ABPM measures. METHODS We compared ABPM measures between African American (n = 178) and White (n = 103) participants at the Year 5 Coronary Artery Risk Development in Young Adults study visit. BP was measured during a study visit and the second and third measurements were averaged. ABPM was conducted over the following 24 hours. RESULTS Mean ± SD age of participants was 29.8 ± 3.8 years and 30.8 ± 3.5 years for African Americans and Whites, respectively. Mean daytime systolic BP (SBP) was 3.90 (SD 1.18) mm Hg higher among African Americans compared with Whites (P < 0.001) after age-gender adjustment and 1.71 (SD 1.03) mm Hg higher after multivariable adjustment including mean clinic SBP (P = 0.10). After multivariable adjustment including mean clinic SBP, nighttime SBP was 4.83 (SD 1.11) mm Hg higher among African Americans compared with Whites (P < 0.001). After multivariable adjustment, the African Americans were more likely than Whites to have nocturnal hypertension (prevalence ratio: 2.44, 95% CI: 0.99-6.05) and nondipping (prevalence ratio: 2.50, 95% CI: 1.39-4.48). The prevalence of masked hypertension among African Americans and Whites was 4.4% and 2.1%, respectively, (P = 0.49) and white coat hypertension was 3.3% and 3.9%, respectively (P = 0.99). Twenty-four hour BP variability on ABPM was higher among African Americans compared with Whites. CONCLUSIONS These data suggest racial differences in several ABPM measures exist.
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Affiliation(s)
- Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA;
| | - Cora E Lewis
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Keith M Diaz
- Department of Medicine, Columbia University, New York, New York, USA
| | - April P Carson
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yongin Kim
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David Calhoun
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yuichiro Yano
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - Anthony J Viera
- Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Daichi Shimbo
- Department of Medicine, Columbia University, New York, New York, USA
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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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Mc Causland FR, McMullan CJ, Sacks FM, Forman JP. Race, plasma renin activity, and morning blood pressure surge--results from the Dietary Approaches to Stop Hypertension trial. Am J Hypertens 2014; 27:530-6. [PMID: 23475701 DOI: 10.1093/ajh/hpt031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The association of preawake (difference between pre- and postwaking blood pressure (BP)) and sleep-through surge (difference between sleeping nadir and postwaking BP) with cardiovascular events is unclear. Examination of factors associated with surge may provide novel insights. We examined the association of race, which associates with nocturnal dipping, and plasma renin activity (PRA) with preawake and sleep-through surge among individuals on a controlled diet. METHODS We performed a post hoc analysis of 323 subjects from the Dietary Approaches to Stop Hypertension trial who had available 24-hour BP data and who ingested a control diet during a 3-week run-in period. Linear regression models were fit to estimate the association of race and PRA with preawake and sleep-through surge. RESULTS Of the 323 individuals, 55% were black, 53% were men, and the average age was 45 years. After controlling for other factors, black race was associated with a 3.2mm Hg lower preawake and a 3.7mm Hg lower sleep-through surge compared with nonblacks. In nonblacks, higher PRA was associated with greater preawake surge only. There was no association of PRA with either preawake or sleep-through surge in blacks. Additional adjustment for dipping status resulted in attenuation of the race-surge associations. CONCLUSIONS Black race is associated with lower preawake and sleep-through surge compared with nonblacks, but the effect is partially attenuated by dipping status. Higher PRA appears to be associated with a higher preawake surge in nonblacks only. Further research should address if morning surge is definitively associated with clinical outcomes in racial subgroups, independent of dipping.
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Affiliation(s)
- Finnian R Mc Causland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Neutel JM, Schumacher H, Gosse P, Lacourcière Y, Williams B. Magnitude of the early morning blood pressure surge in untreated hypertensive patients: a pooled analysis. Int J Clin Pract 2008; 62:1654-63. [PMID: 18795972 DOI: 10.1111/j.1742-1241.2008.01892.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES A post hoc analysis was performed to assess the magnitude of the early morning blood pressure surge (EMBPS), which is associated with peak cardiovascular risk, in untreated hypertensive patients enrolled in two sister studies (Prospective, Randomised Investigation of the Safety and efficacy of MICARDIS vs. ramipril using ambulatory blood pressure monitoring I and II) with identical design. METHODS In adults with a mild-to-moderate primary hypertension and no significant comorbidities, 24-h ambulatory blood pressure monitoring was conducted after a 2- to 4-week placebo run-in period and before treatment initiation. Individual blood pressure measurements at 20-min intervals were analysed. RESULTS In 1419 hypertensive patients with normal sleeping times, blood pressure displayed a typical circadian rhythm, with a mean EMBPS of 29/24 mmHg. An EMBPS of >or= 25 mmHg was observed in around 60% of patients. The surge was significantly increased with smoking, alcohol consumption, longer sleep, later waking times, and increased blood pressure variability during waking and sleeping. The magnitude of the EMBPS was significantly reduced in Black vs. White patients. The surge was not affected by gender, body mass index or duration of hypertension. Further analysis showed that ethnicity, alcohol consumption and smoking were all found to have a significant impact on surge around waking and age, sleep duration and sleep blood pressure variability were all found to have an effect on the prewake surge. CONCLUSIONS In untreated hypertensive patients, the magnitude of the EMBPS is significant when compared with the 24-h mean and is affected by individual patient characteristics. In light of these findings, physicians should understand the importance of 24-h blood pressure control and the modification of certain lifestyle factors as ways of reducing the EMBPS.
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Affiliation(s)
- J M Neutel
- Orange County Research Centre, Tustin, CA, USA.
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