Ambulatory blood pressure as a predictor of target organ disease and outcome in the hypertensive patient

White, William B.

doi:10.1097/00126097-199903000-00014

Cited by 22 publications

(16 citation statements)

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“…Ambulatory BP predicts the risk of cardiovascular morbidity better than clinical BP [10,31]. Blunting of the normal drop in BP from day to night has emerged as a strong prognostic indicator of cardiovascular morbidity and mortality [9,20,21].…”

Section: Discussionmentioning

confidence: 99%

Attenuation of heart rate recovery after exercise in hypertensive patients with blunting of the nighttime blood pressure fall

Polónia

Amaral

Bertoquini

et al. 2006

International Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Attenuation of heart rate recovery after exercise in hypertensive patients with blunting of the nighttime blood pressure fall

Polónia

Amaral

Bertoquini

et al. 2006

International Journal of Cardiology

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“…1,2 In some patients with hypertension or chronic kidney disease however, BP fails to dip during night and these individuals have been called ''non-dippers'', in contrast with those with a normal nocturnal dip, who are called ''dippers''. 2,3 The clinical relevance of establishing a non-dipping BP pattern lies in its proven association with more severe hypertensive target organ damage and increased cardiovascular risk both in hypertensive and normotensive subjects. [4][5][6] Left ventricular hypertrophy, carotid intima-media thickening, microalbuminuria and cerebrovascular disease are more prevalent in non-dippers than in dippers.…”

Section: Introductionmentioning

confidence: 99%

Melatonin secretion is impaired in women with preeclampsia and an abnormal circadian blood pressure rhythm

et al. 2014

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Non-dipping circadian blood pressure (BP) is a common finding in preeclampsia, accompanied by adverse outcomes. Melatonin plays pivotal role in biological circadian rhythms. This study investigated the relationship between melatonin secretion and circadian BP rhythm in preeclampsia. Cases were women with preeclampsia treated between January 2006 and June 2007 in the University Hospital of Larissa. Volunteers with normal pregnancy, matched for chronological and gestational age, served as controls. Twenty-four hour ambulatory BP monitoring was applied. Serum melatonin and urine 6-sulfatoxymelatonin levels were determined in day and night time samples by enzyme-linked immunoassays. Measurements were repeated 2 months after delivery. Thirty-one women with preeclampsia and 20 controls were included. Twenty-one of the 31 women with preeclampsia were non-dippers. Compared to normal pregnancy, in preeclampsia there were significantly lower night time melatonin (48.4 ± 24.7 vs. 85.4 ± 26.9 pg/mL, p50.001) levels. Adjustment for circadian BP rhythm status ascribed this finding exclusively to non-dippers (p50.01). Two months after delivery, in 11 of the 21 non-dippers both circadian BP and melatonin secretion rhythm reappeared. In contrast, in cases with retained non-dipping status (n ¼ 10) melatonin secretion rhythm remained impaired: daytime versus night time melatonin (33.5 ± 13.0 vs. 28.0 ± 13.8 pg/mL, p ¼ 0.386). Urinary 6-sulfatoxymelatonin levels were, overall, similar to serum melatonin. Circadian BP and melatonin secretion rhythm follow parallel course in preeclampsia, both during pregnancy and, at least 2 months after delivery. Our findings may be not sufficient to implicate a putative therapeutic effect of melatonin, however, they clearly emphasize that its involvement in the pathogenesis of a non-dipping BP in preeclampsia needs intensive further investigation.

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“…Cross-sectional studies have indicated that target-organ damage is more pronounced in "nondippers" than in "dipper" patients with comparable clinical blood pressure. 4,5 Furthermore, a circadian pattern becomes obvious in the occurrence of acute cardiovascular diseases such as ischemia, infarction, stroke, and sudden death, 6 and investigators are using new chronotherapeutic approaches in antihypertensive therapy to exploit the knowledge of circadian rhythms to reduce these events. 7 Furthermore, it has been demonstrated that short-term (beatto-beat) variations of BP and HR contain information about the activity of the autonomic nervous system, 8 and power spectral analysis of these parameters shows promise for studying the mechanisms involved in cardiovascular disease.…”

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confidence: 99%

Alterations in Blood Pressure and Heart Rate Variability in Transgenic Rats With Low Brain Angiotensinogen

et al. 2001

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Abstract-To study whether the brain renin-angiotensin system plays a role in the long-term and short-term control of blood pressure and heart rate variability, we examined in transgenic rats [TGR(ASrAOGEN)] with low brain angiotensinogen levels the 24-hour variation of blood pressure and heart rate. Telemetry recordings were made during basal and hypertensive conditions induced by a low-dose subcutaneous infusion of angiotensin II for 7 days. Short-term blood pressure and heart rate variability were evaluated by spectral analysis, and as a measure of baroreflex sensitivity, the average transfer gain between the pressure and heart rate variations was calculated. During the angiotensin II infusion in control but not TGR(ASrAOGEN) rats, the 24-hour rhythm of blood pressure was inverted (5.8Ϯ2 versus Ϫ0.4Ϯ1.8 mm Hg/group of day-night differences of blood pressure, PϽ0.05, respectively). In both the control and TGR(ASrAOGEN) rats, the 24-hour heart rate rhythms remained unaltered and paralleled those of locomotor activity. The transfer gain between 0.3 to 0.6 Hz was significantly higher in TGR(ASrAOGEN) than in control rats during control (0.71Ϯ0.1 versus 0.35Ϯ0.06, PϽ0.05) but not during angiotensin II infusion (0.6Ϯ0.07 versus 0.4Ϯ0.1, PϾ0.05). These results demonstrate that the brain renin-angiotensin system plays an important role in mediating the effects of angiotensin II on the circadian variation of blood pressure. Furthermore, these data indicate that a permanent deficiency in the brain renin-angiotensin system alters the reflex control of heart rate in rats. Key Words: renin-angiotensin system Ⅲ blood pressure Ⅲ baroreflex Ⅲ circadian rhythm Ⅲ brain M ultiple clinical studies have implicated blood pressure (BP) and heart rate (HR) variability in the diagnosis and prognosis of arterial hypertension and cardiovascular diseases. 1,2 It has been shown, for instance, that patients with essential or secondary forms of hypertension can be divided into 2 groups: "dippers" and "nondippers." 3 In "dippers," circadian rhythm of BP is preserved, whereas "nondippers" lack the characteristic nocturnal fall in BP. Cross-sectional studies have indicated that target-organ damage is more pronounced in "nondippers" than in "dipper" patients with comparable clinical blood pressure. 4,5 Furthermore, a circadian pattern becomes obvious in the occurrence of acute cardiovascular diseases such as ischemia, infarction, stroke, and sudden death, 6 and investigators are using new chronotherapeutic approaches in antihypertensive therapy to exploit the knowledge of circadian rhythms to reduce these events. 7 Furthermore, it has been demonstrated that short-term (beatto-beat) variations of BP and HR contain information about the activity of the autonomic nervous system, 8 and power spectral analysis of these parameters shows promise for studying the mechanisms involved in cardiovascular disease. 9,10 There is evidence that in humans, the HR and HR variability (HRV) can be genetically determined. 11 Recently developed approaches based on g...

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Ambulatory blood pressure as a predictor of target organ disease and outcome in the hypertensive patient

Cited by 22 publications

References 0 publications

Attenuation of heart rate recovery after exercise in hypertensive patients with blunting of the nighttime blood pressure fall

Attenuation of heart rate recovery after exercise in hypertensive patients with blunting of the nighttime blood pressure fall

Melatonin secretion is impaired in women with preeclampsia and an abnormal circadian blood pressure rhythm

Alterations in Blood Pressure and Heart Rate Variability in Transgenic Rats With Low Brain Angiotensinogen

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