Ambulatory Blood Pressure Monitoring

Aim. To study the prevalence and severity of left ventricular hypertrophy (LVH), its relationship with fibroblast growth factor (FGF23) in patients with resistant hypertension (RH) depending on the effectiveness of multiagent antihypertensive therapy.Material and methods. The study included 92 patients diagnosed with RH. All patients underwent 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography, general laboratory tests, and the serum FGF23 level was determined.Results. According to ABPM results, patients were divided into following groups: 1st — controlled RH (n=44) and 2nd — uncontrolled (n=48) RH. The groups were comparable in sex, age, main clinical and anthropometric parameters. In group 2, the main parameters of ABPM were higher. There were no differences in general laboratory tests, In the group of uncontrolled RH, the level of FGF23 was higher — 11,7 [8,5; 15,4] pmol/ml vs 9,2 [7,1; 11,6] pmol/ml in the 1st group (p=0,0036). According to echocardiography, a comparable violation of left ventricular (LV) diastolic function, an increase in left atrial size, LV mass (LVM) and LVM index were found. In patients of the 2nd group, large values of interventricular septal thickness were revealed — 1,3 [1,2; 1,4] cm vs 1,2 [1,1; 1,3] cm in the 1st group (p=0, 0043) and relative LV wall thickness (LVWT) — 0,50 [0,48; 0,53] vs, 0,45 [0,43; 0,50] in the 1st group (p<0,0001). In the 1st and 2nd groups, concentric LVH was more common (18 (41%) patients in the 1st and 26 (54,1%) in the 2nd (p=0,044) groups) than eccentric LVH (15 (34,1%) and 13 (27,1%) patients in the 1st and 2nd groups, respectively). Correlation analysis revealed a positive relationship between pulse pressure and HTN duration (r=48, p=0,02) and FGF23 level (r=0,62, p=0,004). The LVM index was positively associated with the diastolic pressure-time index (BP) (r=51, p=0,02). A positive correlation was found between relative LVWT and pulse pressure (r=0,64, p=0,02) and a negative relationship with the duration of regular antihypertensive therapy (r=47, p=0,04), A strong relationship was found between LVEF and FGF23 levels (r=0,75, p=0,005).Conclusion. For patients with uncontrolled resistant hypertension, an increase in pulse pressure and myocardial remodeling in the form of concentric hypertrophy are more characteristic. FGF23 is significantly higher in uncontrolled RH and is positively associated with pulse pressure and relative LVWT.

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Section: материал и методыunclassified

Myocardial remodeling and fibroblast growth factor in patients with resistant hypertension

2022

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“…The circadian rhythm plays a critical role in multiple neurohormonal processes, thus modulating the cardiovascular system [1,2]. The circadian changes in blood pressure have received increasing interest.…”

Section: Introductionmentioning

confidence: 99%

Chronotherapy for morning blood pressure surge in hypertensive patients: a systematic review and meta-analysis

Xie

Zhang

Wang

et al. 2021

BMC Cardiovasc Disord

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Background The morning blood pressure surge (MBPS) is related to an exaggerated risk of cardiovascular diseases and mortality. With increasing attention on circadian change in blood pressure and extensive use of ambulatory blood pressure monitoring (ABPM), chronotherapy that administration of medication according to biological rhythm, is reported to improve cardiovascular outcomes. The aim of this study is to evaluate the influence of chronotherapy of antihypertensive drugs upon MBPS in hypertensive patients. Methods A search strategy was applied in Ovid MEDLINE, EMBASE, Cochrane (Wiley) CENTRAL Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the Chinese Biomedical literature database. No language and date restrictions. Randomized controlled trials (RCT) assessing the efficacy of evening and morning administration of the same medications in adult patients with primary hypertension were included. Results A total of ten trials, comprising 1724 participants with a mean age of 61 and 51% female, were included in this study. Combined analysis observed significant reduction of MBPS (− 5.30 mmHg, 95% CI − 8.80 to − 1.80), night-time SBP (− 2.29 mmHg, 95% CI − 4.43 to − 0.15), night-time DBP (− 1.63 mmHg, 95 %CI − 3.23 to − 0.04) and increase in night blood pressure dipping (3.23%, 95% CI 5.37 to 1.10) in evening dosage compared with traditional morning dosage of blood pressure-lowering drugs. No significant difference was found in the incidence of overall adverse effects (RR 0.65, 95% CI 0.30 to 1.41) and withdrawal due to adverse effects (RR 0.95, 95% CI 0.53 to 1.71). Conclusions Our study suggested that evening administration of antihypertensive medications exerted better blood pressure-lowering effect on MBPS compared with conventional morning dosage. Safety assessment also indicated that the evening regimen did not increase the risk of adverse events. However, endpoint studies need to be carried out to confirm the significance and feasibility of this treatment regimen in clinical practice.

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“…As is emphasized in 3 insightful articles in this issue, accurate measurement of blood pressure is critical. Single office measurements are not sufficient to make a diagnosis of hypertension and commit a patient to a lifetime of antihypertensive therapy.…”

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Hypertension—A Public Health Challenge of Global Proportions

Fisher

Curfman²

2018

JAMA

108

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This issue of JAMA, from illustrated cover to in-depth content, is dedicated to hypertension, a worldwide problem of enormous consequence. High blood pressure affects more than 1 billion people worldwide, and that number is increasing. Untreated or uncontrolled, hypertension is the single largest contributor to cardiovascular disease, causing stroke, heart failure, coronary artery disease, and kidney disease, and also is a major contributor to kidney disease. Progress over the last several decades has led to increased understanding of the relationship between blood pressure and health outcomes and to the development of multiple antihypertensive therapies that reduce the risk. New knowledge carries with it a mandate to address the growing global epidemic of hypertension.Hypertension continues to be the major risk factor for cardiovascular death in every region of the world. Even more striking, in 2010 high blood pressure emerged as the leading single risk factor for the overall global burden of disease, surpassing diseases like diarrheal illness and pneumonia. 1 Systolic blood pressure exceeding 140 mm Hg was estimated to be responsible for 14% of total deaths in 2015. 2 Yet it is now clear that cardiovascular risk begins at pressures much lower than 140 mm Hg. When considering individuals with systolic blood pressure of at least 110 to 115 mm Hg, regarded as the theoretical minimum risk level for blood pressure, an estimated 3.5 billion people are affected. 2 Of all individual risk factors quantified in the global burden of disease study of 2015, a systolic blood pressure of at least 110 to 115 mm Hg was the leading contributor to preventable death in the world. 2 The rising prevalence of high blood pressure dominates the worldwide shift away from risks for communicable diseases in children toward those for noncommunicable diseases in adults. It parallels another disturbing trend: the transition of the burden of hypertension to countries with poorly developed health care systems, as described by Qamar and Braunwald in this issue. 3 From 1975 to 2015, mean blood pressure decreased in high-income western and Asia Pacific countries, yet increased in East and Southeast Asia, South Asia, Oceania, and sub-Saharan Africa. 4 In addition to population growth and aging of populations, multiple factors contribute to the increasing numbers of people with hypertension. Many of these result from the urbanization of societies and the detrimental changes in lifestyle that often follow: westernized di-

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Ambulatory Blood Pressure Monitoring

Cited by 8 publications

References 10 publications

Myocardial remodeling and fibroblast growth factor in patients with resistant hypertension

Myocardial remodeling and fibroblast growth factor in patients with resistant hypertension

Chronotherapy for morning blood pressure surge in hypertensive patients: a systematic review and meta-analysis

Hypertension—A Public Health Challenge of Global Proportions

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