Asleep blood pressure: significant prognostic marker of vascular risk and therapeutic target for prevention

Hermida, Ramón C.; Crespo, Juan J.; Otero, Alfonso; Domínguez-Sardiña, Manuel; Moyá, Ana; Ríos, María T; Castiñeira, M.C.; Callejas, Pedro A.; Pousa, Lorenzo; Sineiro, Elvira; Salgado, José Luis Bernal; Durán, Carmen; Sánchez, Juan José García; Fernández, José R.; Mojón, Artemio; Ayala, Diana E.

doi:10.1093/eurheartj/ehy475

Cited by 114 publications

(96 citation statements)

References 28 publications

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“…[47][48][49][50] The MAPEC clinical trial (2156 hypertensive participants with follow-up 5.6 years) similarly showed that evening (vs morning) administration of BP medications resulted in improved clinical outcomes with reduction in total cardiovascular events and death by 67%, and prevention of CKD. 9,22,[51][52][53][54] In contrast, there have been a few smaller-powered studies with various study designs that reported no difference between evening and morning administration of anti-hypertensive medications. 14,55 One such study, the HARMONY trial, transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] These entities are independently associated with progressive kidney dysfunction, proteinuria, cardiovascular morbidity and mortality in adults with hypertension and CKD. [8][9][10][11][12][13][14] Whether pediatric transplant recipients with nHTN or non-dipping are at higher risk for cardiovascular outcomes in adult life is unknown due to the lack of long-term longitudinal studies; however, it has been shown that young adults with a history of kidney transplantation during childhood and adolescence have a greater than 10-fold risk of cardiovascular death compared with the general population. 15 Hence, restoring the nocturnal dip and normalizing nocturnal BP might be therapeutic targets with potential cardiovascular and kidney disease benefit.…”

Section: Introductionmentioning

confidence: 99%

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Restoration of nocturnal blood pressure dip and reduction of nocturnal blood pressure with evening anti‐hypertensive medication administration in pediatric kidney transplant recipients: A pilot randomized clinical trial

Sethna

Grossman

Dhanantwari

et al. 2020

Pediatric Transplantation

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Non-dipping and nocturnal hypertension are commonly found during ABPM in pediatric kidney transplant recipients. These entities are independently associated with increased cardiovascular disease risk in adults. Kidney transplant recipients aged 5-21 years with eGFR > 30 mL/min/1.73 m 2 and ABPM demonstrating nondipping status and normal daytime BP were randomized to intervention (short acting BP medication added in the evening) or control (no medication change) in this pilot, randomized, open-label, blinded end-point clinical trial. ABPM, echocardiography, and PWV were performed at baseline, 3 months, and 6 months. The trial included 17 intervention and 16 control participants. Conversion to dipper status occurred in 53.3% vs 7.7% (P = .01) at 6 months for intervention and controls, respectively. Systolic dip was greater in the intervention group compared to controls (10.9 ± 4.5 vs 4.2 ± 4.6, P = .001), and average systolic nighttime BP was significantly lower in the intervention group (106 ± 8.3 vs 114.9 ± 9.5 mm Hg, P = .01) at 6 months. There were no significant differences in LVMI, PWV, or eGFR between groups. Within-group changes in the intervention group demonstrated improvements in non-dippers, dipping, systolic nighttime BP and nighttime BP load. Restoration of nocturnal dip and improvement in nocturnal BP were observed in the population following chronotherapy. Future studies are needed with larger sample sizes over a longer period of time to delineate the long-term effect of improved nocturnal dip on target organ damage. K E Y W O R D S ambulatory blood pressure monitoring, chronotherapy, nocturnal hypertension, non-dipping, pediatric renal transplant, randomized clinical trial How to cite this article: Sethna CB, Grossman LG, Dhanantwari P, et al. Restoration of nocturnal blood pressure dip and reduction of nocturnal blood pressure with evening anti-hypertensive medication administration in pediatric kidney transplant recipients: A pilot randomized clinical trial.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Restoration of nocturnal blood pressure dip and reduction of nocturnal blood pressure with evening anti‐hypertensive medication administration in pediatric kidney transplant recipients: A pilot randomized clinical trial

Sethna

Grossman

Dhanantwari

et al. 2020

Pediatric Transplantation

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“…Based on this evidence, many guidelines and reviews focus on morning BP as the object of BP management . However, there has been increasing interest in nocturnal BP as the BP parameter most closely related to cardiovascular risk . As recommended by Kario, controlling morning BP is only the first step toward perfect 24‐hour BP control and should be followed by the control of nocturnal hypertension .…”

Section: Discussionmentioning

confidence: 99%

Nocturnal dipping status and the association of morning blood pressure surge with subclinical target organ damage in untreated hypertensives

Gong

et al. 2019

J of Clinical Hypertension

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The clinical practice of hypertension management involves decision making based on absolute blood pressure (BP) levels, typically referring to the 24-hour, daytime, and nocturnal averages, though complementary indicators such as diurnal BP changes, nocturnal dipping status, and BP variability are also considered. In recognition of the normal circadian evolution of BP, the commonly recommended cutoffs for distinguishing between normotension and hypertension are 135/85 and 120/70 mm Hg for daytime and nocturnal BP, AbstractThe authors aimed to investigate the association between sleep-through morning surge (MS) in blood pressure (BP) and subclinical target organ damage in untreated hypertensives with different nocturnal dipping status. This cross-sectional study included 1252 individuals who underwent anthropometric measurements, serum biochemistry evaluation, 24-hour ambulatory blood pressure monitoring, echocardiography, and carotid ultrasonography. Left ventricular mass index, left atrial dimension, and carotid intima-media thickness were evaluated. Participants were grouped according to nocturnal systolic BP dipping rate (388 dippers, 10%-20%; 674 nondippers, 0%-10%; 190 reverse dippers, <0%). Twenty-two extreme dippers were excluded. While reverse dippers exhibited the most severe signs of damage, only dippers showed significant and positive correlation between MS and hypertension-mediated organ damage (all P < .05), with significant area under the receiver operating characteristic curve for discriminating left ventricular hypertrophy (0.662), left atrial enlargement (0.604), and carotid intima-media thickening (left, 0.758; right, 0.726; all P < .05). MS showed significant association with subclinical organ damage on both logistic and multiple linear regression analysis adjusted for age, sex, body mass index, smoking status, and alcohol consumption status, as well as for the levels of fasting blood glucose, uric acid, serum creatinine, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol, even when 24-hour, daytime, nocturnal, and morning systolic BP were included (odds ratio >1 and P < .01 for all types of damage).Besides race, nocturnal dipping status might affect the role of MS in subclinical target organ damage, with a significant association only in dippers, independent of other systolic BP parameters. Dipping status might account for the discrepancies across previous reports.

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“…In the study of Hermida et al, the asleep systolic BP was the most important risk factor for the primary outcome (defined as composite of cardiovascular death, myocardial infarction, coronary revascularization, heart failure and stroke) during 5.1-year median follow-up, and it was regardless of office and awake systolic BP values. The authors emphasize also the fact that attenuation of above-mentioned parameter was the most significant marker of eventfree survival [5].…”

Section: Introductionmentioning

confidence: 91%

Determinants of the circadian blood pressure pattern in hospitalized hypertensive patients

Zaleska¹,

Możeńska²,

Segiet³

et al. 2019

Arterial Hypertension

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Background. Non-dipping hypertension might be associated with increased cardiovascular risk and multiple diseases. The aim of our study was to assess if there are parameters identified in 24-hour ECG-Holter monitoring (ECG-Holter), transthoracic echocardiography (TTE), ECG parameters or laboratory data that allow prediction of circadian blood pressure profile (CBPP). Material and methods. One hundred and three consecutive patients (male: 50.5%), who underwent 24-hour ambulatory BP measurement and ECG-Holter simultaneously were analyzed. We divided patients into 3 groups: dipping was defined as 10-20% (28.2%), non-dipping as < 10% (50.5%) fall in nocturnal BP and reverse-dipping as higher nocturnal than diurnal BP (21.4%). Additionally, we performed TTE and laboratory check-up in all patients. We built multivariable models for nocturnal fall in systolic BP (SBP) and CBPP. Results. Multivariable model based on clinical factors was: nocturnal fall in SBP (%) = [13.28 -0.11 × age -8.33 × (dilated cardiomyopathy) -5.95 × PAD -6.02 × a-adrenolytic]. Multivariable model based on laboratory, echocardiographic and electrocardiographic parameters was: nocturnal fall in SBP (%) = [-27.28 + 1.47 × hemoglobin -0.14 × CK-MB + 0.14 × maximal heart rate]. Multivariable model for CBPP based on clinical factors included use of bor a-adrenolytics or torasemide.Conclusions. We proved that nocturnal fall in SBP and CBPP could be predicted based on ECG-Holter parameters, laboratory data and TTE results, as well as based on detailed medical history. These findings may have implications on care of patients with hypertension.

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Asleep blood pressure: significant prognostic marker of vascular risk and therapeutic target for prevention

Cited by 114 publications

References 28 publications

Restoration of nocturnal blood pressure dip and reduction of nocturnal blood pressure with evening anti‐hypertensive medication administration in pediatric kidney transplant recipients: A pilot randomized clinical trial

Restoration of nocturnal blood pressure dip and reduction of nocturnal blood pressure with evening anti‐hypertensive medication administration in pediatric kidney transplant recipients: A pilot randomized clinical trial

Nocturnal dipping status and the association of morning blood pressure surge with subclinical target organ damage in untreated hypertensives

Determinants of the circadian blood pressure pattern in hospitalized hypertensive patients

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