Association between Altered Circadian Blood Pressure Profile and Cardiac End-Organ Damage in Patients with Renovascular Hypertension

Abstract

Background: Patients with renovascular hypertension (RVH) have a higher degree of cardiovascular end-organ damage compared to patients with essential hypertension (EH). The precise mechanisms underlying this phenomenon, however, have not been fully elucidated. This study investigated the relationship between circadian blood pressure (BP) profile and cardiac involvement in patients with RVH and EH. Methods: Twenty patients with RVH and 20 with EH, matched for demographic characteristics, underwent simultaneous 24-hour ambulatory BP recording and Holter ECG monitoring. Also, each participant underwent echocardiographic assessment of left ventricular mass. Cardiac damage was defined as the presence of left ventricular hypertrophy, myocardial ischemia or arrhythmias. Results: Casual BP was similar in both groups, whereas 24-hour ambulatory BP values were higher in RVH than in EH patients; moreover, RVH patients had higher blood pressure variability and blunted nocturnal BP fall compared to those with EH. Left ventricular mass, as well as the prevalence of myocardial ischemia and the presence and severity of cardiac arrhythmias, were higher in RVH than in EH patients. Conclusions: Patients with RVH have altered circadian BP profile compared to those with EH. This abnormality might contribute to their increased prevalence of cardiac damage and might adversely affect the prognosis of these patients.

Relationship between Nocturnal Blood Pressure and Left Ventricular Hypertrophy in Hypertensive Patients

“…Consistent study has been demonstrated that hypertensive patients with the increase of night to day blood pressure ratio could higher risks of cardiovascular events [22,23]. In addition, the relation between night blood pressure and left ventricular hypertrophy has been reported [24], but the strength of our present study must be considered compared with previous study. Firstly, all hypertensive patients were not taking antihypertensive drug, which excluded the effects of antihypertensive therapy on left ventricular hypertrophy.…”

Current Approaches to Renovascular Hypertension

“…Careful studies of office and ambulatory blood pressure levels indicate that circadian pressure rhythms are commonly disturbed in subjects with RAS. Such individuals often lack a nocturnal fall in arterial pressure (therefore are classified as “non-dippers”) and may have paradoxically elevated nocturnal pressures (14). The severity of left ventricular hypertrophy, impairment of kidney function and other manifestations of vascular disease are increased for such patients.…”

Disruption of Transitional Stages in 24-h Blood Pressure Recording in Renal Transplant Recipients

“…Hypertension has also been associated to alterations in blood pressure rhythms, in particular with phase-related changes (Iantorno et al, 2003; Perez-Lloret et al, 2004). It is important to note that although both groups were matched by the average of the 24-h MAP, the comparisons of rhythmic parameters have been performed among patients with statistically significant daily rhythm, regardless of the initial matching protocol, so these differences are indeed representative of the changes present in the transplant recipient group.…”