Blood pressure variability and microvascular dysfunction: the Maastricht Study

Zhou, Tan Lai; Rensma, Sytze P; Baan, Frank van de; Henry, Ronald M.A.; Kroon, Abraham A.; Houben, Alfons J.H.M.; Jansen, Jacobus F.A.; Backes, Walter H.; Berendschot, Tos T. J. M.; Schouten, Jan S.A.G.; Dongen, M.C.J.M. van; Eussen, Simone J. P. M.; Dagnelie, Pieter C.; Webers, Carroll A.B.; Schram, Miranda T.; Sloten, Thomas T. van; Stehouwer, Coen D. A.

doi:10.1097/hjh.0000000000002444

Cited by 12 publications

(16 citation statements)

References 70 publications

(101 reference statements)

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“…Moreover, BP is a clinical parameter characterized per se by high variability, which is also detectable during 24-h ambulatory BP measurements (short-term variability) [40]. It was demonstrated that both systolic and diastolic BP variability influence albuminuria levels [41]. Hence, a number of variables were shown to influence albuminuria levels, and this could lead to biased risk estimation, particularly if the risk prediction is based on a single measurement of albuminuria.…”

Section: Kidney Biomarkersmentioning

confidence: 99%

Contribution of Predictive and Prognostic Biomarkers to Clinical Research on Chronic Kidney Disease

Provenzano

Rotundo

Chiodini

et al. 2020

IJMS

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Chronic kidney disease (CKD), defined as the presence of albuminuria and/or reduction in estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2, is considered a growing public health problem, with its prevalence and incidence having almost doubled in the past three decades. The implementation of novel biomarkers in clinical practice is crucial, since it could allow earlier diagnosis and lead to an improvement in CKD outcomes. Nevertheless, a clear guidance on how to develop biomarkers in the setting of CKD is not yet available. The aim of this review is to report the framework for implementing biomarkers in observational and intervention studies. Biomarkers are classified as either prognostic or predictive; the first type is used to identify the likelihood of a patient to develop an endpoint regardless of treatment, whereas the second type is used to determine whether the patient is likely to benefit from a specific treatment. Many single assays and complex biomarkers were shown to improve the prediction of cardiovascular and kidney outcomes in CKD patients on top of the traditional risk factors. Biomarkers were also shown to improve clinical trial designs. Understanding the correct ways to validate and implement novel biomarkers in CKD will help to mitigate the global burden of CKD and to improve the individual prognosis of these high-risk patients.

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Section: Kidney Biomarkersmentioning

confidence: 99%

Contribution of Predictive and Prognostic Biomarkers to Clinical Research on Chronic Kidney Disease

Provenzano

Rotundo

Chiodini

et al. 2020

IJMS

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“…Our observational study suggests that E-selectin is associated with diastolic BP variability, but the causality could not be assessed due to its cross-sectional design. Another limitation of this study is the arbitrary definition of night and day, similarly to those previously reported in other studies [ 34 , 36 , 44 ]. We did not use any diaries or actigraphs to document activity/rest cycles.…”

Section: Discussionmentioning

confidence: 96%

“…Elevated E-selectin levels were previously reported to be positively correlated with daytime systolic BP variability and not with daytime diastolic BP variability in patients with newly diagnosed hypertension without diabetes [ 34 ]. Additionally, recent data published from the Maastricht Study in which 28% of the enrolled participants had type 2 diabetes indicated no associations between short-term BP variability and a composite score of plasma biomarkers that included E-selectin [ 44 ]. The difference between these previous reports and our results could be explained by the inclusion in our study of only patients with type 2 diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Although E-selectin is on the average higher in patients with hypertension [ 12 , 14 ] and diabetes [ 10 , 11 ], the interest for routine E-selectin measurement in the future will depend on the information it will yield in stratifying patients for diagnostic and prognostic purposes. Ongoing clinical studies are aiming to investigate the influence of BP variability on serum E-selectin [ 44 ]. Given the relationship we described between BP variability and E-selectin, it may be possible that increased serum E-selectin levels might be detected before adverse cardiovascular outcomes become clinically manifest.…”

Section: Discussionmentioning

confidence: 99%

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E-Selectin Is Associated with Daytime and 24-Hour Diastolic Blood Pressure Variability in Type 2 Diabetes

et al. 2022

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E-selectin is an endothelial cell adhesion molecule involved in vascular inflammation. Elevated E-selectin has been reported in patients with high blood pressure and diabetes. Given the increasing clinical relevance of parameters derived from ambulatory blood pressure monitoring, further investigation of their relationships with E-selectin is of interest. In this study, we aimed to investigate the association between serum E-selectin, office blood pressure and 24 h ambulatory blood pressure parameters in patients with type 2 diabetes. Blood pressure variability was assessed by computing the standard deviation of mean systolic and diastolic blood pressure separately for daytime and nighttime during 24 h ambulatory blood pressure monitoring in a cohort of patients with type 2 diabetes (n = 132). Additionally, were assessed nighttime systolic dipping and pulse pressure separately for daytime, nighttime, and 24 h. Serum E-selectin was measured using the enzyme-linked immunosorbent assay technique. We found that E-selectin was consistently associated with 24 h diastolic blood pressure variability (r = 0.238; p = 0.019) and daytime diastolic blood pressure variability (r = 0.258; p = 0.012), after adjustment for confounding factors. No association of E-selectin with office blood pressure and other 24 h ambulatory blood pressure parameters was observed. In conclusion, endothelial activation indicated by elevated serum E-selectin is associated with increased ambulatory diastolic blood pressure variability in patients with type 2 diabetes.

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“…Various BPV measurements have been used in previous studies which might be the reason for the inconsistencies found in the reported association between BPV and cerebral lesions. For example, Zhou et al 20 used SD based on seven days home BP measurements, while Filomena et al 30 used several BPV features including SD, CoV, and weighted-SD based on 24 hours BP monitoring. Another possible reason for these inconsistent results was the differences in the measurement of WMH.…”

Section: Discussionmentioning

confidence: 99%

Day to Day Blood Pressure Variability Associated With Cerebral Arterial Dilation and White Matter Hyperintensity

et al. 2022

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Background: Previous studies suggested blood pressure variability (BPV) might help reveal interactions between blood pressure fluctuation and white matter lesions, and the impact of elevated BPV on white matter hyperintensity (WMH) or cerebral arterial dilation is unclear. Methods: This retrospective observational study involved 2634 stroke-free individuals (68.6±11.1 years, 50.3% female), who underwent magnetic resonance imaging and magnetic resonance angiography scans, from a single center in Shanghai, China. Measurements for variability of blood pressure were made based on 7 days blood pressure recordings. WMHs were quantified from T2-FLAIR images and further classified as periventricular WMH or deep WMH. M1 segment of middle cerebral artery dilation was assessed from magnetic resonance angiography images. General linear model was used to examine the associations. Results: Both increased systolic and diastolic BPV were associated with increased WMH volume (systolic: β =0.02 [95% CI, 0.004–0.03], P =0.01; diastolic: β =0.05 [95% CI, 0.03–0.08], P <0.001). Only periventricular WMH was associated with BPV (systolic: β =0.02 [95% CI, 0.005–0.04], P =0.01; diastolic: β =0.06 [95% CI, 0.04–0.09], P <0.001). MCA dilation was found in 125 individuals (4.75%). Systolic BPV was associated with MCA dilation only in the hypertensive individuals ( β =0.11 [95% CI, 0.06–0.17], P <0.001). Increased WMH volume was found associated with dilated MCA ( β =0.17 [95% CI, 0.11–0.23], P <0.001). Conclusions: Increased BPV might be one of the pathophysiological phenomena involving in the small vessel disease independent of hypertension. Increased BPV might independently contribute to intracranial arterial dilation. Management of BPV might be a target to preserve cerebrovascular wellness.

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Blood pressure variability and microvascular dysfunction: the Maastricht Study

Cited by 12 publications

References 70 publications

Contribution of Predictive and Prognostic Biomarkers to Clinical Research on Chronic Kidney Disease

Contribution of Predictive and Prognostic Biomarkers to Clinical Research on Chronic Kidney Disease

E-Selectin Is Associated with Daytime and 24-Hour Diastolic Blood Pressure Variability in Type 2 Diabetes

Day to Day Blood Pressure Variability Associated With Cerebral Arterial Dilation and White Matter Hyperintensity

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