Blood Pressure Variability and Morning Blood Pressure Surge in Elderly Chinese Hypertensive Patients

Abstract

2This retrospective study aimed to investigate blood pressure variability (BPV), morning systolic blood pressure surge (MBPS), and the associated factors in 513 elderly (65 years and older) and 188 younger (younger than 65 years) hypertensive Chinese patients who had ambulatory blood pressure monitoring (ABPM) at our hospital from January 1, 2002, to December 31, 2010. The MBPS was lower in the younger patients compared with the elderly patients, and it was highest in the 75 years and older and younger than 80 group (29.0AE13.4 mm Hg). Compared with other groups, the 80 years and older group had a significant increase in BPV (P<.05). Multiple linear regression analysis showed that body mass index (BMI; P<.01), up to 50 years of smoking (P≤.03), and circadian blood pressure variation (P<.01) were factors associated with MPBS. In summary, systolic BPV and MBPS were increased in elderly Chinese hypertensive patients, and the MBPS was associated with BMI, years of smoking, and circadian blood pressure variation. J Clin Hypertens (Greenwich). 2014;16:511-517. ª2014 Wiley Periodicals, Inc.The overall prevalence of hypertension ranges from 30% to 45% in the general population, and the prevalence increases in the elderly.1 Most studies providing these data have been conducted in industrialized, Western countries. However, similar findings were reported in a recently published study of Chinese adults: 26.6% of the study group had hypertension, but the hypertension prevalence for patients 65 years and older was 56.5%. 2In recent years, data from ambulatory blood pressure monitoring (ABPM) rather than office blood pressure (BP) has been shown to more closely correlate with target organ damage in hypertensive patients. Furthermore, the average 24-hour BP more strongly correlates with morbidity and mortality than does office BP. 1 Additionally, BP variability (BPV), reflecting the extent of BP fluctuation within a specific interval, can serve as a potential indicator of damage to target organs and prognosis in hypertensive patients.3 Dynamic BP has been used to document the phenomenon of the morning BP surge (MBPS): the nocturnal BP decreases during sleep (the lowest at 2 AM-3 AM), then increases rapidly to the highest level within several hours after waking. In the general population, an abrupt increase in morning BP above the 90th percentile is an important independent risk factor for mortality and cardiovascular events, especially in smokers. 4 However, little is known about BPV and circadian rhythm in elderly hypertensive patients in China.In the present retrospective study, the aim was to review ABPM performed in Chinese hypertensive patients aged 65 years and older compared with younger patients and to investigate the factors associated with the MBPS. METHODSThis was a retrospective study conducted at the Department of Cardiovascular Medicine of the Affiliated First Hospital of Sun Yat-sun in Guangdong Province, China, and the People's Hospital of Guangxi Zhuang Autonomous Region, China. Since the study was retrospecti...

Morning surge in blood pressure and blood pressure variability in Asia: Evidence and statement from the HOPE Asia Network

“…Qin et al used ABPM retrospectively to investigate BPV, EMBS, and associated factors in 513 elderly (≥65 years) and 188 younger (<65 years) Chinese patients with hypertension . The EMBS was lower in younger versus elderly patients, and was highest in those aged 75 to 80 years (29.0 ± 13.4 mm Hg).…”

“…Compared with other groups, patients aged ≥80 years showed significantly greater BPV ( P < 0.05). Multiple linear regression analysis showed that body mass index (BMI; P < 0.01), smoking history of up to 50 years ( P ≤ 0.03), and circadian BPV ( P < 0.01) were associated with EMBS . In a study of 340 patients from China, the proportion of subjects with EMBS was higher in patients with hypertension compared with normotensive participants .…”

Age and sex-specific relationships between blood pressure variability and carotid intima-media thickness

“…Mancia et al concluded that BPV increased and heart rate variability decreased with age, but that changes in variability were not so obvious in hypertension [26]. In another report, Qin et al examined the BPV in elderly Chinese hypertension patients, they found that compared with other age groups, the group aged more than 80 years had a significantly increase in BPV (P \ 0.05) [27]. In Imai's study, age and mean BP were positively correlated with the ambulatory BPV evaluated with SD and CV indices [28].…”

Efeito Do Exercício Resistido, Executado Em Diferentes Horas Do Dia Na Pressão Arterial De Idosos Hipertensos

“…Considerando a expressiva variabilidade da PA durante o dia em idosos 46 , os indícios aqui verificados reforçam a necessidade de novos estudos para se tecer conclusões mais efetivas e com fidedignidade, sobre o momento adequado para a realização do exercício resistido em idosos hipertensos.…”