Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure

Cuspidi, Cesare; Meani, Stefano; Salerno, M; Valerio, Cristiana; Fusi, Veronica; Severgnini, B; Lonati, Laura; Magrini, Fabio; Zanchetti, Alberto

doi:10.1097/00004872-200402000-00010

Cited by 187 publications

(157 citation statements)

References 34 publications

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“…31 The reasons of the prognostic superiority of night-time over daytime BP are not clear, although one hypothesis is that the prognostic value of diurnal BP may be reduced by its excessive variability compared to the nocturnal period.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory blood pressure, target organ damage and aortic root size in never-treated essential hypertensive patients

et al. 2007

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The relationship between ambulatory blood pressure (ABP), target organ damage (TOD) and aortic root (AR) size in human hypertension has not been fully explored to date. We investigated the relationship between ABP, different markers of TOD and AR size in never-treated essential hypertensive patients. A total of 519 grade 1 and 2 hypertensive patients (mean age 46712 years) referred for the first time to our outpatient clinic underwent the following procedures: (1) routine examination, (2) 24 h urine collection for microalbuminuria (MA), (3) ambulatory blood pressure monitoring over two 24 h periods within 4 weeks, (4) echocardiography and (5) carotid ultrasonography. AR dilatation was defined by sex-specific criteria (X40 mm in men and X37 mm in women). AR diameter was increased in 3.7% of patients. Demographic variables (body mass index, age and male gender), average night-time diastolic blood pressure (BP) (but not clinic or average 48 h BP), left ventricular mass index and carotid intima-media (IM) thickness showed an independent association with AR size in both univariate and multivariate analyses. When TOD data were analysed in a categorical way, a stepwise increase in the prevalence of left ventricular hypertrophy (LVH) (I ¼ 17.5%, II ¼ 27.6%, III ¼ 35.8%) and carotid IM thickening (I ¼ 20.9%, II ¼ 28.8%, III ¼ 34.4%), but not in MA (I ¼ 6.8%, II ¼ 9.1%, III ¼ 8.7%) was found with the progression of AR size tertiles. Our results show that (1) AR enlargement in uncomplicated never-treated hypertensive patients has a markedly lower prevalence than traditional markers of cardiac and extracardiac TOD; (2) night-time BP, LVH and carotid IM thickening are independent predictors of AR dimension.

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Section: Discussionmentioning

confidence: 99%

Ambulatory blood pressure, target organ damage and aortic root size in never-treated essential hypertensive patients

et al. 2007

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“…On the contrary, a large number of cross-sectional studies in hypertensive subjects have established an almost constant association between nocturnal BP phenotypes with cardiac adaptations including abnormal LV mass and geometry. 7,8,12,21,22 In addition, nondippers and those with hypertensive nocturnal BP values demonstrated impaired LV diastolic function, abnormal aortic root diameters and left atrium structural properties compared with dippers and those with normotensive nocturnal BP levels, respectively. 23,24 However, other studies have reported no difference in cardiac adaptations among dippers and nondippers, [25][26][27][28] whereas nocturnal hypertension was constantly related to LV mass, an issue not addressed by absolute nocturnal systolic and diastolic BP.…”

Section: Cardiac Adaptationsmentioning

confidence: 96%

“…With respect to the latter, there is an ongoing debate for the reduced reproducibility of ABPM measurements possibly resulting in misclassification of the dipping/nondipping status. 12 Furthermore, shift and nighttime work constitute a further issue not addressed by the design of the majority of ABPMoriented studies, and finally, variations in nocturnal body position and diurnal physical activity may affect nighttime and daytime BP, respectively. 13 The nondipping profile is frequently accompanied by enhanced nocturnal BP; thus, the discrimination between them might be an eternal unfulfilled target to address.…”

Section: Dipping Pattern Versus Nighttime Bpmentioning

confidence: 99%

“…33 In addition, among hypertensive patients, those with a positive history of stroke demonstrated higher levels of systolic and diastolic BP than did those without a stroke history. 34,35 Nonetheless, white matter lesions and leukoaraiosis were 25 Cross-sectional 229 HTN Nondipping Indifferent Cardiac structure and LVH Bjö rklund 66 Cross-sectional 1057 Elderly GP Nondipping Indifferent LV mass Grandi 26 Cross-sectional 253 HTN Nondipping Indifferent LVH and diastolic dysfunction Salvetti 28 Cross-sectional 225 GP Nondipping Indifferent LV mass Tsioufis 27 Cross 28 Cross-sectional 225 GP Nondipping Positive Increasing carotid IMT Cuspidi 62 Cross-sectional 141 HTN Nondipping Positive Prevalence of increased IMT Zakopoulos 70 Cross-sectional 514 HTN and NTN Nondipping Indifferent Carotid IMT Cuspidi 12 Cross-sectional 375 HTN Nondipping Indifferent Carotid IMT Cuspidi 23 Cross-sectional 355 HTN Nondipping Indifferent Carotid artery changes (carotid plaques or IMT) Grandi 26 Cross-sectional 253 HTN Nondipping Indifferent PWV Mancia 71 Cross-sectional 1663 HTN Day-to-night BP ratio Indifferent Carotid IMT Tsioufis 27 Cross Nocturnal BP phenotypes and 'hard CV outcomes'…”

Section: Vascular and Cerebral Adaptationsmentioning

confidence: 99%

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Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes

et al. 2010

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At present, clinic blood pressure (BP) evaluation is being increasingly complemented by ambulatory BP measurements for the evaluation of haemodynamic patterns during daily activities and sleep. Nondipping pattern, a measure of decreased attenuation of nighttime over daytime BP, has been correlated with enhanced target organ damage and adverse cardiovascular (CV) outcomes in different clinical settings beyond pure hypertensive cohorts. As the nondipping pattern is a derivative extract of both daytime and nighttime BP, it is yet questionable whether the crude estimate of nocturnal BP is superior to daytime BP and nondipping pattern in the prediction of subclinical damage and CV events. In this review, we aimed at comparing the CV predictive value of the nondipping pattern with that of nocturnal BP using cross-sectional and longitudinal data obtained from different cohort studies within the past 10 years. Our findings suggest that nocturnal BP including the phenotype of isolated nocturnal hypertension is better associated with CV target organ damage and 'hard end points' as compared with the nondipping pattern.

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“…[22][23][24] On the other hand, as ABP is affected by various internal and external environmental factors on a particular day, the reproducibility of its mean value is inferior to that of home BP, [23][24][25] and the reproducibility of circadian BP variations based on ABPM is not enough. [26][27][28][29] Table 1 summarizes the characteristics of home BP compared with clinic BP and ABP. 30 …”

Section: Introductionmentioning

confidence: 99%

The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)

et al. 2012

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INTRODUCTIONSince Riva-Rocci invented indirect brachial cuff sphygmomanometry in 1896 1 and Korotkoff proposed the auscultatory method in 1905, 2 the method for blood pressure (BP) measurements has remained essentially unchanged for the past 100 years.In 1969, Posey et al. 3 identified mean BP on the basis of the cuff-oscillometric method. With subsequent theoretical and technical improvements, the method to determine systolic and diastolic BP (S and D, respectively) was introduced to the cuff-oscillometric method. As a result, many of the automatic electronic sphygmomanometers available today have adopted this method, and those different from the auscultatory method have begun to be used in general clinical practice. Since the advent of indirect methods for sphygmomanometry, the past century has developed the practical and clinical sciences of hypertension. However, BP information necessary for the diagnosis and treatment of hypertension is still obtained essentially on the basis of casual measurements at the outpatient clinic (clinic BP). However, the reliability of clinic BP was called into question 40 years after the advent of indirect sphygmomanometry. In 1940, Ayman and Goldshine 4 widely adopted the concept of self-BP measurements in the field of clinic BP measurements and demonstrated discrepancies between clinic BP and self-BP measurements. Bevan, 5 in the United Kingdom, first reported the results of ambulatory BP (ABP) monitoring (ABPM) using a direct arterial BP measurement method in 1969, and showed that human BP changes markedly with time. The quantity and quality of BP information vary greatly according to different methods, and the problem of interpreting clinic BP, which is obtained specifically in a medical environment, has been an issue in the clinical practice of hypertension during the past 50 years.However, the practice and epidemiology of hypertension still depend entirely on BP information obtained in a medical environment (clinic BP/BP at a health examination), resulting in the

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Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure

Cited by 187 publications

References 34 publications

Ambulatory blood pressure, target organ damage and aortic root size in never-treated essential hypertensive patients

Ambulatory blood pressure, target organ damage and aortic root size in never-treated essential hypertensive patients

Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes

The Japanese Society of Hypertension Guidelines for Self-monitoring of Blood Pressure at Home (Second Edition)

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