Circadian blood pressure: Clinical implications based on the pathophysiology of its variability

Peixoto, Aldo J.; White, William Β.

doi:10.1038/sj.ki.5002130

Cited by 65 publications

(36 citation statements)

References 57 publications

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“…In recent years, a large number of preclinical and clinical studies have clearly identified the contribution of BPV to CV complications associated with hypertension [15,16]. Moreover, preliminary data from retrospective analysis of clinical trials suggest that BPV attenuation by antihypertensive agents is a factor in the prevention of major CV events.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertension is one of leading risk factors of CV and cerebrovascular disease. 16.5% of all deaths worldwide can be attributed to high blood pressure (BP) [1][2][3]. When compared with others, patients with RA have increased CV morbidity and mortality that is primarily a result of premature atherosclerosis of coronary and cerebral arteries.…”

Section: Introductionmentioning

confidence: 99%

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Ambulatory blood pressure monitoring and hypertension related cardiovascular risk in patients with rheumatoid arthritis

Řiháček¹,

Němec²,

Řiháček³

et al. 2017

ISSN 1758-4272 Int. J. Clin. Rheumatol

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Keywords: hypertension • rheumatoid arthritis • 24-hour ambulatory blood pressure monitoring • pulse pressure • morning surge of blood pressure • blood pressure variability • cardiovascular risk Background: To assess hypertension related cardiovascular risk parameters in patients with rheumatoid arthritis. To determine the effect of long-term treatment with corticosteroids, non-steroid antiinflammatory drugs, and methotrexate on diurnal BP variability.Material and methods: 60 patients with clinically stable rheumatoid arthritis and treated hypertension. Casual blood pressure measurement and 24-hour ambulatory blood pressure monitoring.Results: Mean casual systolic blood pressure 139.0 ± 14.6 mmHg, diastolic blood pressure 85.7 ± 6.5 mmHg, and heart rate 74.9 ± 7.2 beats.min -1. Mean 24-hour systolic blood pressure 129.0 ± 12.7 mmHg, diastolic blood pressure 77.6 ± 7.4 mmHg, and heart rate 73.9 ± 8.7 beats.min -1. Mean casual pulse pressure 54.7 ± 15.6 mmHg, and the mean 24-hour ambulatory pulse pressure 50.1 ± 11.0 mmHg. The mean morning surge of systolic blood pressure 35.3 ± 11.00 mmHg. The number of patients with increased short-term variability of their systolic blood pressure using the coefficient of variation 30 (50%). A number of systolic nondippers in the group were treated with corticosteroids and non-steroidal anti-inflammatory drugs 34% and 35%, respectively, and a number of excessive diastolic dippers in the group were treated with methotrexate 49%.Conclusions: Certain hypertension characteristics in patients with rheumatoid arthritis can increase cardiovascular risk: Higher pulse pressure, elevated levels of morning surge of systolic blood pressure, increased short-term 24-hour blood pressure variability, higher number of systolic nondippers treated with corticosteroids and non-steroidal anti-inflammatory drugs, and excessive diastolic dippers treated with methotrexate. In addition increased heart rate may contribute to higher cardiovascular risk.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ambulatory blood pressure monitoring and hypertension related cardiovascular risk in patients with rheumatoid arthritis

Řiháček¹,

Němec²,

Řiháček³

et al. 2017

ISSN 1758-4272 Int. J. Clin. Rheumatol

View full text Add to dashboard Cite

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“…In that case, measures as adoption of a more rigid treatment and the modification of medication administration horary could contribute with the improvement of these individuals' pressure profile and, consequently, change ND pattern 35 .…”

Section: Dm -Diabetes Mellitus; MI -Myocardium Infarction; Dlp -Dislimentioning

confidence: 99%

Ausência de descenso noturno se associa a acidente vascular cerebral e infarto do miocárdio

Vaz-de-Melo¹,

Loureiro²,

Cipullo³

et al. 2010

Arq. Bras. Cardiol.

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“…1,2 However, in as many as 25% to 35% of hypertensive patients, there is a moderate-to-marked loss of this decline in nocturnal BP, a phenomenon that has been associated with excessive cardiac, 3 renal, 4 and cerebrovascular 5 target organ damage. In addition, patients with hypertension who exhibit a nocturnal BP increase compared with daytime BP (so-called "risers") have the worst prognosis for future stroke and cardiac events.…”

mentioning

confidence: 99%

The Riskiest Time for the Brain

White

2007

Hypertension

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T he natural circadian rhythm of blood pressure (BP) typically includes a nocturnal decrease of 10% to 20% in BP compared with daytime, awake values. 1,2 However, in as many as 25% to 35% of hypertensive patients, there is a moderate-to-marked loss of this decline in nocturnal BP, a phenomenon that has been associated with excessive cardiac, 3 renal, 4 and cerebrovascular 5 target organ damage. In addition, patients with hypertension who exhibit a nocturnal BP increase compared with daytime BP (so-called "risers") have the worst prognosis for future stroke and cardiac events. 6 In contrast, there is also some evidence that patients with marked nocturnal BP declines (so-called "extreme dippers") are at greater risk for ischemic strokes and silent myocardial ischemia than patients whose decline in BP during sleep is normal. 7 Both the etiologies and the consequences of an elevated nocturnal BP are diverse. Since Shimada et al 8 first reported a study evaluating ambulatory BP monitoring in older patients with hypertension using MRI 15 years ago, there has been an ongoing issue with our general understanding of BP variability and the brain as a target organ, because most studies have had small sample sizes and have been performed in homogenous populations. In this issue of Hypertension, Schwartz et al 9 have provided us with a large cross-sectional study from Minnesota and Mississippi of 263 black and 343 white subjects who underwent clinic and ambulatory monitoring of the BP and MRI of the brain to assess the relations among the various BP measures and white matter lesion volumes. In both black and white subjects, BP during sleep and the nocturnal decline in BP (ie, the dip in the 24-hour curve) were associated with white matter lesion volume; in contrast, 24-hour mean and daytime awake BP values were associated with white matter lesions in black patients but not in white patients.In comparison to cardiac or renal target organ involvement in patients with hypertension, there is far less information on age-and gender-normalized data for MRI-derived white matter lesions in older patients with hypertension. These lesions, also referred to as leukoaraiosis or small-vessel ischemic disease, may be multifocal or progress to confluence over time. White matter lesion volumes increase with age and multiple risk factors, including elevated homocysteine levels. 10 Studies over the past several years have reported that white matter hyperintensity lesions are associated with increased risk of primary and recurrent stroke, gait and balance disorders, and dementia; hence, the potential for clinical importance seems established. 11 These findings are not surprising, because there are good correlations between neuropathologic subcortical vascular disease and the brain imaging abnormalities. 12 In addition, it is now felt that the white matter lesions seen on T2-weighted MRI are different from lacunar infarctions, because they are hyperintense throughout the lesion rather than hypointense with a T2 hyperintense circumference. 13 Nev...

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Circadian blood pressure: Clinical implications based on the pathophysiology of its variability

Cited by 65 publications

References 57 publications

Ambulatory blood pressure monitoring and hypertension related cardiovascular risk in patients with rheumatoid arthritis

Ambulatory blood pressure monitoring and hypertension related cardiovascular risk in patients with rheumatoid arthritis

Ausência de descenso noturno se associa a acidente vascular cerebral e infarto do miocárdio

The Riskiest Time for the Brain

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