Impaired arterial elasticity in young patients with white-coat hypertension

Longo, Daniele; Zaetta, Vania; Perkovic, Davor; Frezza, Paola; Ragazzo, Fabio; Mos, Lucio; Santonastaso, Massimo; Garbelotto, Raffaella; Bénétos, Athanase; Palatini, Paolo

doi:10.1097/01.mbp.0000209083.47740.35

Cited by 17 publications

(16 citation statements)

References 58 publications

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“…However, the liberal cut-off chosen for defining whitecoat hypertension in that study (daytime diastolic BP <95 mmHg) can have resulted in the inclusion of patients with a high prevalence of target-organ damage [24]. In a larger cross-sectional study by Longo et al [13], carotidradial PWV was higher in white-coat hypertensive patients than in normotensive individuals. However, carotid-radial PWV is a measure of the stiffness of peripheral muscular, rather than central elastic, arteries.…”

Section: Office Hypertension and Arterial Stiffnessmentioning

confidence: 97%

“…On the one hand, BP measured in the office before determining arterial stiffness provides an instantaneous measure of distending pressure, and might be expected to be more closely related to office-based measures of aortic stiffness [11][12][13]. On the other hand, 24-h noninvasive ambulatory BP monitoring is more representative of an individual's true BP load and provides a better prediction of clinical outcome than conventional office-based BP measurements ambulatory BP [14].…”

Section: Introductionmentioning

confidence: 98%

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Combined effects of office and 24-h blood pressure on aortic stiffness in human hypertension

Schillaci

Pucci

Pirro

et al. 2011

Journal of Hypertension

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Section: Office Hypertension and Arterial Stiffnessmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 98%

Combined effects of office and 24-h blood pressure on aortic stiffness in human hypertension

Schillaci

Pucci

Pirro

et al. 2011

Journal of Hypertension

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“…When comparing elasticity indices, systolic and diastolic BPs, heart rate and smoking were also included in the ANCOVA models because these clinical variables have been shown to affect arterial distensibility. 25,28,29 The significance of differences in categorical variables was assessed with the χ 2 test. Longitudinal changes in arterial distensibility parameters were examined by a one-way repeated measure ANCOVA analysis, adjusting for the above confounders and also for parental hypertension, body mass index (BMI), presence/absence of anti-hypertensive treatment, and time elapsed between first and second measurement.…”

Section: Discussionmentioning

confidence: 99%

“…The reproducibility of these indexes during the same session and after 4 months was assessed in 72 subjects, as previously described. 29 …”

Section: Arterial Distensibility Assessmentmentioning

confidence: 99%

Regular physical activity is associated with improved small artery distensibility in young to middle-age stage 1 hypertensives

et al. 2014

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The aim of the present study was to investigate the association of physical activity with small artery elasticity in the early stage of hypertension. We examined 366 young-to-middle-age stage 1 hypertensives (mean blood pressure 145.6±10.3/92.5±5.8 mmHg), divided into two categories of physical activity, sedentary (n=264) and non-sedentary (n=102) subjects. The augmentation index was measured using the Specaway DAT System. Small artery compliance (C2) was measured by applanation tonometry, at the radial artery, with an HDI CR2000 device. After 6 years of follow-up, arterial distensibility assessment was repeated in 151 subjects. Heart rate was lower in active than in sedentary subjects (71.2±8.9 vs 76.6±9.7 bpm, p<0.001). After adjusting for age, sex, heart rate, smoking, and blood pressure, C2 was higher (8.0±2.6 vs 6.4±3.0 ml/mmHg × 100, p=0.008) in non-sedentary than in sedentary patients. The augmentation index was smaller in the former (8.8±20.1 vs 16.8±26.5%, p=0.044) but the difference lost statistical significance after further adjustment for blood pressure. After 6 years, C2 was still higher in the non-sedentary than sedentary subjects. In addition, an improvement in the augmentation index accompanied by a decline in total peripheral resistance was found in the former. These data show that regular physical activity is associated with improved small artery elasticity in the early phase of hypertension. This association persists over time and is independent of blood pressure and heart rate.

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“…The first one 16 suggested that patients with isolated office hypertension had higher aortic stiffness than those with sustained normal BP only if they had concomitantly other cardiovascular risk factors, such as diabetes or dyslipidemia. Another study 34 also reported greater aortic PWV in isolated office hypertensives than in sustained normotensives. However, a third study 35 did not find differences in aortic PWV between sustained normotensives and white-coat hypertensives.…”

Section: Discussionmentioning

confidence: 94%

Uncontrolled isolated office hypertension is associated with subclinical markers of cardiovascular disease in hypertensive type 2 diabetic patients

et al. 2010

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Isolated office hypertension (IOH) has been associated with structural cardiac abnormalities; however, its relation to worse cardiovascular prognosis remains uncertain. Less is known regarding the consequences of uncontrolled IOH in treated hypertensives. The aim was to investigate whether uncontrolled IOH was independently associated with two subclinical markers of cardiovascular disease, aortic stiffness and left ventricular hypertrophy (LVH). Clinical laboratory and 24-h ambulatory blood pressure (BP) data were obtained in 523 hypertensive patients with type 2 diabetes. Controlled office-ambulatory hypertension was defined by office blood pressure o140/90 mm Hg and 24-h BP o130/80 mm Hg, whereas uncontrolled IOH by office blood pressureX140/90 mm Hg and 24-h BP o130/80 mm Hg. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV) and left ventricular mass index (LVMI) by echocardiography. Statistics included multivariate linear and logistic regressions. According to BP patterns, 152 patients (29.1%) had controlled office-ambulatory hypertension, and 172 (32.9%) had uncontrolled IOH. Patients with uncontrolled IOH had greater LVMI (62.0 ± 21.9 vs. 52.9 ± 17.0 g m À2.7 , Po0.001) and PWV (11.5 ± 2.4 vs. 10.2 ± 2.1 m s À1 , Po0.001) than those with controlled hypertension. On linear model, after adjustment for several potential confounders, patients with uncontrolled IOH persisted with higher PWV (P¼0.003) and LVMI (P¼0.015). On logistic regression, the presence of uncontrolled IOH was independently associated with 2.7-fold (95% CI: 1.3-5.5) and 2.1-fold (95% CI: 1.1-4.0) higher risks of having increased aortic stiffness and LVH, respectively. In conclusion, uncontrolled IOH is associated with increased aortic stiffness and LVH in hypertensive type 2 diabetic patients. This may be a link to augmented cardiovascular risk. Keywords: aortic stiffness; left ventricular hypertrophy; type 2 diabetes; uncontrolled isolated office hypertension INTRODUCTION Some studies showed a better cardiovascular prognosis for isolated office hypertension patients (white-coat hypertension) than for those with sustained hypertension; 1-3 however, its prognostic significance in relation to sustained normal blood pressure (BP) remains controversial. 1,4-6 Nonetheless, isolated office hypertension has been associated with structural cardiac abnormalities in general population studies, mainly increased left ventricular mass, 7-9 which is a known marker of increased cardiovascular risk. 10 In normoalbuminuric type 2 diabetic patients, the prevalence of isolated office hypertension appears to be identical to hypertensive nondiabetic individuals, 11 and the presence of isolated office hypertension has been associated with macroalbuminuria and diabetic retinopathy. 12 However, less knowledge is available regarding the importance of uncontrolled isolated office hypertension (the white-coat effect) in treated hypertensives in relation to those with sustained controlled office and ambulatory hypertension.

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Impaired arterial elasticity in young patients with white-coat hypertension

Cited by 17 publications

References 58 publications

Combined effects of office and 24-h blood pressure on aortic stiffness in human hypertension

Combined effects of office and 24-h blood pressure on aortic stiffness in human hypertension

Regular physical activity is associated with improved small artery distensibility in young to middle-age stage 1 hypertensives

Uncontrolled isolated office hypertension is associated with subclinical markers of cardiovascular disease in hypertensive type 2 diabetic patients

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