Morning Blood Pressure Hyper-reactivity Is an Independent Predictor for Hypertensive Cardiac Hypertrophy in a Community-Dwelling Population

Kaneda, Ruri; Kario, Kazuomi; Umeda, Yuji; Hoshide, Yoko; Shimada, Kazuyuki

doi:10.1016/j.amjhyper.2005.06.015

Cited by 68 publications

(47 citation statements)

References 19 publications

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“…[8][9][10][11][12] Especially, morning hypertension and morning BP surge have been reported to be a significant predictor of the cardiovascular events and target organ damage. [13][14][15] A recent report suggested that the control of evening BP as well as morning BP is important in hypertensive patients with pre-diabetes and type 2 diabetes. 17 In the VART, not only office BP but also HBP levels were well controlled in both the groups.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12] Especially, high morning HBP is closely correlated with organ damage and future cardiovascular events. [13][14][15] Self-monitoring of BP at home is now popular in Japan and the Japanese guidelines for the management of hypertension appreciate its usefulness. 16 In the present study, we examined whether there were any differences in HBP and cardiovascular protection between the valsartan group and the amlodipine group in Japanese hypertensive patients who participated in the VART.…”

Section: Introductionmentioning

confidence: 99%

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Effects of valsartan and amlodipine on home blood pressure and cardiovascular events in Japanese hypertensive patients: a subanalysis of the VART

et al. 2011

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The Valsartan Amlodipine Randomized Trial (VART) was performed to compare the beneficial effects of valsartan and amlodipine on cardiovascular events in Japanese hypertensive patients. In this subanalysis of the VART, we assessed the relationship between home blood pressure (HBP) levels and cardiovascular events in the enrolled patients. We enrolled 1021 patients with mildto-moderate hypertension in the VART. The participants were allocated randomly to either the valsartan group or the amlodipine group. The primary end point was a composite of all-cause death, sudden death, cerebrovascular events, cardiac events, vascular events and renal events. A total of 621 patients (valsartan group: 305 and amlodipine group: 316) completed the measurements of HBP (morning and evening) throughout the trial. Both the agents evenly and significantly lowered morning HBP and evening HBP throughout the trial. There was no significant difference in the primary end point between the two groups. However, we observed significant decreases in the left ventricular mass index and urinary albumin to creatinine ratio in the valsartan group but not in the amlodipine group. There were no significant differences in HBP levels and the main outcome of the cardiovascular events between the valsartan and amlodipine groups. However, in the valsartan group, significant improvements in left ventricular hypertrophy and microalbuminuria were observed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of valsartan and amlodipine on home blood pressure and cardiovascular events in Japanese hypertensive patients: a subanalysis of the VART

et al. 2011

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“…[22][23][24] Indeed, various cardiovascular morbidities have been described in patients with an exaggerated morning BP surge. These studies, conducted primarily in adults, consistently indicate that morning BP surge is an important predictor of the development of risk markers such as increased carotid intima thickness 14 myocardial hypertrophy and infarction 25 and cardiovascular events, such as stroke. 26,12 Morning BP surge is a normal phenomenon attributed to enhanced ␣-adrenergic vasoconstrictor response, 27 increased activity of the rennin-angiotensin-aldosterone system, and reduced early morning endothelial function.…”

Section: Discussionmentioning

confidence: 99%

Activity-Adjusted 24-Hour Ambulatory Blood Pressure and Cardiac Remodeling in Children with Sleep Disordered Breathing

et al. 2008

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Abstract-Questions remain as to whether pediatric sleep disordered breathing increases the risk for elevated blood pressure and blood pressure-dependent cardiac remodeling. We tested the hypothesis that activity-adjusted morning blood pressure surge, blood pressure load, and diurnal and nocturnal blood pressure are significantly higher in children with sleep disordered breathing than in healthy controls and that these blood pressure parameters relate to left ventricular remodeling. 24-hour ambulatory blood pressure parameters were compared between groups. The associations between blood pressure and left ventricular relative wall thickness and mass were measured. 140 children met the inclusion criteria. In children with apnea hypopnea index Ͻ5 per hour, a significant difference from controls was the morning blood surge. Significant increases in blood pressure surge, blood pressure load, and in 24-hour ambulatory blood pressure were evident in those whom the apnea hypopnea index exceeded 5 per hour. Sleep disordered breathing and body mass index had similar effect on blood pressure parameters except for nocturnal diastolic blood pressure, where sleep disordered breathing had a significantly greater effect than body mass index. Diurnal and nocturnal systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure predicted the changes in left ventricular relative wall thickness. Therefore, sleep disordered breathing in children who are otherwise healthy is independently associated with an increase in morning blood pressure surge, blood pressure load, and 24-hour ambulatory blood pressure. The association between left ventricular remodeling and 24-hour blood pressure highlights the role of sleep disordered breathing in increasing cardiovascular morbidity. Key Words: sleep apnea Ⅲ children Ⅲ ambulatory blood pressure Ⅲ blood pressure surge Ⅲ blood pressure load Ⅲ cardiac remodeling Ⅲ hypertrophy T he association between sleep disordered breathing (SDB) and cardiovascular morbidity in adults has become an important consideration in the management of patients with SDB. Results from numerous cross-sectional and prospective studies of blood pressure (BP) control in adults support the concept that hypertension is an intermediate end point between SDB and cardiovascular disease. 1,2 Further support of this concept is derived from studies linking SDB to atherosclerotic pathways. [3][4][5][6] These studies provide insight into the mechanisms of vascular injury secondary to SDB. Although the impact of duration of this disorder on the development of risk factors for cardiovascular disease is difficult to estimate, morbidity secondary to SDB seems to manifest gradually, often taking decades. As such, with the exception of isolated cases of heart failure, children with SDB rarely show evidence of cardiovascular disease. Thus far, studies addressing whether children with SDB acquire risk factors for the early development of cardiovascular disease are inconclusive.Findings from several pediatric studies suggest ...

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“…This increase in BP variability is pronounced particularly in the morning, when compared with the other periods, 5 leading to cardiac hypertrophy. 6 In addition, small artery disease may also be associated with exaggerated morning BP surge. In our previous study on elderly hypertensive patients, silent cerebral infarcts, assessed by brain MRI, were significantly associated with exaggerated morning BP surge.…”

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confidence: 99%

Vascular Damage in Exaggerated Morning Surge in Blood Pressure

Kario

2007

Hypertension

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R ecent clinical studies demonstrated that an exaggerated morning blood pressure (BP) surge is a risk for cardiovascular events, such as ischemic and hemorrhagic stroke. [1][2][3] Simultaneously, neurohumoral factors and various cardiovascular risk factors are exaggerated in the morning. Although the precise molecular mechanisms remain unclear, exaggerated morning BP surge has been closely associated with other cardiovascular risk factors potentiated in the morning (Figure). The main mechanisms of morning BP surge and associated neurohumoral activation on cardiovascular disease consist of progression of cardiovascular remodeling and atherosclerosis, as well as direct effects of BP surges that may trigger cardiovascular events.An exaggerated morning BP surge may advance vascular remodeling from the larger arteries to the small resistance vessel through increased mechanical pressure and shear stress of an exaggerated fluctuation of blood flow on the vessel wall. In hypertensive patients, morning BP surge and time of morning BP variability in the morning were significantly correlated with increased carotid intima-media thickness, and these associations were independent of 24-hour BP levels. 4 On the other hands, increased stiffness of large arteries increases BP variability through impaired baroreceptor sensitivity. This increase in BP variability is pronounced particularly in the morning, when compared with the other periods, 5 leading to cardiac hypertrophy. 6 In addition, small artery disease may also be associated with exaggerated morning BP surge. In our previous study on elderly hypertensive patients, silent cerebral infarcts, assessed by brain MRI, were significantly associated with exaggerated morning BP surge. 7 This association was prominent between multiple cerebral infarcts and morning BP surge and appeared to depend on ␣-adrenergic sympathetic activity. The reactivity of morning BP surge depends on the ␣-adrenergic vasoconstrictor response of small resistance vessel, and it may be closely related to remodeling of the small vessel. Thus, morning BP surge and vascular remodeling of various arterial sizes could form a vicious cycle of cardiovascular risk.As shown in the Figure, the morning BP surge also seems to have some role in the initial stage and the progression of atherosclerosis. In the model of sinoaortic denervation rat, which exhibits the marked BP variation, the neointimal formation after vascular injury was significantly increased. 8 In healthy subjects without atherosclerotic disease, flow-mediated vasodilation, which reflects endothelial function, was reduced early in the morning. Reduced endothelial function could contribute to the high BP reactivity in the morning. 9 In addition, because activity of the sympathetic nervous system and renin-angiotensin-aldosterone system is the highest in the morning, the impact of exaggerated BP variability in the morning to lead to endothelial cell damage and subsequent atherosclerosis would be greater than in other periods of the day.In this issue, Marfe...

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Morning Blood Pressure Hyper-reactivity Is an Independent Predictor for Hypertensive Cardiac Hypertrophy in a Community-Dwelling Population

Abstract: Exaggerated MBPS, adjusted for physical activity, is associated with cardiac hypertrophy independent of ambulatory BP level in a community-dwelling population.

Cited by 68 publications

References 19 publications

Effects of valsartan and amlodipine on home blood pressure and cardiovascular events in Japanese hypertensive patients: a subanalysis of the VART

Effects of valsartan and amlodipine on home blood pressure and cardiovascular events in Japanese hypertensive patients: a subanalysis of the VART

Activity-Adjusted 24-Hour Ambulatory Blood Pressure and Cardiac Remodeling in Children with Sleep Disordered Breathing

Vascular Damage in Exaggerated Morning Surge in Blood Pressure

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