Morning blood pressure surge is associated with arterial stiffness and sympathetic baroreflex sensitivity in hypertensive seniors

Abstract

Morning blood pressure (BP) surge is considered to be an independent risk factor for cardiovascular diseases. We tested the hypothesis that increased large-artery stiffness and impaired sympathetic baroreflex sensitivity (BRS) contribute to augmented morning surge in elderly hypertensive subjects. Morning surge was assessed as morning systolic BP averaged for 2 h just after waking up minus minimal sleeping systolic BP by using ambulatory BP monitoring (ABPM) in 40 untreated hypertensive [68 ± 1 (SE) yr] and 30 normotensive (68 ± 1 yr) subjects. Beat-by-beat finger BP and muscle sympathetic nerve activity (MSNA) were recorded in the supine position and at 60° upright tilt. We assessed arterial stiffness with carotid-to-femoral pulse wave velocity (cfPWV) and sympathetic BRS during spontaneous breathing. Awake and asleep ABPM-BPs and morning surge were higher in hypertensive than normotensive subjects (all P < 0.001). cfPWV was higher (P = 0.002) and sympathetic BRS was lower (P = 0.096) in hypertensive than normotensive subjects. Hypertensive subjects with morning surge ≥35 mmHg (median value) had higher cfPWV (11.9 ± 0.5 vs. 9.9 ± 0.4 m/s, P = 0.002) and lower sympathetic BRS (supine: -2.71 ± 0.25 vs. -3.73 ± 0.29, P = 0.011; upright: -2.62 ± 0.22 vs. -3.51 ± 0.35 bursts·100 beats(-1)·mmHg(-1), P = 0.052) than those with morning surge <35 mmHg. MSNA indices were similar between groups (all P > 0.05), while upright total peripheral resistance was higher in hypertensive subjects with greater morning surge than those with lesser morning surge (P = 0.050). Morning surge was correlated positively with cfPWV (r = 0.59, P < 0.001) and negatively with sympathetic BRS (r = 0.51, P < 0.001) in hypertensive subjects only. Thus, morning BP surge is associated with arterial stiffness and sympathetic BRS, as well as vasoreactivity during orthostasis in hypertensive seniors.

Reliability of arterial stiffness indices at rest and following a single bout of moderate‐intensity exercise in older adults

“…These observations are the first in older individuals and are similar to the responses recently reviewed in healthy younger adults (Mutter et al, 2017). Indeed, there is evidence of altered sympathetic baroreflex sensitivity that is exacerbated with exercise (Okada et al, 2013), revealing underlying dysfunction that is not evident at rest (Shim et al, 2011). Elevations in arterial stiffness following exercise in obese and hypertensive adults (Shim et al, 2011;Gkaliagkousi et al, 2014;Moon et al, 2015;Bunsawat et al, 2017) are potentially detrimental and may be due to underlying dysfunction of these mechanisms.…”

The Importance of Walking for Control of Blood Pressure: Proof Using a Telemedicine System

“…The morning BP peak is associated with morning sympathetic over activity in hypertensive patients. 27,28 In contrast, increased PA reduces and controls sympathetic activity. 7 Reduced sympathetic activity due to daily walking might reduce BP, especially morning BP.…”

Increased morning blood pressure surge and coronary microvascular dysfunction in patient with early stage hypertension

“…Increased stiffness of the large arteries enhances BP variability by impairing baroreceptor sensitivity. 26 This increase in BP variability is reported particularly in the morning and is associated with cardiac hypertrophy. 30,31 MBPS can trigger the alphaadrenergic vasoconstrictor response of small resistance vessels, and it may be related to remodeling of the small vessels.…”