Relationship of 24-Hour Blood Pressure Mean and Variability to Severity of Target-Organ Damage in Hypertension

Parati, Gianfranco; Pomidossi, G.; Albini, Fabio; Malaspina, D.; Mancia, Giuseppe

doi:10.1097/00004872-198702000-00013

Cited by 903 publications

(501 citation statements)

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“…Increased BP variability and an extreme drop or no drop in BP during sleep have been found to be risk factors for the rate and severity of target-organ damage. 16,25 In the present study, elderly subjects were found to display increased BP variability only during the time they were awake. Elderly women in particular displayed the highest levels of variability for SBP and DBP.…”

Section: Discussionsupporting

confidence: 43%

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Effects of age and gender on ambulatory blood pressure and heart rate

Jaquet

Shapiro

1998

J Hum Hypertens

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In a large group of young (n = 194) and elderly (n = 148) healthy subjects, we explored the relationship between ambulatory blood pressure (BP) levels, within-subject BP variability, and age in men and women. The questions asked were: Do elderly subjects display higher BP levels and variability compared to a young group? Are there gender differences in BP level and variability? Are these gender differences similar in the young and the elderly subjects? Do age or gender influence BP in a similar way during waking and during sleep? Subjects wore an ambulatory BP monitor (Accutracker II) for 24 h.

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Section: Discussionsupporting

confidence: 43%

“…11 BP variability has been found to be an independent risk factor for cardiovascular morbidity 14 and the rate and severity of target-organ damage. 15,16 However, since gender differences have generally been ignored, it is not known if the changes in BP and HR variability occur in both men and women as they age.…”

Section: Introductionmentioning

confidence: 99%

Effects of age and gender on ambulatory blood pressure and heart rate

Jaquet

Shapiro

1998

J Hum Hypertens

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“…These studies also suggest that aliskiren inhibits the intrarenal RAAS, and that such inhibition is enduring. In view of the growing evidence that 24-h BP control predicts better outcomes for target organ protection, [92][93][94] such long-acting inhibition of the intrarenal RAAS may be especially important in conditions in which this pathway is activated, such as believed to occur in DN. 78 Aliskiren may bind to intrarenal renin The autoradiographic images discussed above 87 provoke questions regarding the intracellular fate of aliskiren.…”

Section: Aliskiren Localizes In the Kidneymentioning

confidence: 99%

New insights into the renoprotective actions of the renin inhibitor aliskiren in experimental renal disease

Feldman

2010

Hypertens Res

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The renin-angiotensin-aldosterone system (RAAS) has a central function in the regulation of blood pressure. Aliskiren, the first direct renin inhibitor to be approved for the treatment of hypertension, blocks the RAAS at its point of activation. As renin inhibition acts at the top of the RAAS cascade, this mechanism has been proposed to offer advantages over existing modes of RAAS blockade. The RAAS is also considered to be a major factor in the pathogenesis of many renal diseases, especially diabetic nephropathy (DN), the main cause of end-stage renal disease. Existing therapies to block the RAAS slow the progression of DN, but they do not halt the disease. Therefore, more effective modes of interventions are needed. Studies to determine the efficacy of aliskiren in human renal disease are in progress. This review summarizes in vivo studies in which the efficacy of aliskiren was tested in experimental models of renal disease, and presents in vitro studies that provide insights into the possible mechanisms by which aliskiren confers renoprotection in animals. These works are discussed in the framework of the intrarenal RAAS and suggest that aliskiren may act by unique renoprotective mechanisms. Keywords: aliskiren; kidney; mechanism; nephropathy; renin INTRODUCTIONThe renin-angiotensin-aldosterone system (RAAS) is an ancient pathway 1 that has evolved into a central mechanism by which mammalian blood pressure (BP) and fluid homeostasis are regulated. Research in this field started with the discovery in 1898 by Tigerstedt and Berman 2 that a renal extract when injected into rabbits induced a rapid increase in systemic BP. Subsequent work over many years established the RAAS as a pivotal contributor to cardiorenal diseases. Hence, inhibitors of the middle and distal portions of the RAAS pathway, angiotensin-converting enzyme (ACE) inhibitors (ACEI) and AT 1 receptor blockers, respectively, have become mainstay therapies for treating hypertension. In 2007, aliskiren, the first direct renin inhibitor (DRI), was approved for the treatment of hypertension. This heralded the therapeutic control of BP by inhibiting the RAAS at its first and rate-limiting step. However, RAAS blockade is also effective for treating renal disease 3-6 and the efficacy of aliskiren for this purpose is currently being investigated. Accordingly, the subject of this review is to summarize the preclinical evidence for renoprotection by aliskiren, and to discuss recently published information on the possible mechanism(s) for these benefits. As it is well recognized that there is a tissue as well as circulating RAAS, 7 the preclinical actions of aliskiren will be discussed in the context of the intrarenal RAAS and the potential for its inhibition by aliskiren.

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“…The estimation of BP and heart rate variability with intermittent ambulatory recorders does have its limitations 24 and provides only an incomplete assessment of overall short-and long-term variability, with additional information being available in recent studies using new techniques such as wide-band power spectral analysis 49 which have not been used in the current study. BP variability from ambulatory recorders has been independently related to adverse outcomes, 7,8 and theoretically improvements in baroreflex homeostatic mechanisms should translate into reduced BP variability and increased heart rate variability. However, other workers have similarly not found that increases in BRS with the treatment of hypertension necessarily lead to reduced longer-term BP variability.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Several studies have addressed the issue of the modification of arterial baroreceptor-cardiac reflex sensitivity (BRS) with antihypertensive treatment in young and elderly subjects, predominantly with either angiotensin-converting enzyme inhibitors [9][10][11][12] or with calcium channel blocking drugs. [12][13][14][15][16][17] The basis for the observed increases in BRS with treatment, although not seen in every study, 17 is thought to be an increase in large artery compliance permitting resetting of baroreflexes.…”

Section: Introductionmentioning

confidence: 99%

Baroreflex sensitivity changes with calcium antagonist therapy in elderly subjects with isolated systolic hypertension

et al. 1999

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In order to study the effects of calcium-blocking therapy on cardiovascular homeostasis in elderly subjects with isolated systolic hypertension, we performed a randomised double-blind placebo-controlled crossover study of 6 weeks therapy with modified-release nifedipine or placebo. Changes with calcium-blocker treatment in clinic and 24-h blood pressure (BP), heart rate, BP variability, baroreflex sensitivity (BRS) by three methods (Valsalva manoeuvre, phenylephrine and sodium nitroprusside injection), and in baroreflex-and non-baroreflexmediated reflexes (tilt and cold face stimulus) were studied in 14 elderly subjects (mean age [± SEM] 70 ± 1 years) with sustained isolated systolic hypertension (clinic BP 179 ± 3/85 ± 1 mm Hg). Clinic systolic BP, but not diastolic BP, was reduced with treatment (by 14 ± 6 mm Hg, P = 0.03, diastolic BP 4 ± 3 mm Hg, P = 0.16).

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Relationship of 24-Hour Blood Pressure Mean and Variability to Severity of Target-Organ Damage in Hypertension

Cited by 903 publications

References 0 publications

Effects of age and gender on ambulatory blood pressure and heart rate

Effects of age and gender on ambulatory blood pressure and heart rate

New insights into the renoprotective actions of the renin inhibitor aliskiren in experimental renal disease

Baroreflex sensitivity changes with calcium antagonist therapy in elderly subjects with isolated systolic hypertension

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