Relationships between new risk factors and circadian blood pressure variation in untreated subjects with essential hypertension

Tsioufis, Costas; Antoniadis, D.; Stefanadis, Christodoulos; Tzioumis, Konstantinos; Pitsavos, Christos; Kallikazaros, Ioannis; Psarros, Themis K.; Lalos, Spyros; Michaelides, Andreas; Toutouzas, P.

doi:10.1016/s0895-7061(02)02954-0

Cited by 41 publications

(30 citation statements)

References 28 publications

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“…[44][45][46] In our clinic hypertensive population, only patients with both clinic and ambulatory hypertension (sustained hypertension), but not those with only clinic hypertension (white coat hypertension), had higher homocysteine levels than normotensive subjects. Moreover, we did not find a significant correlation between homocysteine levels and clinic BP, in accordance with Lip et al, 50 but we found a significant correlation between homocysteine levels and 24-h BP, in accordance with Tsioufis et al 51 Whether this finding represents an association because of the clustering of cardiovascular risk factors in the sustained hypertensive population or is related to the influence of homocysteine on ambulatory BP is at present unknown. Further studies are needed to evaluate whether homocysteine plays a role in the pathophysiology of hypertension.…”

Section: 39supporting

confidence: 89%

Circulating homocysteine levels in sustained and white coat hypertension

et al. 2003

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Although white coat hypertension has been widely studied in the last years, its risk profile is not yet completely clear. The aim of this study was to evaluate circulating homocysteine levels, an emerging cardiovascular risk factor, in subjects with white coat and sustained hypertension. We selected 31 sustained hypertensive subjects, 31 white coat hypertensive subjects and 31 normotensive subjects matched for age, gender, body mass index and occupation. Women were also matched for menopausal status. Subjects with smoking habit, dyslipidaemia and diabetes mellitus were excluded from the study. White coat hypertension was defined as clinical hypertension and daytime ambulatory blood pressure o135/85 mmHg. Blood samples were drawn after a fasting period of 12 h for routine laboratory tests and homocysteine determination. Homocysteine levels were evaluated by fluorescence polarization immunoassay. Creatinine, glucose, cholesterol and triglycerides were not different among the groups. White coat hypertensive subjects had significantly lower homocysteine levels than sustained hypertensive patients (8.2 7 2.0 vs 12.6 7 3.9 lmol/l, P ¼ 0.0003). No significant difference was observed between white coat hypertensive and normotensive subjects regarding this parameter (8.2 7 2.0 vs 7.6 7 1.9 lmol/l, P ¼ 0.9). In conclusion, our data show that middle-aged white coat hypertensive subjects without other cardiovascular risk factors have lower circulating homocysteine levels than sustained hypertensive patients suggesting that they are at lower cardiovascular risk.

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Section: 39supporting

confidence: 89%

Circulating homocysteine levels in sustained and white coat hypertension

et al. 2003

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“…Posterior wall thickness > in nondippers (24 † ,31) Atrial/brain natriuretic peptide > in nondippers (58) Left ventricular ejection fraction ↓ in nondippers (49,58) Supraventricular/ventricular ectopies > in nondippers (49,59) QT dispersion/QTc interval > in nondippers (60,61) Systemic vascular resistance ↑ at night in nondippers (62) ↓ at night in dippers (62) Stroke index ↑ at night in nondippers (63) ↓ at night in dippers (63) Cardiac index less of a ↓ at night in nondippers (63) ↓ at night in dippers (63) Cardiac output No difference between nondippers and dippers (24,62) Pulse pressure less of a ↓ at night in nondippers (12,67) ↓ at night in dippers (12,67) Carotid artery intima-media > in nondippers (9,14 (46,(73)(74)(75) Lacunae > in nondippers (6,10) Periventricular hyperintensities > in nondippers (6,10) White matter lesions > in nondippers (76) Previous cerebrovascular event More nondipping in those with previous events (71) Cognitive impairment > in nondippers (79) Dementia > in nondippers (78,81) Memory ↓ in nondippers (82) Sensory motor speed ↓ in nondippers (82) Microalbuminuria > in nondippers (6,27,84,85) *Cardiovascular eve...…”

Section: Cardiac Structural Alterationsmentioning

confidence: 99%

“…Tsioufis et al (27) examined the relationship between microalbuminuria and the circadian BP variation in untreated persons newly diagnosed with essential hypertension. Nondippers were found to have higher rates of microalbuminuria than dippers.…”

Section: Microalbuminuriamentioning

confidence: 99%

“…First, researchers that have discovered an association between nondipping and higher levels of microalbuminuria also have reported higher 24 h BP among the nondippers. Therefore, early renal vascular injury may be the result of increased pressure load on the blood vessels (27). Second, renal and cardiac injuries may not occur at the same time during the initial phase of hypertension (85).…”

Section: Microalbuminuriamentioning

confidence: 99%

“…Several studies involving subjects with uncomplicated essential hypertension have revealed an association between a nondipper BP profile and an increased risk of target organ damage at the cardiac, renal, vascular and cerebrovascular levels (6,9,10,15,18,27,28,(42)(43)(44)(45). Target organ damage has also been found to be linked with two additional abnormal BP patterns: reverse dipping (nocturnal rise in night-time BP) and extreme dipping (nocturnal fall in night-time BP of greater than 20%) (46).…”

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confidence: 99%

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Night-time blood pressure patterns and target organ damage: A review

Routledge

McFetridge-Durdle

Dean

2007

Canadian Journal of Cardiology

115

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A mbulatory blood pressure monitoring (ABPM) is a noninvasive, automated portable technology that measures and records blood pressure (BP) over a 24 h period (1). This technique has allowed researchers and clinicians to measure the percentage of elevated BP readings, as well as 24 h BP loads and BP patterns (2). Consequently, it has been discovered that BP varies over 24 h in a diurnal manner, being higher during the day and lower at night (3). The normal variation in BP is characterized by a 10% to 20% reduction in BP from day to night (2). Individuals with this decline in night-time BP are known as 'dippers', and those who experience a blunted decline in night-time BP are known as 'nondippers' (4). Researchers have determined individuals to be nondippers on the basis of a less than 10% reduction in night-time systolic BP (SBP) (5-11), diastolic BP (DBP) (5) or both SBP and DBP measurements (12-31).The exact mechanisms of action responsible for nondipping are not fully understood. However, data suggest that nondippers have an increase in sympathetic nervous system activity (32,33) and a decrease in parasympathetic nervous system activity throughout the night (32,34). Nondipping is more commonly found among individuals with renal diseases, autonomic neuropathies, diabetes, sleep apnea, autonomic dysfunction, malignant hypertension and secondary hypertension (35,36). In addition, approximately 25% of individuals with essential hypertension have a nondipping BP profile (37).There is evidence to suggest that individuals who exhibit a nondipping BP profile are at higher risk of cardiac and extracardiac morbidity (38). Verdecchia et al (39) used data from the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study to examine the morbidity and mortality rates of 715 essential hypertensive patients over a one-to 13-year BACKGROUND: Individuals who do not have a 10% to 20% reduction in blood pressure (BP) during the night are known as 'nondippers'. The cause of this nondipping phenomenon is not fully understood; however, there is a growing body of evidence linking a nondipping BP pattern with target organ damage. OBJECTIVE: To review the literature and present an overview of the target organ damage found to be associated with a nondipping BP pattern. METHODS: PubMed, CINAHL and Medscape searches of all available English language articles from 1986 to 2005 were performed. Search terms included 'BP nondipping', 'BP dipping' and 'target organ damage'. RESULTS: There is evidence to suggest that individuals with hypertension who exhibit a nondipping BP profile are at higher risk of cardiac and extracardiac morbidity and mortality. In particular, nondippers with essential hypertension have been found to have more advanced left ventricular hypertrophy, left ventricular mass and left ventricular mass index, carotid artery wall thickness, carotid artery atherosclerotic plaques, silent cerebral infarct, stroke, cognitive impairment and microalbuminuria. CONCLUSION: A better understanding of the importance of the cir...

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