Serum phosphate in white-coat hypertensive patients: focus on dipping status and metabolic syndrome

Abstract

Recent studies indicate an association between serum phosphate levels and blood pressure in hypertensive patients. A growing body of evidence suggests that white-coat hypertension (WCH) is associated with target organ damage. Furthermore, metabolic syndrome (MS) and a non-dipping pattern are associated with increased cardiovascular risk. The purpose of this study was to explore the nocturnal blood pressure fall in patients with WCH according to their serum phosphate levels and number of MS components fulfilled. The study included 2600 patients with WCH who attended our outpatient clinics. All patients underwent repeated office blood pressure measurements, 24-h ambulatory blood pressure monitoring and full clinical and laboratory evaluation. The diagnosis of MS was made according to the Adult Treatment Panel III criteria. Dipping pattern was defined as follows: 'dippers' had a nocturnal systolic blood pressure (NSBP) fall X10% but o20%; 'non-dippers' had an NSBP fall o10%; 'extreme dippers' had an NSBP fall X20% and 'reverse dippers' had an NSBP increase. There were 314 extreme dippers, 1337 dippers, 734 non-dippers and 116 reverse dippers. Reverse dippers presented with significantly lower levels of serum phosphate, whereas extreme dippers had significantly higher levels (3.39 ± 3.29 vs. 3.58 ± 3.52 mg per 100 ml, Po0.0001). The patients were classified according to the number of MS components and the main observation was the inverse relationship of serum phosphate with MS components (3.53±0.36, 3.50±0.38, 3.49±0.38, 3.44±0.36 and 3.35±0.31 mg per 100 ml, respectively, P¼0.003). Patients with WCH and low serum phosphate levels appear to have a higher incidence of a non-dipping NSBP profile and an impaired metabolic profile. This observation may be important for the stratification of the cardiovascular risk in WCH patients.

Ambulatory blood pressure monitoring and subclinical inflammation in children with chronic kidney disease

“…Surprisingly, in our cohort indices of mineral metabolism correlated with diastolic not with systolic blood pressure. Opposite to our results, Vyssoulis et al in a study of hypertensive adults found positive relation between phosphate concentration and dipping status -highest phosphate status was revealed in "extreme" dippers [28].…”

Can Serum Levels of Alkaline Phosphatase and Phosphate Predict Cardiovascular Diseases and Total Mortality in Individuals with Preserved Renal Function? A Systemic Review and Meta-Analysis

“…Then 84 studies were excluded after full-text reading, because of which, 46 studies had no unqualified results, 1 had no full text, and 37 contained patients without exposure to serum ALP or phosphate. Among these excluded ones, Camille P. [11] and Ana Ludimila [12] studied the association between ALP/phosphate and vascular calcification; the research of Jinkwon and his colleagues [13] studied the functional outcomes of cerebrum with ALP and phosphate; Jason P. [14] focused on aortic valve calcification; the study of Gregory [15] was about phosphate and hypertension; and Bernard M.Y [16] investigated the association between alkaline phosphatase and peripheral arterial disease. Finally, a total of 24 trials [16]–[39] with 147634 individuals were identified from 2011 potentially relevant publications (Figure 1).…”

Refeeding and metabolic syndromes: two sides of the same coin

“…In brief, the majority of the studies showed an inverse relationship between phosphorus status and adiposity, 31, 41, 42, 43, 44, 45, 46, 47, 48, 49 glycemia, 31, 32, 44, 45, 46, 47, 48, 50, 51 lipid profile 32, 47, 51 and blood pressure. 43, 45, 46, 47, 48, 49, 51, 52, 53, 54, 55, 56, 57, 58, 59 …”