Sleep-time blood pressure: Unique sensitive prognostic marker of vascular risk and therapeutic target for prevention

Hermida, Ramón C.; Ayala, Diana E.; Smolensky, Michael H.; Fernández, José R.; Mojón, Artemio; Portaluppi, Francesco

doi:10.1016/j.smrv.2016.04.001

Cited by 52 publications

(36 citation statements)

References 121 publications

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“…A chronotherapy of hypertension, aimed at more carefully controlling nocturnal BP levels and converting a nondipping into a dipping BP profile, has been proposed as a convenient treatment strategy. 104 …”

Section: Bp Variability In Osamentioning

confidence: 99%

Blood-pressure variability in patients with obstructive sleep apnea: current perspectives

Marrone

Bonsignore

2018

NSS

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Obstructive sleep apnea (OSA) is often associated with hypertension and other cardiovascular diseases. Blood pressure (BP) variability is part of the assessment of cardiovascular risk. In OSA, BP variability has been studied mainly as very short-term (beat-by-beat) and short-term (24-hour BP profile) variability. BP measured on consecutive heartbeats has been demonstrated to be highly variable, due to repeated peaks during sleep, so that an accurate assessment of nocturnal BP levels in OSA may require peculiar methodologies. In 24-hour recordings, BP frequently features a “nondipping” profile, ie, <10% fall from day to night, which may increase cardiovascular risk and occurrence of major cardiovascular events in the nocturnal hours. Also, BP tends to show a large “morning BP surge”, a still controversial negative prognostic sign. Increased very short-term BP variability, high morning BP, and nondipping BP profile appear related to the severity of OSA. Treatment of OSA slightly reduces mean 24-hour BP levels and nocturnal beat-by-beat BP variability by abolishing nocturnal BP peaks. In some patients OSA treatment turns a nondipping into a dipping BP profile. Treatment of arterial hypertension in OSA usually requires both antihypertensive pharmacological therapy and treatment of apnea. Addressing BP variability could help improve the management of OSA and reduce cardiovascular risk. Possibly, drug administration at an appropriate time would ensure a dipping-BP profile.

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Section: Bp Variability In Osamentioning

confidence: 99%

Blood-pressure variability in patients with obstructive sleep apnea: current perspectives

Marrone

Bonsignore

2018

NSS

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“…Even if REM sleep is preserved, the greater the sleep fragmentation, the farther the sympathovagal modulation is tilted toward sympathetic dominance [ 27 ]. Blood pressure regulation during the biological night (the usual sleep time) is uniquely related to cardiovascular risk, including the risk of stroke [ 28 - 30 ]. Non-dipping—loss of the typical blood pressure drop during sleep—is associated with a host of poor cardiac, neurological, metabolic, and renal outcomes [ 31 - 36 ].…”

Section: Introductionmentioning

confidence: 99%

Sleep Disturbances as a Risk Factor for Stroke

et al. 2018

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Sleep, a vital process of human being, is carefully orchestrated by the brain and consists of cyclic transitions between rapid eye movement (REM) and non-REM (NREM) sleep. Autonomic tranquility during NREM sleep is characterized by vagal dominance and stable breathing, providing an opportunity for the cardiovascular-neural axis to restore homeostasis, in response to use, distress or fatigue inflicted during wakefulness. Abrupt irregular swings in sympathovagal balance during REM sleep act as phasic loads on the resting cardiovascular system. Any causes of sleep curtailment or fragmentation such as sleep restriction, sleep apnea, insomnia, periodic limb movements during sleep, and shift work, not only impair cardiovascular restoration but also impose a stress on the cardiovascular system. Sleep disturbances have been reported to play a role in the development of stroke and other cardiovascular disorders. This review aims to provide updated information on the role of abnormal sleep in the development of stroke, to discuss the implications of recent research findings, and to help both stroke clinicians and researchers understand the importance of identification and management of sleep pathology for stroke prevention and care.

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“…Elevated nocturnal blood pressure as is noted with nocturnal catecholamine surges in patients with OSAS adds to poor outcomes. Findings from the MAPEC (Monitorizacion Ambulatoria para Prediccion de Eventos Cardiovasculares) study suggest that bedtime chronotherapy with ≥1 conventional hypertension medication to target sleep blood pressure significantly reduces cardiovascular disease risk [13]. The main acute physiological outcomes of OSAS are intermittent hypoxia, intrapleural pressure changes, and sleep fragmentation which induce endothelial dysfunction, sympathetic activation, renin-angiotensin-aldosterone system activation, and increased oxidative stress [14].…”

Section: Introductionmentioning

confidence: 99%

Review of and Updates on Hypertension in Obstructive Sleep Apnea

Ahmad

Makati

Akbar

2017

International Journal of Hypertension

111

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Obstructive sleep apnea (OSA) is a prevalent sleep disorder as is hypertension (HTN) in the 21st century with the rising incidence of obesity. Numerous studies have shown a strong association of OSA with cardiovascular morbidity and mortality. There is overwhelming evidence supporting the relationship between OSA and hypertension (HTN). The pathophysiology of HTN in OSA is complex and dependent on various factors such as sympathetic tone, renin-angiotensin-aldosterone system, endothelial dysfunction, and altered baroreceptor reflexes. The treatment of OSA is multifactorial ranging from CPAP to oral appliances to lifestyle modifications to antihypertensive drugs. OSA and HTN both need prompt diagnosis and treatment to help address the growing cardiovascular morbidity and mortality due to these two entities.

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Sleep-time blood pressure: Unique sensitive prognostic marker of vascular risk and therapeutic target for prevention

Cited by 52 publications

References 121 publications

Blood-pressure variability in patients with obstructive sleep apnea: current perspectives

Blood-pressure variability in patients with obstructive sleep apnea: current perspectives

Sleep Disturbances as a Risk Factor for Stroke

Review of and Updates on Hypertension in Obstructive Sleep Apnea

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