Time Rate of Blood Pressure Variation Is Associated With Increased Common Carotid Artery Intima-Media Thickness

Abstract

Abstract-The extent of target-organ damage has been positively associated with the magnitude of blood pressure (BP) variability in essential hypertension. However, the clinical implications of the rate of BP changes have never been investigated. We evaluated the association between the rate of systolic BP (SBP) variation derived from ambulatory BP monitoring (ABPM) data analysis and the extent of common carotid artery (CCA) intima-media thickness (IMT) in normotensive (nϭ280) and in uncomplicated hypertensive subjects (nϭ234 Key Words: blood pressure Ⅲ carotid arteries Ⅲ blood pressure monitoring Ⅲ baroreflex Ⅲ ultrasonography P rospective studies in treated and untreated hypertensive patients and in the general population have demonstrated that even after adjusting for established risk factors, the incidence of cardiovascular events is correlated with blood pressure (BP) on conventional as well as ambulatory measurements. 1,2 However, ambulatory BP monitoring (ABPM) significantly refines the prediction already provided by office recordings because target-organ damage is more closely associated with ambulatory than clinic BP. 1,2 Intra-arterial beat-to-beat monitoring has shown that BP is highly variable. 3 Despite difficulties in the assessment of BP variability, particularly with noninvasive techniques, 4 evidence from cross-sectional 5-9 and longitudinal studies 10 -12 has suggested an independent and positive relationship between the extent of target-organ damage (measured by left ventricular mass, early carotid atherosclerosis, subcortical brain lesions, or a comprehensive end-organ damage score) and the magnitude of BP variability in essential hypertension. Besides, BP variability was an independent predictor for cardiovascular mortality in the general population. 13 Interestingly, Mancia et al reported recently that hypertensive patients compared with normotensive subjects present steeper fast-and short-duration beat-to-beat BP changes, documented by means of intra-arterial BP monitoring. 14 Furthermore, experimental studies have suggested that the traumatic effect of intravascular pressure on the vessel wall, which results in vascular remodeling and atherosclerosis, may be more closely associated to oscillatory than to steady laminar shear stress. [15][16][17] This evidence raises the issue of whether a hypertensive patient's prognosis depends not only on average BP level but, to some extent, also on the degree and rate of BP variation.However, the clinical implications of the time rate of noninvasive ambulatory BP changes have never been investigated in essential hypertension. Quantitative B-mode ultrasound imaging offers the opportunity to assess the intimamedia thickness (IMT) of the common carotid artery (CCA), which is considered a reliable marker for the extent of early atherosclerosis 18 and an indicator of the risk of cardiovascular diseases. 19 Moreover, Zanchetti et al reported that CCA-IMT

Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes

“…33 In addition, among hypertensive patients, those with a positive history of stroke demonstrated higher levels of systolic and diastolic BP than did those without a stroke history. 34,35 Nonetheless, white matter lesions and leukoaraiosis were 25 Cross-sectional 229 HTN Nondipping Indifferent Cardiac structure and LVH Bjö rklund 66 Cross-sectional 1057 Elderly GP Nondipping Indifferent LV mass Grandi 26 Cross-sectional 253 HTN Nondipping Indifferent LVH and diastolic dysfunction Salvetti 28 Cross-sectional 225 GP Nondipping Indifferent LV mass Tsioufis 27 Cross 28 Cross-sectional 225 GP Nondipping Positive Increasing carotid IMT Cuspidi 62 Cross-sectional 141 HTN Nondipping Positive Prevalence of increased IMT Zakopoulos 70 Cross-sectional 514 HTN and NTN Nondipping Indifferent Carotid IMT Cuspidi 12 Cross-sectional 375 HTN Nondipping Indifferent Carotid IMT Cuspidi 23 Cross-sectional 355 HTN Nondipping Indifferent Carotid artery changes (carotid plaques or IMT) Grandi 26 Cross-sectional 253 HTN Nondipping Indifferent PWV Mancia 71 Cross-sectional 1663 HTN Day-to-night BP ratio Indifferent Carotid IMT Tsioufis 27 Cross Nocturnal BP phenotypes and 'hard CV outcomes'…”

Simvastatin prevents large blood pressure variability induced aggravation of cardiac hypertrophy in hypertensive rats by inhibiting RhoA/Ras–ERK pathways

“…[3][4][5][6] Large BP variability aggravates cardiac remodeling in hypertensive patients. [7][8][9] Further, large BP variability is an independent risk factor for cardiovascular events in hypertensive patients.…”

Activity-Adjusted 24-Hour Ambulatory Blood Pressure and Cardiac Remodeling in Children with Sleep Disordered Breathing

“…Among these measures are the rate of BP rise during the transition from sleep to wakefulness (referred to as morning BP surge), BP load, and diurnal and nocturnal BP measurements, all of which are important predictors of cardiovascular disease. [11][12][13][14][15] These parameters are known to be influenced by physical activity, degree of adiposity, and demographic characteristics. A rigorous comparison of these parameters in children with SDB and healthy controls that adjusts for these confounding factors has not, however, been performed.…”