Determinants of the circadian blood pressure pattern in hospitalized hypertensive patients
Abstract
Background. Non-dipping hypertension might be associated with increased cardiovascular risk and multiple diseases. The aim of our study was to assess if there are parameters identified in 24-hour ECG-Holter monitoring (ECG-Holter), transthoracic echocardiography (TTE), ECG parameters or laboratory data that allow prediction of circadian blood pressure profile (CBPP).
Material and methods. One hundred and three consecutive patients (male: 50.5%), who underwent 24-hour ambulatory BP measurement and ECG-Holter simultaneously were analyzed. We divided patients into 3 groups: dipping was defined as 10–20% (28.2%), non-dipping as < 10% (50.5%) fall in nocturnal BP and reverse-dipping as higher nocturnal than diurnal BP (21.4%). Additionally, we performed TTE and laboratory check-up in all patients. We built multivariable models for nocturnal fall in systolic BP (SBP) and CBPP.
Results. Multivariable model based on clinical factors was: nocturnal fall in SBP (%) = [13.28 – 0.11 × age – 8.33 × (dilated cardiomyopathy) – 5.95 × PAD – 6.02 × a-adrenolytic]. Multivariable model based on laboratory, echocardiographic and electrocardiographic parameters was: nocturnal fall in SBP (%) = [–27.28 + 1.47 × hemoglobin – 0.14 × CK-MB + 0.14 × maximal heart rate]. Multivariable model for CBPP based on clinical factors included use of beta- or alpha-adrenolytics or torasemide.
Conclusions. We proved that nocturnal fall in SBP and CBPP could be predicted based on ECG-Holter parameters, laboratory data and TTE results, as well as based on detailed medical history. These findings may have implications on care of patients with hypertension.
Keywords: ambulatory blood pressure monitoringcircadian rhythmhypertensionhypotensive therapy
References
- Kearney PM, Whelton M, Reynolds K, et al. Global burden of hypertension: analysis of worldwide data. Lancet. 2005; 365(9455): 217–223.
- Guilbert JJ. The world health report 2002 — reducing risks, promoting healthy life. Educ Health (Abingdon). 2003; 16(2): 230.
- Timio M, Venanzi S, Lolli S, et al. "Non-dipper" hypertensive patients and progressive renal insufficiency: a 3-year longitudinal study. Clin Nephrol. 1995; 43(6): 382–387.
- Suzuki M, Guilleminault C, Otsuka K, et al. Blood pressure "dipping" and "non-dipping" in obstructive sleep apnea syndrome patients. Sleep. 1996; 19(5): 382–387.
- Hermida RC, Crespo JJ, Otero A, et al. Asleep blood pressure: significant prognostic marker of vascular risk and therapeutic target for prevention. Eur Heart J. 2018; 39(47): 4159–4171.
- Verdecchia P, Schillaci G, Reboldi G, et al. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension. 1994; 24(6): 793–801.
- Staessen JA, Bieniaszewski L, O'Brien E, et al. Nocturnal blood pressure fall on ambulatory monitoring in a large international database. The "Ad Hoc" Working Group. Hypertension. 1997; 29(1 Pt 1): 30–39.
- Team RCR. Team RCR. A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna 2012: ISBN 3-900051-07-0; 2014.
- Millar-Craig MW, Bishop CN, Raftery EB. Circadian variation of blood-pressure. Lancet. 1978; 1(8068): 795–797.
- Pickering TG, Hall JE, Appel LJ, et al. Council on High Blood Pressure Research Professional and Public Education Subcommittee, American Heart Association. Recommendations for blood pressure measurement in humans: an AHA scientific statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee. J Clin Hypertens (Greenwich). 2005; 7(2): 102–109.
- Cuspidi C, Meani S, Salerno M, et al. Cardiovascular target organ damage in essential hypertensives with or without reproducible nocturnal fall in blood pressure. J Hypertens. 2004; 22(2): 273–280.
- Cuspidi C, Michev I, Meani S, et al. Reduced nocturnal fall in blood pressure, assessed by two ambulatory blood pressure monitorings and cardiac alterations in early phases of untreated essential hypertension. J Hum Hypertens. 2003; 17(4): 245–251.
- Ijiri H, Kohno I, Yin D, et al. Cardiac arrhythmias and left ventricular hypertrophy in dipper and nondipper patients with essential hypertension. Jpn Circ J. 2000; 64(7): 499–504.
- Passino C, Magagna A, Conforti F, et al. Ventricular repolarization is prolonged in nondipper hypertensive patients: role of left ventricular hypertrophy and autonomic dysfunction. J Hypertens. 2003; 21(2): 445–451.
- Hermida RC, Ayala DE, Crespo JJ, et al. Influence of age and hypertension treatment-time on ambulatory blood pressure in hypertensive patients. Chronobiol Int. 2013; 30(1–2): 176–191.
- Di Iorio A, Marini E, Lupinetti M, et al. Blood pressure rhythm and prevalence of vascular events in hypertensive subjects. Age Ageing. 1999; 28(1): 23–28.
- Verdecchia P, Schillaci G, Borgioni C, et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation. 1990; 81(2): 528–536.
- Balci B, Yilmaz O, Yesildag O. The influence of ambulatory blood pressure profile on left ventricular geometry. Echocardiography. 2004; 21(1): 7–10.
- Cuspidi C, Michev I, Meani S, et al. Non-dipper treated hypertensive patients do not have increased cardiac structural alterations. Cardiovasc Ultrasound. 2003; 1: 1.
- Wyss TR, Adam L, Haynes AG, et al. Impact of cardiovascular risk factors on severity of peripheral artery disease. Atherosclerosis. 2015; 242(1): 97–101.
- Vasunta RL, Kesäniemi YA, Ylitalo A, et al. Nondipping pattern and carotid atherosclerosis in a middle-aged population: OPERA Study. Am J Hypertens. 2012; 25(1): 60–66.
- Cuspidi C, Macca G, Sampieri L, et al. Target organ damage and non-dipping pattern defined by two sessions of ambulatory blood pressure monitoring in recently diagnosed essential hypertensive patients. J Hypertens. 2001; 19(9): 1539–1545.
- Kario K, Schwartz JE, Pickering TG. Changes of nocturnal blood pressure dipping status in hypertensives by nighttime dosing of alpha-adrenergic blocker, doxazosin : results from the HALT study. Hypertension. 2000; 35(3): 787–794.
- Pickering TG, Levenstein M, Walmsley P. Nighttime dosing of doxazosin has peak effect on morning ambulatory blood pressure. Results of the HALT Study. Hypertension and Lipid Trial Study Group. Am J Hypertens. 1994; 7(9 Pt 1): 844–847.
- Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013; 34(28): 2159–2219.
- Stanton A, O’Brien E. Auswirkungen der Therapie auf das zirkadiane Blutdruckprofil. Kardio. 1994; 3: 1–8.
- Uzu T, Kimura G. Diuretics shift circadian rhythm of blood pressure from nondipper to dipper in essential hypertension. Circulation. 1999; 100(15): 1635–1638.
- Malha L, Mann SJ. Loop Diuretics in the Treatment of Hypertension. Curr Hypertens Rep. 2016; 18(4): 27.
- Hermida RC, Ayala DE, Smolensky MH, et al. Chronotherapy improves blood pressure control and reduces vascular risk in CKD. Nat Rev Nephrol. 2013; 9(6): 358–368.
- Agarwal R, Kariyanna SS, Light RP. Circadian blood pressure classification scheme and the health of patients with chronic kidney disease. Am J Nephrol. 2009; 30(6): 536–546.
- Panjeta M, Tahirovic I, Karamehic J, et al. The Relation of Erythropoietin Towards Hemoglobin and Hematocrit in Varying Degrees of Renal Insufficiency. Mater Sociomed. 2015; 27(3): 144–148.
- Hojo Y, Noma S, Ohki T, et al. Autonomic nervous system activity in essential hypertension: a comparison between dippers and non-dippers. J Hum Hypertens. 1997; 11(10): 665–671.