Abstract
BackgroundWe determined clinical predictors of the rate of rise (RoR) in blood pressure in the morning as well as a novel measure of the power of the BP surge (BPpower) derived from ambulatory blood pressure recordings.MethodsBPpower and RoR were calculated from 409 ambulatory blood pressure (ABP) recordings from subjects attending a cardiovascular risk clinic. Anthropometric data, blood biochemistry, and history were recorded. The 409 subjects were 20–82 years old (average 57, SD = 13), 46% male, 9% with hypertension but not on medication and 34% on antihypertensive medication.ResultsAverage RoR was 11.1 mmHg/hour (SD = 8) and BPpower was 273 mmHg2/hour (SD = 235). Only cholesterol, low density lipoprotein and body mass index (BMI) were associated with higher BPpower and RoR (P<0.05) from 25 variables assessed. BPpower was lower in those taking beta-blockers or diuretics. Multivariate analysis identified that only BMI was associated with RoR (4.2% increase/unit BMI, P = 0.020) while cholesterol was the only remaining associated variable with BPpower (17.5% increase/mmol/L cholesterol, P = 0.047). A follow up of 213 subjects with repeated ABP after an average 1.8 years identified that baseline cholesterol was the only predictor for an increasing RoR and BPpower (P<0.05). 37 patients who commenced statin subsequently had lower BPpower whereas 90 age and weight matched controls had similar BPpower on follow-up.ConclusionsCholesterol is an independent predictor of a greater and more rapid rise in morning BP as well as of further increases over several years. Reduction of cholesterol with statin therapy is very effective in reducing the morning blood pressure surge.
Highlights
The circadian variation in blood pressure (BP) in humans has been established since the first chronic intra-arterial recordings were made in the late 1960’s [1]
The importance of this circadian pattern has been brought to the fore by the extensive literature that has been developed over the last two decades to show that cardiovascular events, such as stroke, transient ischemic attacks, myocardial infarction and sudden cardiac death occur most frequently during the morning hours which coincides with the rapid rise in BP and heart rate (HR) [2,3,4,5,6,7,8,9]
While males and females were of similar ages and body mass index (BMI) plasma cholesterol including high density lipoprotein (HDL) and low density lipoprotein (LDL) were slightly higher in females and triglycerides were lower (Table 1, P,0.05 for all)
Summary
The circadian variation in blood pressure (BP) in humans has been established since the first chronic intra-arterial recordings were made in the late 1960’s [1]. It is well known that many factors such as physical activity and periods of rest strongly influence the diurnal BP pattern as well as circadian variation in autonomic and hormonal systems The importance of this circadian pattern has been brought to the fore by the extensive literature that has been developed over the last two decades to show that cardiovascular events, such as stroke, transient ischemic attacks, myocardial infarction and sudden cardiac death occur most frequently during the morning hours which coincides with the rapid rise in BP and heart rate (HR) [2,3,4,5,6,7,8,9]. We determined clinical predictors of the rate of rise (RoR) in blood pressure in the morning as well as a novel measure of the power of the BP surge (BPpower) derived from ambulatory blood pressure recordings
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