Variación estacional del fibrinógeno plasmático en pacientes dippers y no dippers con hipertensión arterial esencial ligera-moderada

Abstract

Increased plasma fibrinogen is recognized as a significant parameter for assessing the potential risk of myocardial infarction and stroke. A seasonal variation has been reported for plasma fibrinogen, with highest values occurring in the coldest months of the year. On the other hand, the lack of nocturnal decline in blood pressure has been associated with an increase in cardiovascular events. Accordingly, we have quantified the yearly variation in plasma fibrinogen in hypertensive patients classified according to their nocturnal decline in blood pressure. We studied 577 mild-to-moderate hypertensive patients (254 men), 53.8 13.8 years of age. Blood pressure was measured every 20 min during the day and every 30 min at night for 48 consecutive hours. Physical activity was simultaneously evaluated at 1-min intervals with a wrist actigraph. A complete blood test was performed on the same day before starting blood pressure monitoring. The circannual variation of plasma fibrinogen was established for all patients as well as for subgroups of dippers (n = 287) and non-dippers (n = 290; patients with a nocturnal blood pressure decline < 10% of the diurnal mean) by multiple-component analysis. For the whole group of hypertensive patients, plasma fibrinogen was characterized by a highly significant seasonal variation (p < 0.001), with a mean value of 324 mg/dl, double circannual amplitude (i.e, extent of predictable change along the year) of 75 mg/dl, and time of peak value on the first week of March. This circannual variation can be best represented by a model that includes components with periods of 12 and 6 months. The same model also characterized dippers as well as non-dippers, analyzed separately. Non-dippers showed higher plasma fibrinogen throughout the whole year as compared to dippers (p = 0.002). The elevation of plasma fibrinogen in non-dipper patients as compared to dippers could support the association between the lack of nocturnal decline in blood pressure with an increase in cardiovascular events, since the circannual variation in fibrinogen is timely correlated with the reported yearly variation in coronary events.