Blood Pressure Surge Research Articles

Ambulatory blood pressure variability measures in hypertensive patients according to non-alcoholic fatty liver disease state

Abstract Background Nonalcoholic fatty liver disease (NAFLD) represents the most frequent cause of chronic hepatic disease and independently determines hypertension and future cardiovascular events. Increased blood pressure variability (BPV) assessed by 24-hour blood pressure (BP) monitoring including mean arterial morning surge have been also associated with increased rates of cardiovascular events. Purpose To compare different BPV measures in hypertensive patients with and without NAFLD. Methods Consecutive newly diagnosed untreated hypertensive patients without history of cardiovascular disease underwent clinic and ambulatory BP measurements. NAFLD was diagnosed by liver ultrasound to separate patients into those with and without NAFLD. BPV was derived by assessment of standard deviation (SD) of systolic and diastolic BP (24-h, daytime and nighttime), average real variability (ARV) of systolic and diastolic BP, coefficient of variation (CV) of systolic BP (24-h, daytime), weighted SD (wSD) of systolic BP (24-h, daytime), maximum BP and mean arterial morning surge. Results Among 146 hypertensive patients (mean age 57±11 years, 64 men, 24-h mean systolic/diastolic BP 140±10/84±9 mmHg) those with NAFLD (n=76) compared to the non-NAFLD group (n=70) were younger (54.7±10.1 vs 58.6±11.2 years, respectively, p=0.03), male gender was more prevalent (42 vs 22 respectively, p=0.004), and body mass index was more increased (33.2±4.1 vs 27.0±3.5 kg/m2, p<0.001). Moreover, NAFLD patients compared to those without NAFLD were characterized by higher levels of mean arterial pressure morning surge (12.4±8.9 vs 8.7±8.5 mmHg, p=0.03), but the remaining BPV measures were not different between the two groups. NAFLD was a determinant of both diastolic BP ARV (B=0.34, p=0.007) and mean arterial morning surge (B=0.47, p=0.006) after adjustment. Conclusions Mean arterial pressure morning surge was significantly higher in hypertensive patients with NAFLD compared to their non-NAFLD counterparts, while whole day BPV measures were not increased in NAFLD except for ARV of diastolic BP. Our findings may partially explain the increased cardiovascular risk of comorbid NAFLD in hypertension. Funding Acknowledgement Type of funding sources: None.

Exploring the cross-talk between liver and vessels through increased morning blood pressure in hypertension

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is associated with hypertension and predicts future cardiovascular events. Purpose To compare blood pressure (BP) morning surge assessed by ambulatory blood pressure monitoring (ABPM) in hypertensive patients with and without NAFLD. Methods Sixty-five consecutive patients with newly diagnosed essential hypertension (age 57±10 years, office BP 139/87±16/9 mmHg) were studied. In all patients a routine biochemical blood examination was undertaken while BP morning surge was automatically calculated by a Spacelabs 90207 device. NAFLD was confirmed by a liver ultrasound. Accordingly, patients were divided in those with and without NAFLD (control group). Results Patients with NAFLD (n=44) in comparison with controls (n=21) had similar 24h systolic (141.6±9.9 vs 143.2±10.4 mmHg) and diastolic BP (83.6±10.23 vs 84.7±9.53 mmHg) while office BP was also not different between groups (p=NS). However, those with NAFLD were younger (55±10 vs 61±9 years, respectively, p=0.046), had higher body mass index (32.5±4.5 vs 26.3±3.8 kg/m2, p<0.001), glomerular filtration rate (93.8±17 vs 82.6±9.2 ml/min/1.73m2, p=0.013), and higher levels of morning BP surge (14.29±8.5 vs 5.92±9.01mmHg, p=0.034), compared to the non-NAFLD group. Standard deviation of BP, average real variability, coefficient of variation and dipping status were not different between groups. Conclusions At the same levels of clinic and ambulatory BP, hypertensive patients with NAFLD compared to their non-NAFLD counterparts demonstrated increased morning surge BP levels. Our finding suggests that NAFLD may demonstrate a detrimental effect to early-morning at variance to the whole-day hemodynamics. Funding Acknowledgement Type of funding sources: None.

Открытое одноцентровое исследования эффективности снижения артериального давления в утренние часы у пациентов с мягкой и умеренной артериальной гипертензией с контролируемым офисным давлением и неконтролируемыми пиками артериального давления в утренние ч

Целью нашего исследования было оценить эффективность снижения артериального давления (АД) в течение последних 6 часов из 24 после приема последней дозы препарата по результатам суточного мониторирования артериального давления через 12 недель лечения у пациентов с мягкой и умеренной артериальной гипертензией (АГ), которые контролировали офисное давление и имели неконтролируемые пики АД в течение последних 6 часов после приема последней дозы антигипертензивного препарата. Материалы и методы. В исследование было включено 67 пациентов с мягкой и умеренной АГ. Пациентам выполняли общий анализ крови, биохимическое исследование крови, измерение офисного АД, амбулаторное 24-часовое мониторирование АД с определением циркадности АД, утреннего подъема АД, определение центрального АД, скорости распространения пульсовой волны. В утренние (1-я подгруппа) или вечерние (2-я подгруппа) часы назначали телмисартан в дозе 40 или 80 мг один раз в день (Телсартан, «Др. Редди’с Лабораториз Лимитед») или фиксированную комбинацию телмисартана 40 или 80 мг с гидрохлортиазидом 12,5 мг (Телсартан-Н, «Др. Редди’с Лабораториз Лимитед»); при недостижении целевого уровня офисного АД меньше 140/90 мм рт.ст. через 4 недели добавляли амлодипин 5 или 10 мг один раз в сутки (Стамло, «Др. Редди’с Лабораториз Лимитед»). Пациенты проходили первичное обследование и обследование через 12 недель (3 месяца) терапии. Результаты. Уменьшение офисного систолического АД (САД)/диастолического АД (ДАД) в среднем составило за 8 недель 16,92/9,56 мм рт.ст. (р < 0,05), а через 12 недель лечения — 21,26/12,12 мм рт.ст. (р < 0,05). Офисная частота сердечных сокращений (ЧСС) достоверно не изменилась. В результате проведенной терапии Телсартаном и Телсартаном-Н происходило достоверное уменьшение среднесуточного САД (с 134,45 ± 1,39 мм рт.ст. до 122,01 ± 1,16 мм рт.ст., р < 0,05) и ДАД (с 81,51 ± 1,15 мм рт.ст. до 71,62 ± 1,01, р < 0,05), что в среднем составило 12,44/9,89 мм рт.ст. Отмечено также достоверное уменьшение среднедневных показателей САД и ДАД с 138,92 ± ± 1,38 мм рт.ст. и 85,22 ± 1,20 мм рт.ст. до 126,35 ± 1,20 мм рт.ст. и 75,70 ± 1,11 мм рт.ст. (р < 0,05) соответственно, что в среднем составило 12,57 и 9,52 мм рт.ст., и середненочных показателей САД и ДАД с 126,13 ± 1,18 мм рт.ст. и 74,28 ± ± 1,46 мм рт.ст. до 113,37 ± 1,40 мм рт.ст. и 63,73 ± 1,09 мм рт.ст. (р < 0,05) соответственно (12,76 и 11,05 мм рт.ст.). Достоверных изменений суточной ЧСС не было. Доля достижения целевого АД на фоне приема Телсартана или Телсартана-Н самостоятельно или в комбинации с амлодипином при офисном измерении составила 80,6 %, а при суточном мониторировании — 75,61 %. Следовательно, у больных с мягкой и умеренной артериальной гипертензией с конт-ролируемым офисным давлением и неконтролируемыми пиками АД в течение последних 6 часов после приема последней дозы антигипертензивного препарата исследуемые препараты Телсартан и Телсартан-Н продемонстрировали достаточно высокий антигипертензивный эффект как при использовании без амлодипина, так и в комбинации с ним. Телмисартан более эффективно снижал среднедневное и ночное САД и ДАД при утреннем приеме по сравнению с вечерним. Отмечено достоверное снижение средних САД, ДАД в утренние часы с 140,14 ± 1,51 мм рт.ст. и 87,19 ± 1,56 мм рт.ст. до 124,77 ± 1,40 мм рт.ст. и 73,23 ± 1,31 мм рт.ст. (р < 0,05), на 15,37 и 13,96 мм рт.ст. соответственно. Также происходило снижение скорости повышения САД в утренние часы на 3,67 мм рт.ст/ч на фоне терапии Телсартаном и Телсартаном-Н. Произошло уменьшение величины утреннего подъема САД на 11,34 мм рт.ст. (р < 0,05). Выводы. Терапия Телсартаном и Телсартаном-Н как без комбинации с препаратом Стамло, так и в сочетании с ним у пациентов с мягкой и умеренной АГ с контролируемым офисным давлением и неконтролируемыми пиками АД в течение последних 6 часов после приема последней дозы антигипертензивного препарата достоверно снижала как офисное АД, так и АД при суточном мониторировании и способствовала снижению величины АД в утренние часы, уменьшению скорости повышения АД в утренние часы.

Association of morning blood pressure surge with chronic kidney disease progression in patients with chronic kidney disease and hypertension.

Blood pressure (BP) usually rise from being asleep to awake, which is named the morning blood pressure surge (MBPS). Researches have reported that elevated MBPS was related with CV events, incident CKD in hypertensive patients. However, there have been no studies that have investigated the association between MBPS and renal or heart outcomes in patients with CKD and hypertension, in these patients, the MBPS is much lower because of high prevalence of night hypertension and reduced BP dipping. In this prospective two‐center observational study, we enrolled patients with CKD and hypertension and the 24 h ambulatory blood pressure monitoring (ABPM) was conducted in all patients. Time to total mortality, CKD progression and CV events was recorded; Finally, a total of 304 patients were enrolled and 94 (30.9%) of them had elevated MBPS. After a follow‐up for median 30 months, 23 (7.6%), 34 (11.2%), and 95 (31.3%) patients occurred death, CKD progression and new‐onset CV events, respectively. The Cox regression analysis suggested the elevated MBPS was a strong predictor of CKD progression (HR 2.35, 95%CI 1.2 ‐4.63, p = .013), independent of morning BP, while no associations were found between elevated MBPS and CV events (HR 1.02, 95%CI 0.66 ‐1.57), as well as death (HR 1.08, 95%CI 0.46 ‐2.55). In conclusion, we provided the first evidence that elevated MBPS was an important risk factor of CKD progression in patients with CKD and hypertension. Appropriate evaluation and management of MBPS may be helpful to postpone CKD progression.

The Association of Morning Hypertension With Target Organ Damage in Patients With Chronic Kidney Disease and Hypertension.

Objectives: To determine the association between morning hypertension and target organ damage (TOD) in patients with chronic kidney disease (CKD) and hypertension.Methods: In this cross-sectional study, 447 patients with CKD and hypertension from two centers were enrolled. Ambulatory blood pressure monitoring was conducted in all patients. Linear regression and logistic regression analysis were used to determine the association between morning hypertension and TOD in patients with CKD and hypertension, including assessments of estimated glomerular filtration rate (eGFR), left ventricular mass index (LVMI), urine protein/creatinine ratio (UPCR), and left ventricular hypertrophy (LVH).Results: Overall, 194 (43.4%) participants had morning hypertension. Morning hypertension was strongly correlated with LVH [odds ratio (OR), 2.14; 95% confidence interval (CI), 1.3–3.51; p < 0.01], lower level of eGFR (β = −0.51; 95%CI, −0.95–−0.08; p < 0.05), higher LVMI (β = 0.06; 95%CI, 0.04–0.08, p < 0.001), and UPCR (β = 0.22; 95%CI, 0.06–0.38, p < 0.01), independent of nocturnal hypertension and elevated morning blood pressure surge. As a continuous variable, both morning systolic blood pressure (SBP) and diastolic blood pressure (DBP) were found to be associated with LVH and higher level of UPCR and LVMI (p < 0.05), whereas only morning SBP was negatively correlated with eGFR (p < 0.01).Conclusion: Morning hypertension was strongly correlated with cardiac damage and impaired kidney function in CKD patients with hypertension, independent of nocturnal hypertension and morning surge in blood pressure. Morning hypertension in CKD patients warrants further attention.

Differential Effect of the Morning Blood Pressure Surge on Prognoses Between Heart Failure With Reduced and Preserved Ejection Fractions.

Rising blood pressure (BP) in the morning, known as the morning BP surge (MBPS), is known to pose a risk for cardiovascular events in hypertensive individuals. It was not known whether the MBPS was associated with a worse prognosis in patients with heart failure (HF) with a reduced (HFrEF) or preserved (HFpEF) ejection fraction.Methods and Results:We performed a prospective, observational cohort study of hospitalized HF patients who underwent ambulatory BP monitoring (ABPM). The MBPS was calculated by subtracting the mean systolic BP (SBP) during the 1 h that included the lowest sleep BP from the mean SBP during the 2 h after waking. The MBPS group was defined as the top decile of MBPS (>40 mmHg). In all, 456 hospitalized HF patients (mean [±SD] age 68±13 years, 63.9% male) were followed-up for a median of 1.67 years. There were 90 events (16.3 per 100 person-years) of the composite outcome (all-cause mortality and worsening HF) in the HFrEF group, compared with 53 events (19.6 per 100 person-years) in the HFpEF group. Multivariate Cox regression analysis showed that MBPS was a significant predictor of outcome (hazard ratio 2.84, 95% confidence interval 1.58-5.10, P<0.01) in the HFrEF but not HFpEF group. MBPS was found to be a novel predictor of worsening HF in patients with HFrEF.

Different Prognostic Impact of the Morning Blood Pressure Surge in Heart Failure With Reduced vs. Preserved Ejection Fraction.

Different Prognostic Impact of the Morning Blood Pressure Surge in Heart Failure With Reduced vs. Preserved Ejection Fraction.

Electroconvulsive Therapy in Elderly Patients With Cerebral Aneurysms: A Systematic Review With Clinical Recommendations.

Electroconvulsive therapy (ECT) is commonly used in the elderly due to its proven efficacy and safety profile. However, presence of cardiovascular comorbidities such as cerebral aneurysms may complicate the course of treatment. Our knowledge about the possible risk factors and precautionary measures remains limited. We performed a systematic review of published case reports of elderly patients with cerebral aneurysms treated with ECT. A total of 11 cases were included for the review. One patient died because of subarachnoid hemorrhage (SAH) secondary to ictal hypertensive surge during treatment with ECT. Risk factors such as history of hypertension, age of the patient, extent of the ictal surge in blood pressure, efficacy of prophylactic treatment to control surge in blood pressure and characteristics of cerebral aneurysm each elevated the risk of complication in these cases. We reviewed safety measures based on the evidence from the current literature available. ECT is safe in elderly patients with cerebral aneurysms provided appropriate safety measures are employed. Screening for cerebral aneurysms in high risk patients, effective prevention and management of blood pressure elevation acutely during ECT is the best practice to avoid adverse outcomes.

Morning blood pressure surge in the early stage of hypertensive patients impacts three-dimensional left ventricular speckle tracking echocardiography

BackgroundThe aim of this study was to examine left ventricular (LV) function in untreated, newly diagnosed hypertensive patients with morning blood pressure surge (MBPS) status using three-dimensional (3D) speckle tracking echocardiography (STE).MethodsIn this study, 163 newly diagnosed hypertensive patients were included, and all patients underwent 24-h ambulatory blood pressure monitoring (ABPM). According to ABPM, participants were divided into a MBPS group and a non-MBPS group. The entire study population was examined by complete two-dimensional (2D) transthoracic echocardiography (TTE) and 3D STE.ResultThe results of this study showed that 3D LV longitudinal strain was significantly decreased in the MBPS group compared with the non-MBPS group (− 30.1 ± 2.0 vs. -31.1 ± 2.7, p = 0.045). Similar trends were observed for 3D twist (9.6 ± 6.1 vs. 12.1 ± 4.8, p = 0.011) as well as for 3D torsion (1.23 ± 0.78 vs. 1.49 ± 0.62, p = 0.042). The LV principal strain was decreased in the MBPS group (− 33.9 ± 1.7 vs. -35.5 ± 2.8, p < 0.001). The 3D LV global longitudinal strain (GLS) and principal strain were significantly associated with quartile of MBPS as measured by systolic blood pressure (SBP).ConclusionThe 3D STE revealed that LV mechanics were more impaired in the MBPS group than in the non-surge newly diagnosed, untreated hypertensive patients; even the 2D TTE parameters showed no difference.

Can Systemic Immune-Inflammation Index Detect the Presence of Exxaggerated Morning Blood Pressure Surge in Newly Diagnosed Treatment-Naive Hypertensive Patients?

ABSTRACT Background: The exaggerated morning blood pressure surge (MS) is associated with target organ damage and cardiovascular events. Systemic immune-inflammation index (SII) has been detected as a useful marker in tumors and cardiovascular diseases. The role of inflammation in the pathogenesis of hypertension is a well-known issue. We aimed to investigate whether there is an association between SII and exaggerated MS in newly diagnosed treatment-naive hypertensive patients. Material and Methods: In total, 343 newly diagnosed in clinical and 24-h ambulatory blood pressure (BP) monitoring treatment-naive hypertensive patients were included in this study. Morning surge was defined as the difference between morning BP, which was the mean of BP during 2 h after wake-up, and the lowest BP, which was the mean of three lowest BP during nighttime. A cutoff value of 52.1 mmHg was used to discriminate the high- and low value MS groups. SII was calculated based on neutrophil, platelet, and lymphocyte counts. Results: Neutrophil, platelet, SII, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) were higher, whereas lymphocyte counts were lower in the high-value MS than the low-value MS. These indices were all independently associated with exaggerated MS and SII was superior to all other indices for detecting the presence of exaggerated MS. SII was moderately correlated with morning BP surge (r: 0.489, p < 0.0001). Conclusion: SII was higher in patients with exaggerated MS and was independently associated with exaggerated MS. Furthermore, SII might be a better indicator than platelet, neutrophil, lymphocyte, NLR, and PLR for the presence of exaggerated MS.

Morning Surge in Blood Pressure and Stroke Events in a Large Modern Ambulatory Blood Pressure Monitoring Cohort: Results of the JAMP Study.

Morning Surge in Blood Pressure and Stroke Events in a Large Modern Ambulatory Blood Pressure Monitoring Cohort: Results of the JAMP Study.

Effect of Antihypertensive Drugs on Circadian Variation of Blood Pressure Measured by Ambulatory Blood Pressure Monitoring in Controlled Hypertensive Individuals

Background: Rewinding back a 100 years ago, Riva Rocci introduced the meticulous way of measuring blood pressure (BP) in clinical practice. With recent years, ambulatory BP monitoring came into existence which is still not used routinely in the management of hypertension. This thought led to the commencement of our study to analyze the variations in ambulatory BP recording over a 24-h cycle. Objectives: The objectives of the study are to determine the BP differences throughout the circadian cycle and to analyze the variations in circadian rhythm due to various antihypertensive drugs. Methods: On the first visit to the Medicine Outpatient Department, patient's medical history was recorded. Three readings of office BP were recorded using a sphygmomanometer. The patient was then provided with the ambulatory BP monitoring device, sent home and asked to follow-up after 24 h and the report was recorded. Results: On comparing the nocturnal pattern among candidates taking single versus combination drug, the dip was found to be in 31.7% in patients on single drug compared to 38.6% combination therapy. The surge in BP was seen in 56.8% of patients on single-drug therapy compared to 43.3% patients on combination drug therapy. Conclusion: Single-drug therapy for hypertension did not show a significant nocturnal pattern compared to the combination drug therapy for hypertension. The presence of the risk factors such as obesity smoking, dyslipidemia, diabetes mellitus, hypothyroidism, family history, and chronic kidney disease showed a presence of dipping and nondipping pattern in BP.

Relationship between morning blood pressure surge and the frontal plane QRS-T angle in newly diagnosed hypertensive patients

ABSTRACT Background Morning blood pressure surge (MBPS) plays an important role in target organ damage and major adverse cardiac events. The frontal QRS-T [f(QRS-T)] angle is the electrocardiographic marker and index of ventricular arrhythmogenic events. We aimed to investigate the relationship between MBPS and the f(QRS-T) angle, which is an indicator of ventricular repolarization disorder, in patients with newly diagnosed HT. Methods Between June 2020 and March 2021, 263 patients with newly diagnosed HT who were admitted to our outpatient clinic were prospectively included in the study. According to ambulatory blood pressure monitoring (ABPM), the patients were categorized into two groups: Group-I: low-value MBPS (<37 mm Hg), and group-II: high-value MBPS (≥37 mm Hg). The f(QRS-T) angle calculated from the 12-lead electrocardiogram and all other data were compared between the groups. Results A total of 186 newly diagnosed HT patients who met the inclusion criteria were included in the study. The average f(QRS-T) angle in Groups I and 2 was 21° ± 16° and 51° ± 30°, respectively (P < .001). According to multivariate regression analysis, T peak-end and MBPS were found to be independent predictors of the f(QRS-T) angle. Conclusions As a result of our study, we found that the f(QRS-T) angle was widened in patients with exaggerated MBPS. The cause of increased cardiovascular outcomes in patients with exaggerated MBPS may be explained by widened in the f(QRS-T) angle that is a ventricular repolarization parameter.

Intradialytic hypertension prevalence and predictive factors: A single centre study

Introduction: Intradialytic hypertension (IDH) is associated with significant vascular and cardiac adverse outcomes. Objectives: This study was performed to know the prevalence and factors predicting IDH. Patients and Methods: A single-center cross-sectional observational study at a tertiary care hospital. After ethics committee approval and informed consent, all patients over 18 years on twice weekly hemodialysis were included, those on peritoneal dialysis and acute kidney injury excluded. Primary outcome was prevalence of IDH based on three definitions and secondary outcome was predictive factors. IDH was defined as ≥10 mm Hg surge in systolic blood pressure (SBP) between pre-and postdialysis in 4 of 6 successive sessions or &gt;15 mm Hg rise in mean arterial pressure (MAP) between start and end of dialysis or symptomatic rise in blood pressure requiring intervention. SBP and MAP were measured on standardized monitors before, hourly and 30 minutes post dialysis. Results: Of 136 patients, prevalence of intra-dialytic hypertension was 78/136 (57%), 33/136 (24%), 15/136 (11%) based on systolic rise, rise in MAP and symptomatic rise in BP respectively. Among those with systolic rise, diabetes mellitus (P= 0.03), undernourishment (P=0.03), inter-dialytic weight gain &gt;3 kg (P&lt; 0.001) and dialysis vintage &gt; 3 years (P&lt; 0.001) were significantly associated with IDH. Conclusion: IDH prevalence varied from 11 to 57% with different definitions. Diabetes mellitus, under nutrition, inter-dialytic weight gain &gt;3 kg and dialysis vintage &gt;3 years predicted IDH.

Chronotherapy for morning blood pressure surge in hypertensive patients: a systematic review and meta-analysis

BackgroundThe morning blood pressure surge (MBPS) is related to an exaggerated risk of cardiovascular diseases and mortality. With increasing attention on circadian change in blood pressure and extensive use of ambulatory blood pressure monitoring (ABPM), chronotherapy that administration of medication according to biological rhythm, is reported to improve cardiovascular outcomes. The aim of this study is to evaluate the influence of chronotherapy of antihypertensive drugs upon MBPS in hypertensive patients.Methods A search strategy was applied in Ovid MEDLINE, EMBASE, Cochrane (Wiley) CENTRAL Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the Chinese Biomedical literature database. No language and date restrictions. Randomized controlled trials (RCT) assessing the efficacy of evening and morning administration of the same medications in adult patients with primary hypertension were included.ResultsA total of ten trials, comprising 1724 participants with a mean age of 61 and 51% female, were included in this study. Combined analysis observed significant reduction of MBPS (− 5.30 mmHg, 95% CI − 8.80 to − 1.80), night-time SBP (− 2.29 mmHg, 95% CI − 4.43 to − 0.15), night-time DBP (− 1.63 mmHg, 95 %CI − 3.23 to − 0.04) and increase in night blood pressure dipping (3.23%, 95% CI 5.37 to 1.10) in evening dosage compared with traditional morning dosage of blood pressure-lowering drugs. No significant difference was found in the incidence of overall adverse effects (RR 0.65, 95% CI 0.30 to 1.41) and withdrawal due to adverse effects (RR 0.95, 95% CI 0.53 to 1.71).ConclusionsOur study suggested that evening administration of antihypertensive medications exerted better blood pressure-lowering effect on MBPS compared with conventional morning dosage. Safety assessment also indicated that the evening regimen did not increase the risk of adverse events. However, endpoint studies need to be carried out to confirm the significance and feasibility of this treatment regimen in clinical practice.

Association Between Morning Surge in Systolic Blood Pressure and SYNTAX Score I in Patients With Stable Coronary Artery Disease.

A high morning surge in systolic blood pressure poses a risk in people who have cardiovascular disease. We investigated the relationship between this phenomenon and the SYNTAX score I in patients who had stable coronary artery disease. Our single-center study included 125 consecutive patients (109 men and 16 women; mean age, 54.3 ± 9 yr) in whom coronary angiography revealed stable coronary artery disease. We calculated each patient's sleep-trough morning surge in systolic blood pressure, then calculated the SYNTAX score I. The morning surge was significantly higher in patients whose score was >22 (mean, 22.7 ± 13.2) than in those whose score was ≤22 (mean, 12.4 ± 7.5) (P <0.001). Forward stepwise logistic regression analysis revealed that morning surge in systolic blood pressure was the only independent predictor of an intermediate-to-high score (odds ratio=1.183; 95% CI, 1.025-1.364; P=0.021). To our knowledge, this is the first study to show an association between morning surge in systolic blood pressure and the SYNTAX score I in patients who have stable coronary artery disease.

Bedtime administration of antihypertensive medication can reduce morning blood pressure surges in hypertensive patients: a systematic review and meta-analysis.

The risk of cardiovascular and cerebrovascular events is the highest during the first several hours post-awakening in patients with hypertension. This is largely due to surges in morning blood pressure (BP). The current meta-analysis explored whether morning BP is affected by the timing of antihypertensive drug administration. Four medical databases were searched for clinical trials that examined the relationship between the timing of antihypertensive drug administration and morning BP levels. This meta-analysis compared morning BP surges in patients administered medication at bedtime versus patients administered medication during the day. The random effects model demonstrated that bedtime administration of antihypertensive drugs reduced morning systolic blood pressure (SBP) by 1.17 mmHg [with 95% confidence interval (CI): -2.47 to 0.37; P=0.08), and reduced morning diastolic blood pressure (DBP) by 0.95 mmHg (95% CI: -2.03 to 0.13; P=0.08), compared with patients who were administered medication during the daytime hours. However, the results did not demonstrate statistical significance. There was strong heterogeneity in both morning SBP (I2 =77.9% >50%, and Q test >0.1) and morning DBP results (I2 =77.9% >50%, and Q test >0.1). The funnel plots showed no publication bias in this study. Studies have shown that a 1 mmHg change was sufficient to reduce the risk of cardiovascular-related deaths by 2.1%. Therefore, changing the time of taking antihypertensive medications may significantly reduce cardiovascular-associated mortality. There were certain limitations to this meta-analysis. First, the heterogeneity of the meta-analysis was strong, with undefined reasons. Second, the sample size was relatively small, and future studies involving larger cohorts are warranted to further assess the effects of bedtime antihypertensive medication on minimizing morning BP surges.

The Association of Morning Surge and Night-Time Dipping Blood Pressure with Significant and Complex Coronary Artery Lesions.

Hypertension responsible for more than 10 million deaths annually worldwide and abnormal diurnal blood pressure (BP) variation is associated with cardiovascular events. This study aimed to investigate the association between the 24-h ambulatory night BP dipping and morning BP surge (MS) with characteristic of coronary artery lesions that may contribute cardiovascular events and mortality burden. A cross sectional study over 1-year, collected 263 cases of hypertensive (80%) and non-hypertensive patients, aged 61 ± 10 years, who undergoing invasive coronary angiography (CAG) and 24-h ambulatory BP monitoring admitted to cardiology department complain of chest pain. The night-time/day-time dip and sleep-trough MS were calculated. Non-dipper status was considered when night-time/day-time dip < 10%, and significant coronary lesion (SCL) when ≥ 50 % stenosis in 1.5 mm vessels. The SYNTAX (Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score was used to quantify the complexity of SCL. The mean morning systolic BP (SBP) surge was higher in the high SYNTAX Score subgroup than low and intermediate subgroups (25 ± 11 vs 17 ± 13 and 10 ± 10 mmHg, p < 0.010). Non-dipper SBP status was more frequently in patients with SCL than non-SCL (p < 0.019). In ordinal regression, hypertension was independent predictor of SCL (odd ratio: 0.40, p < 0.003), the night-time/day-time BP dip was independent predictor of being in a higher SYNTAX score subgroup (systolic odd ratio: 0.88, diastolic odd ratio: 1.14 p < 0.05). Hypertension is associated with SCL and the night-time/day-time BP dip as a continuous variable is associated with complex coronary lesion. Non-dipping as categorical variable and morning BP surge were not independent predictors of significant or complex coronary lesions.

Abstract P096: Association Of Accurately Measured Office, Self-measured Home, And Ambulatory Blood Pressure And Their Variability With Intracranial Arterial Stenosis

Background: Few studies have compared accurately measured office, self-measured home, and ambulatory blood pressure (BP) for asymptomatic intracranial artery stenosis (ICAS). Relationship of day-by-day or short-term variability in BP to asymptomatic ICAS remains unclear. Objectives: To examine the association of office, home (mean value and day-by-day variability), and ambulatory BP indices (24-hour/daytime/nighttime mean values, short-term variability, nocturnal decline, and morning pressor surge) with asymptomatic ICAS. Methods: Data on office and 7-day home BP and magnetic resonance angiography to assess ICAS were obtained in 677 men (mean age, 70.0 years) from a population-based cohort. Among them, 468 underwent 24-hour ambulatory BP monitoring. Mild- or severe-ICAS was defined as 1-49% or ≥50% stenosis, respectively, and any-ICAS as either mild or severe-ICAS. Results: We observed mild- and severe-ICAS in 153 (22.6%) and 36 (5.3%) participants, respectively. In multivariable Poisson regression with robust error variance, higher systolic BP at office, home, or ambulatory BP monitoring was associated with the presence of any- or severe-ICAS. The associations with ICAS were comparable between office, home, and ambulatory systolic BP (all heterogeneity Ps &gt;0.1). Independent of mean systolic BP, greater nocturnal decline or morning pressor surge in systolic BP was associated with higher burden of any- or severe-ICAS. Conclusion: The magnitude of association of BP accurately measured at office for asymptomatic ICAS was comparable with that of BP at home or ambulatory BP monitoring. Circadian BP variation based on ambulatory BP monitoring may be considered when assessing ICAS in apparently healthy individuals.

RCVS\u2013TCH score can predict reversible cerebral vasoconstriction syndrome in patients with thunderclap headache

Reversible cerebral vasoconstriction syndrome (RCVS) is one of the most important differential diagnosis in patients with thunderclap headache (TCH). We aimed to develop a new scoring system for RCVS in patients with TCH. We retrospectively analyzed 72 patients enrolled in the prospective study of TCH conducted in 2015–2016 (derivation set). We identified possible predictors for the diagnosis of RCVS and constructed a prediction model (RCVS–TCH score) using the multivariable logistic regression model. Diagnostic performance was validated to an independent validation set from our headache registry. The derivation set comprised 41 patients with RCVS and 31 with non-RCVS, and the validation set included 253 patients with TCH (165 with RCVS and 88 with non-RCVS). The RCVS–TCH score (range: 0–12) contained four predictors: recurrent TCHs, female sex, triggering factor for TCH (single or multi) and blood pressure surge. The C-index of RCVS–TCH score was 0.929 (95% CI = 0.874–0.984). The RCVS–TCH score ≥ 7 had a sensitivity of 80% and a specificity of 97% in discriminating RCVS from non-RCVS. In the validation set, RCVS–TCH score showed a C-index of 0.861 (95% CI = 0.815–0.908). In our study, the RCVS–TCH showed good performance, which may aid the diagnosis of RCVS among patients with TCH.